Population study and long-term outcome in pediatric trauma

Abstract

Objective The first objective of this thesis was to describe trends in pediatric trauma in the Netherlands, and to describe changes in mortality rates and referral behavior after regionalization of trauma care. The second objective of this thesis was to describe the health condition and the health-related quality of life long-term after major pediatric trauma, with additionally the objective to select the most suitable measures to do so. Methods All children with moderate to severe trauma that were discharged from trauma care region ‘Central Netherlands’ from 1996 to 2009 were included. Selection was made based on an Injury Severity Score of at least 4, trauma-related ‘International Classification of Diseases’ (ICD-9) diagnostic codes, and ‘External Causes of Injury and Poisoning’ codes (E-codes). Referral behavior of children with major trauma and the in-hospital mortality rates were compared before (1996-1998) and after (2001-2006) regionalization of trauma care. Secondly, a systematic review of health-related quality of life measures for long-term follow-up in children after major trauma was conducted. Finally, the long-term health condition and health-related quality of life was measured in a pilot study among forty severely injured children that were discharged from the University Medical Center Utrecht in 1999 or 2000. About seven years after the accident the health condition was measured by the guides to the evaluation of permanent impairment of the American Medical Association, the Glasgow Outcome Scales, the Vineland Adaptive Behavior Scales, the Child Behavior Checklist, and the Strengths and Difficulties Questionnaire. Health-related quality of life was measured by the PedsQL, the EuroQol 5D, and the EuroQol Visual Analogue Scale (EQ-VAS). Results The incidence rate of moderate to severe trauma increased since 2001 with 1.1% annually (95% CI 0.7-1.5). This trend was caused by an increase of falls, sport injuries, and bicycle injuries. The mortality rates for adolescents were reduced after regionalization, but no changes in referral behavior were found. Measures that were suitable for the long-term follow-up measurement of health-related quality of life in children after major trauma were the DISABKIDS, the KIDSCREEN-52, and the Pediatric Quality of Life Inventory (PedsQL). Long-term after major trauma forty percent of the children was physically impaired or restricted in daily activities. The outcome on the health-related quality of life was inconclusive.