A seven item scale for the assessment of disabilities after child and adolescent injuries

Prevalence and predictors of sub-acute phase disability after injury among hospitalised and non-hospitalised groups: a longitudinal cohort study

INTRODUCTION

To reduce the burden on injury survivors and their supporters, factors associated with poor outcomes need to be identified so that timely post-injury interventions can be implemented. To date, few studies have investigated outcomes for both those who were hospitalised and those who were not.

AIM

To describe the prevalence and to identify pre-injury and injury-related predictors of disability among hospitalised and non-hospitalised people, three months after injury.

METHODS

Participants in the Prospective Outcomes of Injury Study were aged 18-64 years and on an injury entitlement claims register with New Zealand's no-fault injury compensation insurer, following referral by healthcare professionals. A wide range of pre-injury demographic, health and injury-related characteristics were collected at interview. Participants were categorised as 'hospitalised' if they were placed on New Zealand's National Minimum Data Set within seven days of the injury event. Injury severity scores (NISS) and 12 injury categories were derived from ICD-10 codes. WHODAS assessed disability. Multivariable analyses examined relationships between explanatory variables and disability.

RESULTS

Of 2856 participants, 2752 (96%) had WHODAS scores available for multivariable analysis; 673 were hospitalised; 2079 were not. Disability was highly prevalent among hospitalised (53.6%) and non-hospitalised (39.4%) participants, three-months after injury. In both groups, pre-injury disability, obesity and higher injury severity were associated with increased odds of post-injury disability. A range of other factors were associated with disability in only one group: e.g. female, ≥ 2 chronic conditions and leg fracture among hospitalised; aged 35-54 years, trouble accessing healthcare, spine or lower extremity sprains/dislocations and assault among non-hospitalised.

SIGNIFICANCE

Disability was highly prevalent among both groups yet, with a few exceptions, factors associated with disability were not common to both groups. Where possible, including a range of injured people in studies, hospitalised and not, will increase understanding of the burden of disability in the sub-acute phase.

A systematic review of studies measuring health-related quality of life of general injury populations

Background

It is important to obtain greater insight into health-related quality of life (HRQL) of injury patients in order to document people's pathways to recovery and to quantify the impact of injury on population health over time. We performed a systematic review of studies measuring HRQL in general injury populations with a generic health state measure to summarize existing knowledge.

Methods

Injury studies (1995-2009) were identified with main inclusion criteria being the use of a generic health status measure and not being restricted to one specific type of injury. Articles were collated by study design, HRQL instrument used, timing of assessment(s), predictive variables and ability to detect change over time.

Results

Forty one studies met inclusion criteria, using 24 different generic HRQL and functional status measures (most used were SF-36, FIM, GOS, EQ-5D). The majority of the studies used a longitudinal design, but with different lengths and timings of follow-up (mostly 6, 12, and 24 months). Different generic health measures were able to discriminate between the health status of subgroups and picked up changes in health status between discharge and 12 month follow-up. Most studies reported high prevalences of health problems within the first year after injury. The twelve studies that reported HRQL utility scores showed considerable but incomplete recovery in the first year after discharge.

Conclusion

This systematic review demonstrates large variation in use of HRQL instruments, study populations, and assessment time points used in studies measuring HRQL of general injury populations. This variability impedes comparison of HRQL summary scores between studies and prevented formal meta-analyses aiming to quantify and improve precision of the impact of injury on population health over time.

Functional balance tests for children with traumatic brain injury: within-session reliability

PURPOSE

To assess the within-session reliability of the Modified Functional Reach Test (MFRT) and the Timed Up and Go (TUG) test in children with traumatic brain injury (TBI) and children with typical development (TD).

METHODS

A convenience sample of 24 children with TBI and 24 children with TD matched for age and sex were tested. Following 1 practice trial, 3 trials of the MFRT and TUG were completed and recorded for each child.

RESULTS

Within-session reliability for the MFRT was excellent [children with TBI (intraclass correlation coefficient, ICC (1,1) = 0.92-0.97), children with TD (ICC (1,1) = 0.94-0.95)]. Within-session reliability for the TUG test was good [children with TBI (ICC (1,1) = 0.86), children with TD (ICC (1,1) = 0.85)]. The average of the first and second trials showed the least measurement error for the TUG test.

CONCLUSION

Within-session reliability values are excellent for the MFRT and good for the TUG test in children with TBI.

Fractures among children: incidence and impact on daily activities

OBJECTIVES

The study's objective was to examine incidence of fractures and associated activity restriction among children aged 0-12 years.

DESIGN

Injuries were prospectively recorded over the four year period from 1992-95 in a cohort of children aged 0-12 years, representing 193,540 children years. Information about length and extent of activity restriction was collected from parents by a mailed questionnaire for a subsample of 192 children with a fracture.

RESULTS

A total of 2477 fractures occurred in the study population (128 per 10,000 children annually). The incidence increased linearly with age, by 14 cases per 10,000 children year for each year of age. Boys and girls showed similar patterns of fracture occurrence. There was a significant difference in length of activity restrictions for different types of fractures. The mean and 95% confidence interval (CI) of activity restricted days for leg fractures were 26 (95% CI 7 to 45) days, for arm fractures, 14 (95% CI 8 to 20) days, and for other fractures, 5 (95% CI 1 to 8) days. Arm fractures represented 66% of the cases and 62% of the activity restricted days; leg fractures 19% of cases and 33% of all activity restricted days; and other fractures 16% of the cases but only 5% of the activity restricted days in this population.

CONCLUSION

The incidence of fractures increases in childhood. Different types of fractures among children cause different amounts of activity restriction.