Factors associated with functional impairment after pediatric injury

1. Most injured children and adolescents return to baseline functional status by discharge.

2. Pediatric populations with extremity injuries or severe head injuries were at greatest risk of functional impairment at discharge.

Evidence Rating Level: 2 (Good)

Pediatric injuries often result in short- and long-term functional impairments, negatively impacting quality of life to a degree that cannot be ascertained by mortality statistics. Quality of care may be better assessed by investigating these impairments and the characteristics of children and adolescents at highest risk. This prospective cohort study of the Assessment of Functional Outcomes and Health-Related Quality of Life After Pediatric Injury evaluated injury categories associated with increased prevalence of functional impairment in pediatric populations receiving treatment at one of seven pediatric trauma centers from March 2018 to February 2020. Participants were all >15 years and hospitalized with ≥1 serious injury (Abbreviated Injury Scale score ≥3, or Glasgow Coma Scale score <9, or Glasgow Coma Scale motor score <5). The Functional Status Scale (FSS) was used to assess changes in morbidity in mental status, sensory, communication, motor function, feeding, and respiratory domains. The study included 427 injured children and adolescents (median [IQR] age = 7.2 [2.5 to 11.7] years, 36.5% female). Of these, 17.3% had a new FSS domain morbidity at discharge. Increases in new FSS domain morbidities was greatest among those with several injured body regions and severe head trauma (83.3%). The lowest increases in new morbidities were found among those with isolated head injuries of mild-to-moderate severity (1.2%). Adjusting for oversampling of specific injury types, 14.4% of seriously injured children and adolescents had functional impairment at discharge, with the largest proportions attributable to extremity injuries (40.3%) and severe traumatic brain injuries (34.4%). Overall, this study found that most children and adolescents with injuries returned to baseline status by hospital discharge. However, more significant extremity and head injuries suggest a greater risk of functional impairment at discharge.

Click to read the study in JAMA Surgery

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