The impact of injury: The experiences of children and families after a child's traumatic injury

A longitudinal follow-up study of parent-reported family impact and quality of life in young patients with traumatic and non-traumatic brain injury

PURPOSE

Brain injuries (traumatic-/nontraumatic, TBI/nTBI) in young patients may lead to problems e.g., decreased health-related quality of life (HRQoL), and causes family impact. Knowledge regarding the family impact and the relationship with patients' HRQoL over time is scarce. This follow-up study describes family impact/HRQoL and their mutual relationship in young patients (5-24 years) after TBI/nTBI.

MATERIALS AND METHODS

Parents of patients that were referred to outpatient rehabilitation completed the PedsQL™Family-Impact-Module questionnaire to assess the family impact and the parent-reported PedsQL™Generic-core-set-4.0 to assess patients' HRQoL (lower scores: more family impact/worse HRQoL). Questionnaires were completed at the time of referral to rehabilitation (baseline) and one/two years later (T1/T2). Linear-mixed models were used to examine family impact/HRQoL change scores, and repeated-measure correlations (r) to determine longitudinal relationships.

RESULTS

Two-hundred-forty-six parents participated at baseline, 72 (at T2), median patient's age at baseline was 14 years (IQR:11-16), and 181 (74%) had TBI. Mean (SD) PedsQL™Family-Impact-Module score at baseline was 71.7 (SD:16.4) and PedsQL™Generic-core-set-4.0: 61.4 (SD:17.0). Over time, PedsQL™Family-Impact-Module scores remained stable, while PedsQL™Generic-core-set-4.0 scores improved significantly(p < 0.05). A moderately strong longitudinal correlation was found between family impact&HRQoL (r = 0.51).

CONCLUSIONS

Family impact does not tend to decrease over time but remained a considerable problem, although patients' HRQoL improved. Next to focusing on patients' HRQoL, it remains important to consider family impact and offer family support throughout rehabilitation.IMPLICATIONS FOR REHABILITATIONThis longitudinal study found that in young patients with traumatic brain injury (TBI) or non-traumatic brain injury (nTBI) referred for rehabilitation there is a considerable impact on the family until two years after referral, whereas the patients' health-related quality of life (HRQoL) improved significantly.Improvements in patients' quality of life status may not automatically lead to a decrease of family impact.Rehabilitation clinicians should monitor the impact on the family over time and provide long-term family support with special attention to parental worrying when needed.Clinicians should be aware that, despite significant differences between the clinical characteristics of patients with TBI and nTBI, the courses of family impact are very similar.

Children's participatory needs in injury prevention: reflections on supporting children's right to invite and comfort in discussing sensitive topics

BACKGROUND

Child-centred approaches in injury prevention emphasise the importance of practising bidirectional communications and decentring researcher-child power relations to support children's participation in research. To date, however, a dearth of scholarship offers methodological reflections on how to bolster children's feelings of comfort in discussing sensitive topics such as their injury experiences.

GOAL

Drawing from lessons we learnt working with children in a low-income to mid-income neighbourhood in Vancouver, Canada, we discuss the ways in which our strategies to support their participation succeeded in, and at times fell short of, supporting their participatory needs.

DISCUSSION

Our discussions focus attention on two important areas for consideration in future injury prevention studies: (1) Children's inclusion in research and the demand for them to share experience and (2) supporting children's right to invite and comfort in discussing sensitive topics such as injury experiences. We discuss the benefits of making research fun for children and being sensitive to their needs at preliminary recruitment and data collection stages.

IMPLICATIONS

These discussions can strengthen researchers' work with children by helping them to reflect on strategies that can bolster their desire to participate and feel comfortable sharing perspectives.

Nothing less than a creative triumph: a study of children admitted to hospital for serious somatic illness or injury and their experience of art therapy

Background

Hospitalization can be an extremely distressing experience for seriously ill and injured children. Art therapy has a well-established clinical history, and recent research has begun to demonstrate its effectiveness in somatic pediatric wards. Descriptive and statistical research indicates that art therapy can alleviate anxiety and fear, improve mood, and enhance communication among children, parents, and healthcare professionals. This study aims to enhance our understanding of the specific elements of art therapy that facilitate a connection with the healthier aspects of the self.

Method

A total of 12 hospitalized children, aged 4-12, participated in an art therapy session led by a certified art therapist. Verbalizations during the sessions were recorded, and subsequent observations were synchronized with verbatim transcriptions of audio recordings. A reflexive thematic analysis was conducted to identify relevant patterns of meaning.

Findings

The study identified four significant dimensions of the children's experiences during art therapy: (1) The child feels safe, (2) The child becomes a competent artist, bursting with creativity, (3) The healthy child emerges, and (4) The child achieves something beyond its limits - a triumph.

Discussion

The active ingredients contributing to effective art therapy include the stimulation of creativity, guided art-making with scaffolding support, task variation, granting children control over the artistic process, encouragement of free expression, and the display of positive regard. This study also delves into the therapeutic alliance, emphasizing its role in facilitating children's learning, self-expression, concentration, and the creation of work they take pride in. Additionally, certain psychotherapy-like interactions, such as control-mastery dynamics, were observed. Nevertheless, more extensive research with larger sample sizes is required to draw broader conclusions.

Experiences of parents of children with corrosive esophageal ingestion: a qualitative study

PURPOSE

To describe the experiences of parents of children treated for corrosive esophageal ingestion.

METHODS

In-depth interviews were conducted with 17 parents (nine mothers and eight fathers) of children who had suffered a corrosive esophageal ingestion requiring hospitalization. Online interviews were also conducted with parents of children who were still undergoing treatment for corrosive esophageal ingestion. The interview guide explored the parents' overall experiences and included research questions that explored the participants' perceptions, thoughts, feelings and problems. The interviews were digitally recorded and transcribed verbatim. Inductive reflective thematic analysis was performed using MAXQDA.

RESULTS

Analysis of the interview transcripts generated three themes and nine sub-themes describing parents' experiences: emotional consequences, social consequences and facilitators. The results reveal that caregivers experienced anxiety and difficulties, prompting them to seek support from their family and social environment.

CONCLUSION

These findings highlight the importance of identifying and understanding parental experiences. This understanding will also enable healthcare professionals to optimize the parental experience in caring for children with corrosive esophageal ingestion within a holistic clinical service. Understanding the experiences of children with corrosive esophageal ingestion from the parents' perspective identifies opportunities for systematic treatment and care.

The Perceived Meaning of Traumatic Brain Injury for Older Adults: A Longitudinal-Multiple Case Study

PURPOSE

The aim of this study was to explore the perceived meaning of traumatic brain injury (TBI) over the first-year postinjury among older adults and to explore if and how meaning changes.

DESIGN

A longitudinal multiple-case study design was used.

METHODS

Semistructured face-to-face interviews were completed at 1 week and 1, 3, 6, and 12 months postinjury. Transcripts were analyzed using inductive thematic analysis.

RESULTS

Fifty-five interviews were conducted with 12 participants. Four themes were identified: gratitude, vulnerability and dependence, slowing down and being more careful, and a chance for reflecting on life. Most participants' perceptions of their TBI remained either consistently positive or negative over the first-year postinjury.

CLINICAL RELEVANCE

Nurses should elicit and support patients' positive illness perceptions regarding their brain injury, which can contribute to a higher quality of life. For those patients with negative illness perceptions, nurses should provide resources in order to support coping and resilience following brain injury.

CONCLUSIONS

This study is the first study to explore individual perceptions over time of the meaning made from experiencing TBI among older adults. Findings can serve as a foundation for tailored supportive interventions among older adults following TBI to maximize quality of life.

Using Nvivo to Analyze the Impact of Computer Simulation of Parent-Child Cooperative Art Activities on the Growth of Preschool Children

Psychology originally defined parent-child conflict in terms of interpersonal relationships, where parent-child conflict is a process of inconsistent attitudes between parents and children that occurs in a family setting. For this end, we aims to investigate the influence of parental awareness on preschoolers' perception of parent-child conflict and the mediating role of preschoolers' self-esteem. This paper proposes a dynamic parent-child relationship discovery algorithm based on the impact of parent-child cooperation activities on preschool children's development. We applied SPSS and Mplus statistical software for data processing and analysis, and Nvivo 11.0 qualitative software for validation and analysis. The reliability of preschool children's perceived parent-child conflict and sub-dimensions were: 0.901, 0.799, 0.791, 0.811, 0.729; the total scale and the retest reliability of each dimension were: 0.914, 0.837, 0.836, 0.792, 0.711. Validated factor analysis using Mplus: RMSEA = 0.075, TLI = 0.856, CFI = 0.876, SRMR = 0.064.

Development and validation of the MAnchester Needs Tool for Injured Children (MANTIC)

OBJECTIVE

To develop a measure of the needs injured children and their families' needs throughout recovery; The MAnchester Needs Tool for Injured Children (MANTIC).

DESIGN

Tool development, psychometric testing.

SETTING

Five children's major trauma centres in England.

PARTICIPANTS

Children aged 2 to 16 years with any type of moderate/severe injury(ies) treated in a major trauma centre within 12 months of injury, plus their parents.

METHODS

Stage 1a (Item generation): Interviews with injured children and their parents to generate draft items. Stage 1b (Co-production): Feedback about item clarity, relevance and appropriate response options was provided by parents and the patient and public involvement group. Stage 2 (Psychometric development): Completion of the prototype MANTIC by injured children and their parents with restructuring (as necessary) to establish construct validity. Concurrent validity was assessed by correlation with quality of life (EQ-5D-Y). MANTICs were repeated 2 weeks later to assess test-retest reliability.

RESULTS

Stages 1a,b: Interviews (13 injured children, 19 parents) generated 64 items with semantic differential four-point response scale (strongly disagree, disagree, agree, strongly agree). Stage 2: One hundred and forty-four participants completed MANTIC questionnaires (mean age 9.8 years, SD 3.8; 68.1% male). Item responses were strong requiring only minor changes to establish construct validity. Concurrent validity with quality of life was moderate (r = 0.55, P < 0.01) as was test-retest reliability (ICC = 0.46 and 0.59, P < 0.001). Uni-dimensionality was strong (Cronbach's α > 0.7).

CONCLUSION

The MANTIC is a feasible, acceptable, valid self-report measure of the needs of injured children and their families, freely available for clinical or research purposes.

Interventions to change parental parenting behaviour to reduce unintentional childhood injury: a randomised controlled trial

OBJECTIVE

The previous study has shown the impact of paternal involvement in childcare on unintentional childhood injury; yet the causality is unknown. The purpose of this study is to investigate whether the intervention of an educational video on paternal involvement in childcare can prevent unintentional injury among young children.

METHODS

A randomised controlled trial of parents of children born at two obstetrics wards in Japan (n=451, intervention group: 223, control group: 228) was conducted. Parents in the intervention group watched an educational video that promote paternal involvement in childcare, while parents in the control group watched an educational video on the prevention of shaken baby syndrome. The participants were followed for up to 18 months after the birth of their child. The primary outcome of this study was unintentional injury at 3, 6, 12 and 18 months. The secondary outcome was paternal involvement in childcare based on maternal observation. Unintentional injury-free rates over time were assessed using the Cox proportional hazard model.

RESULTS

Children in the intervention group were less likely to have unintentional injury, such as burn (HR: 0.29 (95% CI: 0.09 to 0.87)) and caught by a door (HR: 0.66 (95% CI: 0.48 to 0.91)) compared with the control group. Fathers in the intervention group showed higher frequency of taking their children for a walk (coefficient: 0.19 (95% CI: 0.05 to 0.32)).

CONCLUSIONS

Educational videos promoting paternal involvement in childcare is effective to prevent unintentional childhood injury.

Traumatised Children's Perspectives on Their Lived Experience: A Review

Introduction: Most children have exposure of traumatic events during their life, such as natural disasters, accidents, and abuses. A review of traumatised children's perspective on traumatic events plays an important role in enhancing our understanding and promoting appropriate tailor-made intervention and support to these children. Methods: Four main health-related electronic databases were searched for all English full-text qualitative research articles over the past 11 years to uncover the recent best available perspective/evidence from traumatised children. The PRISMA checklist was adopted to guide the review process. Results: Five themes about children's experiences and perspectives towards the traumatic events encountered were summarised and integrated from 19 qualitative studies identified. They included daily life problems related to trauma, negative responses to trauma, perceived health needs, coping strategies related to trauma and stress, and growth from traumatic experience. Conclusions: This systematic review provides evidence about responses/impacts and perceived health needs of traumatised children and informs the direction caregivers' training can take, helping these children by early identification and timely intervention. More research is needed to examine/compare traumatised children's responses and coping between diverse traumatic experiences, time from exposure, and the sociodemographic characteristics of these children.

The association between wind speed and the risk of injuries among preschool children: New insight from a sentinel-surveillance-based study

BACKGROUND

Injuries among preschool children are an important public health concern worldwide. Significant gaps remain in understanding the potential impact of wind speed on injuries among preschoolers. We aimed to clarify the association and its variation across subgroups to capture the vulnerability features.

METHODS

Using a case-crossover design and conditional logistic regression model, we compared the exposure to wind speed right before the injury events (case period) with that of control periods to determine the excess rate (ER) of injury on each of 0-3 lag days in Guangzhou, 2016-2020. Results were also stratified by sociodemographic characteristics of patients, basic characteristics of injury events, and clinical features of injuries to identify the most vulnerable subgroups of preschoolers.

RESULTS

Higher wind speed was significantly associated with an increased risk of injuries among preschoolers on lag 0, reaching an ER of 2.93 % (95 % confidence interval [CI] = 0.87, 5.03), but not on other lag days. The results of the stratified analyses showed that children under 3-year-old (3.41 %; 95 % CI = 0.36, 6.55), boys (3.66 %; 95 % CI = 1.04, 6.35), and non-locally registered children (3.65; 95 % CI = 0.02, 7.40) were more prone to wind-related injuries. Falls (2.67 %; 95 % CI = 0.11, 5.30) were the main cause of wind-related injuries, and taking transportation was the main activity when injuries occurred (13.16 %; 95 % CI = 4.45, 22.60). Additionally, injuries involving buildings/grounds/obstacles (4.69 %; 95 % CI = 1.66, 7.81) and the occurrence of sprain/strain (7.60 %; 95 % CI = 0.64, 15.04) showed a positive association with wind speed.

CONCLUSIONS

Higher wind speed was associated with a significantly elevated rate of injuries among preschoolers without delayed effects, where children under 3-year-old, boys, and non-locally registered subgroups were more susceptible to wind-related injuries. This study may provide new insights for refining the prevention measures against wind-related injuries among preschoolers.

Psychological and psychosocial aspects of major trauma care: A survey of current practice across UK and Ireland

Introduction

Psychological and psychosocial impacts of major trauma, defined as any injury that has the potential to be life-threatening and/or life changing, are common, far-reaching and often enduring. There is evidence that these aspects of major trauma care are often underserved. The aim of this research was to gain insight into the current provision and operationalisation of psychological and psychosocial aspects of major trauma care across the UK and Ireland.

Methods

A cross-sectional online survey, open to health professionals working in major trauma network hospitals was undertaken. The survey had 69 questions across six sections: Participant Demographics, Psychological First Aid, Psychosocial Assessment and Care, Assessing and Responding to Distress, Clinical Psychology Services, and Major Trauma Keyworker (Coordinator) Role.

Results

There were 102 respondents from across the regions and from a range of professional groups. Survey findings indicate a lack of formalised systems to assess, respond and evaluate psychological and psychosocial aspects of major trauma care, most notably for patients with lower-level distress and psychosocial support needs, and for trauma populations that don't reach threshold for serious injury or complex health need. The findings highlight the role of major trauma keyworkers (coordinators) in psychosocial aspects of care and that although major trauma clinical psychology services are increasingly embedded, many lack the capacity to meet demand.

Conclusion

Neglecting psychological and psychosocial aspects of major trauma care may extend peritraumatic distress, result in preventable Years Lived with Disability and widen post-trauma health inequalities. A stepped psychological and psychosocial care pathway for major trauma patients and their families from the point of injury and continuing as they move through services towards recovery is needed. Research to fulfil knowledge gaps to develop and implement such a model for major trauma populations should be prioritised along with the development of corresponding service specifications for providers.

Parents’/guardians’ experiences with their adolescents’ prolonged recovery from a sport-related concussion

Sport-related concussions (SRCs) occur at alarming rates among adolescents and evidence suggests that adolescents experience more severe and longer-lasting symptoms compared to other age groups. Developmentally, adolescence is a time when youth become less reliant on their parents, establish their personal identity, and rely more on other social support networks (e.g., peers, teammates). However, previous studies show that parents play a prominent role in the recovery process from an SRC, especially in situations where recovery is prolonged. The purpose of this study was to examine the lived experiences of parents/guardians of teens who were recovering from a concussion and whose symptoms were persistent. Participants ( N = 12) were individually interviewed to better understand how they navigated and advocated for their teen during their prolonged recovery. An inductive content analysis revealed eight thematic categories that were interpreted with a developmental lens: (a) difficulties enforcing cognitive and physical rest, (b) concerns about depression and isolation, (c) observing struggles with athletic identity, (d) feelings of frustration, helplessness, and stress, (e) challenges of a hidden injury, (f) decisions about returning to sport, (g) being lied to about symptoms, and (h) offering strategies and practical advice. The themes illustrate how challenging and complicated the recovery process can be for parents of teenagers in particular, which is supported in previous concussion studies and the broader developmental literature. These results reinforce the idea that taking a biopsychosocial approach to care is best in order to adequately support parents/guardians and adolescents during the SRC recovery process.

Hospital service use following an injury hospitalisation for young males and females in a population-level matched retrospective cohort study

BACKGROUND

Children and young people who sustain injuries resulting in a hospital admission may experience adverse effects for months or years following the event. Understanding the attributable burden and health service needs is vital for public health planning as well as individual care provision. This study aims to identify the hospitalised morbidity associated with injury among young people by sex using a population-level matched cohort.

METHOD

A population-level matched case-comparison retrospective cohort study of young people aged ≤18 years hospitalised for an injury during 2005-2018 in New South Wales, Australia using linked birth, health, and mortality records. The comparison cohort was matched on age, gender and residential postcode. Adjusted rate ratios (ARR) were calculated for age group, injury severity and nature of injury by sex.

RESULTS

There were 122,660 (60.9%) males and 78,712 (39.1%) females aged ≤18 years hospitalised after sustaining an injury. Males (ARR 2.89; 95%CI 2.81-2.97) and females (ARR 2.79; 95%CI 2.68-2.90) who were hospitalised after an injury had a higher risk of subsequent hospital admission than their matched peers. Males (ARR 3.38; 95%CI 2.81-4.05) and females (ARR 3.41; 95%CI 2.72-4.26) with serious injuries had a higher risk of admission compared to peers. Males with dislocations, sprains and strains (ARR 3.40; 95%CI 3.03-3.82), burns (ARR 3.37; 95%CI 2.99-3.80), and fractures (ARR 3.20; 95%CI 3.07-3.33), and females with burns (ARR 3.84; 95%CI 3.40-4.33), dislocations, sprains and strains (ARR 3.54; 95%CI 2.96-4.23), and traumatic brain injury (ARR 3.39; 95%CI 3.01-3.82) had the highest risk of subsequent hospitalisation compared to peers.

CONCLUSION

Patient management and care extends beyond the injury admission as many young people face high levels of contact with health services in the months and years following injury. These findings will inform health service planning and trauma care management for young people and families affected by injury.

Clinical Application of Restrictive Brace Combined with Psychological Intervention after Replantation of Severed Fingers in Children

Objective

After replantation of severed fingers in infants, the utility model patent upper limb restrictive brace-assisted bed rest braking, combined with psychological intervention, can alleviate children's anxiety, so as to reduce the occurrence of vascular crisis.

Methods

The study period was from April 2015 to July 2018. In this paper, 30 children with finger injuries in hand surgery in the CIS electronic medical record system of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital were selected as the research objects. Replantation was performed in 30 infants with severed fingers. Among them, 15 cases were applied with the method of aircraft chest arm gypsum splint combined with sedative drug braking and the utility model patented product upper limb restrictive brace fixation-assisted bed rest braking, and the method of psychological intervention was applied at the same time.

Results

Among the 15 fingers in the control group, 6 had vascular crisis and 1 in the experimental group. The incidence of vascular crisis in the experimental group was lower, and the difference between the two groups was statistically significant (P < 0.05). The patients were followed up for 9~18 months, with an average of 9.72 ± 1.07 months. In the control group, 15 cases of severed fingers survived, and there were 13 cases of replantation finger necrosis in 2 cases of intractable arterial crisis. In the experimental group, 14 cases of severed fingers survived in 15 cases and there was 1 case of replanted finger necrosis in intractable arterial crisis after operation. There was no significant difference in the survival rate between the two groups (P > 0.05). In addition, the replanted finger function was evaluated. In the control group, 9 cases were excellent, 4 cases were good, and 1 case was fair. In the experimental group, 14 cases were excellent, 1 case was good, and 0 case was fair. The functional evaluation of the experimental group was better than that of the control group, and the difference between the two groups was statistically significant (P < 0.05).

Conclusion

For infants after replantation of severed fingers, the application of the utility model patented product upper limb restrictive brace can effectively make up for the insufficient fixation of aircraft chest arm gypsum splint, reduce the occurrence of vascular crisis, and assist children in bed. In addition, the application of psychological intervention can reduce children's postoperative crying and is conducive to children's postoperative recovery.

Psychological and psychosocial aspects of major trauma care in the United Kingdom: A scoping review of primary research

Introduction

More people are surviving major trauma, often with life changing injuries. Alongside physical injury, many survivors of major trauma experience psychological and psychosocial impacts. Presently, there is little guidance at the UK national level for psychological and psychosocial aspects of major trauma care. Set in the context of the regional model of major trauma care implemented in the UK in 2012, the purpose of this review was to identify and bring together primary research about psychological and psychosocial aspects of major trauma care in the UK to produce an overview of the field to date, identify knowledge gaps and set research priorities.

Methods

A scoping review was undertaken. Seven electronic databases (MEDLINE, Cochrane Library, CINAHL, Embase, PsycINFO, SocINDEX with Full Text and PROSPERO) were searched alongside a targeted grey literature search. Data from included studies were extracted using a predefined extraction form and underwent bibliometric analysis. Included studies were then grouped by type of research, summarised, and synthesised to produce a descriptive summary and overview of the field.

Results

The searches identified 5,975 articles. Following screening, 43 primary research studies were included in the scoping review. The scoping review, along with previous research, illustrates that psychological and psychosocial impacts are to be expected following major trauma. However, it also found that these aspects of care are commonly underserved and that there are inherent inequities across major trauma care pathways in the UK.

Conclusion

Though the scoping review identified a growing body of research investigating psychological and psychosocial aspects of major trauma care pathways in the UK, significant gaps in the evidence base remain. Research is needed to establish clinically effective psychological and psychosocial assessment tools, corresponding interventions, and patient-centred outcome measures so that survivors of major trauma (and family members or carers) receive the most appropriate care and intervention.

Pediatric Trauma: What Hurts?

OBJECTIVES

Pediatric trauma patients are injured during crucial developmental years and require subsequent absence from school and activities. The impact of these changes on pediatric trauma patients is not well studied. We sought to assess the functional and emotional impact of pediatric trauma. In addition, the inpatient experience was evaluated for performance improvement purposes.

METHODS

A prospective survey was conducted at our trauma center (February 2019 to May 2019) of admitted trauma patients (<18 years). Patients who died before admission and nonaccidental trauma patients were excluded. Patients completed an inpatient survey and another at 3 months postdischarge.

RESULTS

Sixty patients were enrolled; 31 completed follow-up. Patients were 10 ± 5 years, 75% being male (n = 45), with an Injury Severity Score of 7 ± 6. A total of 13% were seen by behavioral medicine while inpatient; 18% of patients had preexisting anxiety. Preexisting functional limitations existed in 7% of the patients. At 3 months, 71% were back to preinjury academics, and 58% had returned to extracurriculars. At follow-up, 10% of patients felt withdrawn, and 32% felt emotional/distracted. Only 13% of patients were undergoing therapy compared with 7% preinjury. Patients communicated their best/worst experiences.

CONCLUSION

Pediatric trauma patients experience significant functional and emotional limitations after trauma. This suggests that all pediatric trauma patients should be evaluated by behavioral medicine during their admission with postdischarge support services offered. Performance improvement opportunities were identified in areas of pain control and communication.