Functional status of pediatric patients with trauma and risk factors for mortality from a single center in China

Yu-Hang Yang; Tie-Ning Zhang; Ni Yang; Wei Xu; Li-Jie Wang; Shan-Yan Gao; Chun-Feng Liu

doi:10.3389/fped.2023.1051759

Functional status of pediatric patients with trauma and risk factors for mortality from a single center in China

Front Pediatr. 2023 May 3:11:1051759. doi: 10.3389/fped.2023.1051759. eCollection 2023.

Authors

Yu-Hang Yang¹, Tie-Ning Zhang¹, Ni Yang¹, Wei Xu¹, Li-Jie Wang¹, Shan-Yan Gao², Chun-Feng Liu¹

Affiliations

¹ Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
² Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.

Abstract

Introduction: The influence of reduced functional status has become increasingly relevant because of the gradual decline in mortality rate over the recent years. Nonetheless, only a few studies investigating the functional status of patients with trauma at hospital discharge have been conducted. This study aimed to identify the risk factors influencing the mortality rate in pediatric trauma survivors at a pediatric intensive care unit and analyze their functional status using the Functional Status Scale (FSS).

Methods: A retrospective analysis was conducted at Shengjing Hospital of China Medical University. Children admitted to the pediatric intensive care unit between January 2015 and January 2020 who met the trauma diagnostic criteria were included. The FSS score and the Injury Severity Score (ISS) were recorded upon admission and discharge, respectively. Clinical data were compared between the survival and non-survival groups to identify the risk factors for poor prognosis. The risk factors for mortality were identified using multivariate and univariate analyses.

Results: A total of 246 children {59.8%, male; median [interquartile range (IQR)] age: 3 [1-7] years} were diagnosed with trauma (including head trauma, chest trauma, abdominal trauma, and extremity trauma). Of these patients, 207 were discharged, 11 dropped out mid-treatment, and 39 died (hospital mortality rate, 15.9%). Upon admission, the median FSS and trauma scores were 14 (IQR, 11-18) and 22 (IQR, 14-33) points, respectively. At discharge, the FSS score was 8 (IQR, 6-10) points. The patient clinical status improved with a ΔFSS score of -4 (IQR, -7, 0) points. At hospital discharge, 119 (48.3%), 47 (19.1%), 27 (11.0%), 12 (4.8%), and 2 (0.9%) survivors had good, mildly abnormal, moderately abnormal, severely abnormal, and very severely abnormal function, respectively. Reduced functional status in patients was categorized as follows: motor, 46.4%; feeding, 26.1%; sensory, 23.2%; mental, 18.4%; and communication, 17.9%. In the univariate analysis, ISS >25 points, shock, respiratory failure, and coma were independently associated with the mortality rate. Multivariate analysis revealed that the ISS was an independent risk factor for mortality.

Conclusion: The mortality rate of patients with trauma was high. ISS was an independent risk factor for mortality. Mildly reduced functional status remained at discharge and was reported in nearly half of the discharged patients. Motor and feeding functions were the most severely impacted domains.

Keywords: functional status; injury severity score; mortality; motor disorders; wounds and injuries.

Grants and funding

This research was funded by the National Natural Science Foundation of China (No. 81971810), the Major Scientific and Technological Special Project of Liaoning Province (No. 2020JH1/10300001), and the Science and Technology Program of Shenyang (No. 20-205-4-002). These funding sources had no role in the study design; collection, analysis, and interpretation of the data; writing of the report; and decision to submit the article for publication.