Cause, treatment costs and 12-month functional outcomes of children with major injury in NSW, Australia

Abstract

Background: Information about children treated in New South Wales (NSW), Australia following major injury has been limited to those treated at trauma centres using mortality as the main outcome measure, restricting assessment of the effectiveness of the Trauma System. This study sought to describe the detailed characteristics as well as functional and psychosocial health outcomes of all children suffering major injury in NSW.Methods: A longitudinal study was conducted between July 2015 and November 2017 and included children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW or who died following injury. Children were identified through the three NSW Paediatric Trauma Centres (PTC), the NSW Trauma Registry, NSW Aeromedical Retrieval Registry (AirMaestro) and the National Coronial Information System (NCIS). Health-related quality of life (HRQoL) outcomes for children treated at the three PTCs were collected at baseline, 6 and 12 months using the Paediatric Quality of Life inventory (PedsQL 4.0) and EuroQol five-dimensional EQ-5D-Y.Results: There were 625 children, with a median (interquartile range) age of 7 (2-13) years and 71.7% were male. Around half were injured in major cities (51.2%). The median (IQR) injury severity score (ISS) was 10 (9-17). Twelve-month HRQoL measured by PedsQL remained below baseline for psychosocial health. Treatment costs increased with injury severity ( p = < 0.001) and polytrauma ( p = < 0.001). No survival benefit was demonstrated between PTC versus non-PTC definitive care. Injured females and children from rural / remote NSW were overrepresented in the deceased. Conclusion:Children treated in NSW following major injury have reduced quality of life and in particular, reduced emotional well-being at 12 months post-injury. Improved psychosocial care and outpatient follow-up is required to minimise the long-term emotional impact of injury on the child.

Vacuum and Electromagnetic Fields Treatment to Regenerate a Diffuse Mature Facial Scar Caused by Sulfuric Acid Assault

“…Finally, it is essential not to forget the fact that people with scars due to acid attacks are first of all victims, which must be followed from a psychological point of view, even during treatments, given the strong emotional impact that aesthetic-functional recovery can have [ 78 , 79 , 80 ].…”

The Socioeconomic Characteristics of Childhood Injuries in Regional Victoria, Australia: What the Missing Data Tells Us

“…More than half of injured children were males in both VEMD (56.2%) and Non-VEMD (58.8%) reporting hospitals ( Table 1 ); a considerably lower proportion than that reported by other Australian sources [ 4 , 23 , 24 ]. There were similar proportions of children injured in the toddler and child years, with an increase in teenage years: not dissimilar to other reports [ 22 , 23 ].…”

Emergency department management of severely injured children in New South Wales

“…The present study, undertaken as part of the aforementioned larger longitudinal study, 5 included children who ultimately received definitive care at a NSW PTC, <16 years requiring ICU or an ISS ≥9 treated in NSW or who died following injury between July 2015 and September 2016. The 491 children identified via NSW PTCs, account for 79% of the longitudinal study cohort, and were included as their medical records were accessible.…”

“…In a study of 625 children in New South Wales (NSW) sustaining major injury, there was no survival benefit for children receiving definitive care at a PTC. 5 However, peer review of a cohort children from the same study demonstrated an overall adverse event (AE) rate of 7.6%. Of these cases, 37% were determined to be a near miss that did not result in death, 15% preventable errors that resulted in lasting disability, and one case a near miss 6 of death.…”