Prevalence and Prognostic Factors of Disability After Childhood Injury

Abstract

ABSTRACT. Objective. To assess the prevalence and the prognostic factors of disabilities after minor and major childhood injuries and to analyze which sociodemographic and injury-related factors are predictive for suboptimal functioning in the long term.Method. We conducted a patient follow-up study in a stratified sample of 1221 injured children who were aged 5 to 14 years and had visited an emergency department in the Netherlands. Our study sample was stratified so that severe, less common injuries were overrepresented. Postal questionnaires were sent 2.5, 5, and 9 months after the injury. We gathered injury and external cause data, sociodemographic information, and data on functional outcome with a generic health status measure EuroQol (EQ-5D) with an additional cognitive dimension. A nonresponse analysis was performed by multivariate logistic regression, and the data were adjusted for nonresponse and the sample stratification. We performed bootstrap analysis to estimate the prevalence of disability in terms of the EQ-5D summary score and the occurrence of limitations in separate health domains: mobility, self-care, usual activities, pain/discomfort, anxiety/depression, and cognition. Respondents also rated their own health state on a visual analog scale, between 0 (worst imaginable health state) and 100 (best imaginable health state). We analyzed the relationship between functional outcome and sociodemographic (age and gender) and injury-related determinants (type of injury, external cause, multiple injury, admission to hospital, and length of stay) by logistic regression analysis.Results. Response rates with respect to the original sample were 43%, 31%, and 30%, respectively. A total of 37% of the children were admitted to the hospital. The mean age of the children was 9.6 years. In two thirds (65%) of the cases, the injury was attributed to a home and/or leisure injury. The health status of injured children improved from 0.92 (EQ-5D summary score) at 2.5 months to 0.96 at 5 months and 0.98 at 9 months. Of all injured children, 26% had at least 1 functional limitation after 2.5 months, 18% after 5 months, and 8% still experienced functional limitations after 9 months. After 2.5 months, lower extremity fractures and other injuries (eg, spinal cord injury, injury of the nerves) demonstrated the worst functional outcome. Independent of the type of injury, our sample of injured children generally showed good recovery between 2.5 and 9 months. The highest prevalence of dysfunction after 9 months existed for pain/discomfort (7%) and usual activities (5%). Hospital admission (odds ratio: 3.6 -5.8) and female gender (odds ratio: 3.0) were predictive for long-term disability. Girls reported more problems for all health domains (except self-care) compared with boys after 9 months, which was also confirmed by the visual analog scale score for selfrelated health (89 for girls vs 95 for boys). Almost one fifth of injured children with a hospital stay of >3 days still had pain and problems with usual activities 9 months ...

Injuries in children and adolescents seen during 2006 at the emergency department of the National District Hospital, Bloemfontein

“…This observation corresponds with findings reported by Polinder et al 2 and Gofin et al, 3 who found, respectively, that 48.7% and 65% of injuries sustained by children occur at home. A possible argument in support of this observation could be that many parents are absent from home during the afternoon, i.e.…”

“…It could be recommended that one of the senior doctors in the emergency department should receive further training in orthopaedics to minimise the number of referrals. Polinder et al 2 found that 75% of children with lasting disabilities were treated for their injuries at the emergency department only and not referred for specialist attention.…”

“…1 Most children make an uneventful recovery from minor physically traumatic events, while some will remain permanently disabled or scarred, irrespective of the cause and part of the body affected by the injury. 2 The consequences of the injury affect not only the child or adolescent, but the family unit and, indirectly, society at large. 3,4 Furthermore, contrary to the belief that a child's emotional response to traumatic events is shortlived and has little or no permanent sequelae, it is now recognised that children who have experienced trauma are at risk for behavioural, developmental, functional and psychiatric complications.…”

Assessing the burden of injury in six European countries

“…In our results the YLD for noniadmitted injury patients are underi i estimated owing to incomplete DALY estimates; for some frequently occurring injuries (concussion, superficial injury), no disability weights were estimated in the GBD study. Among these primarily noniadmitted patients, there is a small proportion with longiterm disability, which may lead to a high estimate of prevalence of disability owing to high annual numbers of patients, 16,17 and thus results in an underestimation of YLD. Although burns are a very disabling type of injury, they were excluded from our analysis.…”

Assessing the burden of injury in six European countries

“…In our results the YLD for non-admitted injury patients are underestimated owing to incomplete DALY estimates; for some frequently occurring injuries (concussion, superficial injury), no disability weights were estimated in the GBD study. Among these primarily non-admitted patients, there is a small proportion with long-term disability, which may lead to a high estimate of prevalence of disability owing to high annual numbers of patients, 16,17 and thus results in an underestimation of YLD. Although burns are a very disabling type of injury, they were excluded from our analysis.…”