Predictors of 12 month functional outcomes and length of stay of severely injured children in NSW, Australia. A longitudinal multi-centre study

Kate Curtis; Belinda Kennedy; Mary K Lam; Rebecca J Mitchell; Deborah Black; Stephen Jan; Brian Burns; Michael Dinh; Andrew Ja Holland

doi:10.1016/j.injury.2021.12.057

Predictors of 12 month functional outcomes and length of stay of severely injured children in NSW, Australia. A longitudinal multi-centre study

Injury. 2022 May;53(5):1684-1689. doi: 10.1016/j.injury.2021.12.057. Epub 2022 Jan 5.

Authors

Kate Curtis¹, Belinda Kennedy², Mary K Lam², Rebecca J Mitchell³, Deborah Black⁴, Stephen Jan⁵, Brian Burns⁶, Michael Dinh⁷, Andrew Ja Holland⁸

Affiliations

¹ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, The University of Sydney, NSW 2006, Australia; Emergency Services, Illawarra Shoalhaven LHD, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; The George Institute for Global Health, King St, Newtown, NSW, Australia. Electronic address: Kate.curtis@sydney.edu.au.
² Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, The University of Sydney, NSW 2006, Australia.
³ Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, North Ryde NSW 2113, Australia.
⁴ Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia.
⁵ The George Institute for Global Health, King St, Newtown, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia.
⁶ Greater Sydney Area HEMS, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport NSW 2200, Australia; Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia.
⁷ NSW Institute of Trauma and Injury Management, Agency for Clinical Innovation, 1 Reserve Rd, St Leonards NSW 2065, Australia.
⁸ Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia; The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia.

PMID: 35031107
DOI: 10.1016/j.injury.2021.12.057

Abstract

Background: The majority of paediatric injury outcomes studies focus on mortality rather than the impact on long-term quality of life, health care use and other health-related outcomes. This study sought to determine predictors of 12-month functional and psychosocial outcomes for children sustaining major injury in NSW.

Methods: The study included all children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW at a paediatric trauma centre (PTC). Children were identified through the three PTCs and NSW Trauma Registry. The paediatric Quality of Life Inventory (PedsQL) and EuroQol five-dimensional EQ-5D-Y were used to measure HRQoL post-injury, completed via parent/carer proxy recruited through NSW PTCs.

Results: There were 510 children treated at the three NSW PTCs during the 15-month study period. The mean (SD) age was 6.7 (6.0) years, with a median NISS (New Injury Severity Score) of 11 (IQR: 9-18). Regression analysis showed worse psychosocial health at twelve months was associated with hospital length of stay (LoS) and number of body regions injured (F₂,₆₅ = 5.85, p = 0.005). Physical outcome was associated with LoS and intensive care unit (ICU) admission (F_2,66 = 13.48, p < 0.001). Hospital LoS was significantly associated with NISS and head injury (F_2,398 = 51.5, p < 0.001).

Conclusion: Hospital length of stay and polytrauma are independent factors that negatively influence psychological and physical outcomes of children with major injuries. Early intervention to enable emotional well-being, discharge home and long-term follow up such as dedicated family support and rehabilitation at home could reduce preventable poor outcomes.

Keywords: Emergency; Injury; Outcomes; Paediatric; Psychosocial.

Publication types

Multicenter Study

MeSH terms

Australia
Child
Humans
Injury Severity Score
Length of Stay
Quality of Life*
Trauma Centers
Wounds and Injuries* / therapy