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Six years beyond pediatric trauma: child and parental ratings of children’s health-related quality of life in relation to parental mental health
The Swedish Red Cross University College, Department of Technology and Welfare. Department of Molecular Medicine and Surgery, Karolinska University Hospital; Department of Molecular Medicine and Surgery, Karolinska Institutet; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.ORCID iD: 0000-0002-9273-9448
Department of Pediatric Emergency Surgery, Astrid Lindgrens’ Children’s Hospital, Karolinska University Hospital.
Department of Molecular Medicine and Surgery, Karolinska Institutet.
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Infectious Diseases Karolinska University Hospital, Huddinge; School of Health Sciences, City University London, UK.
2015 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 24, no 11, 2689-2699 p.Article in journal (Refereed) Published
Abstract [en]

Purpose

To examine the relationship between child self-report and parent proxy report of health-related quality of life (HRQL) and how parents’ mental health status relates to the HRQL ratings 6 years after minor to severe injury of the child.

Materials and methods

This cross-sectional cohort study was performed at a regional pediatric trauma center in Stockholm, Sweden. The PedsQL 4.0 versions for ages 5–7, 8–12, and 13–18 years were completed by 177 child–parent dyads 6 years after injury to the child. The parents also rated their own mental health through the mental health domain (MH) in the SF-36 Health Survey.

Results

The children’s median age was 13 years (IQR 10–16 years), 54 % were males, and the median ISS was 5 (IQR 2–9). Most of the parents were female (77 %), born in Sweden (79 %), and half had university degrees. There was no statistically significant difference between child self-report and parent proxy report in any of the PedsQL 4.0 scales or summary scales. The levels of agreement between child self-report and parent proxy reports were excellent (ICC ≥ 0.80) for all scales with the exception of emotional functioning (ICC 0.53) which also was the scale with the lowest internal consistency in child self-report (α 0.60). Multiple regression analyses showed that worse parental mental health status correlated with worse child self-report and parent proxy report of children’s HRQL.

Conclusions

Children and their parents’ reports on child’s HRQL were in agreement. Decreased mental health in parents was associated with lower scores on parent proxy reports and child self-reports of HRQL after injury. The current investigation highlights the possible relationship between parent’s mental health status and children’s HRQL long after an injury, which should be considered in future investigations and in clinical care.

Place, publisher, year, edition, pages
2015. Vol. 24, no 11, 2689-2699 p.
Keyword [en]
Injury, Trauma, Pediatric, Parents, PedsQL, Mental health, Depression, Health-related quality of life
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:rkh:diva-843DOI: 10.1007/s11136-015-1002-yPubMedID: 26001639OAI: oai:DiVA.org:rkh-843DiVA: diva2:723621
Note

As manuscript in dissertation

Available from: 2014-06-11 Created: 2014-06-10 Last updated: 2015-10-14Bibliographically approved
In thesis
1. Adult and pediatric trauma: outcomes and health-related quality of life
Open this publication in new window or tab >>Adult and pediatric trauma: outcomes and health-related quality of life
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Trauma is the number one killer of children and young adults and the  most common cause for hospital admissions for these age-groups in Sweden. Trauma is  also one of the most common causes for hospital care and early death for older people.  In the last decades trauma care has advanced and improved short-term survival of  injured but knowledge of the long-term outcome is limited.

The overall aim of this thesis is to investigate long-term outcome and health-related  quality of life after injuries in different age groups and to identify factors associated  with outcome.

Methods: The thesis is based on four studies. In the first study patients with major  trauma were contacted 5 years after injury and HRQL was measures using the SF-36  questionnaire and compared to an age and sex-matched reference group. In the second  study data was collected on children with injuries to describe demographic and injury  characteristics and outcome. The sample in the second study was the source for the  third and fourth study. The third study measured HRQL using the PedsQL 4.0 in a  cohort of children 6 years after injury and determined the relationship within subgroups  in the cohort. The fourth study measured child HRQL in a sample of children after  injury and their parent´s and determined the relationship within scoring results and the impact of parents reported mental health status.

Results: The adult major trauma patients (n=205) reported significantly lower HRQL  scores in all eight domains compared to the reference group. A large number of patients  suffered from physical (68%) and psychological disabilities (41%) and nearly half reported the need for better follow-up after discharge from hospital. The severity of the injury did not anticipate a lower health-related quality of life. In the pediatric group  (n=432) the median injury severity score was 4 (IQR 1-9), 50% sustained head injuries  and the most severe head injuries were seen in the youngest age group. Mortality rate  was low (1%), 19% stayed in a PICU and the median length of hospital stay was two  days. In the follow-up study (n=204) the youngest children had the lowest PedsQL  scores. Children who suffered from extremity injuries had lower scores in the school  functioning compared to children with head injuries. The levels of agreement between  child self-report and parent proxy report of PedsQL 4.0 scales were excellent  (ICC≥0.80) for all scales with the exception of children´s self-reported emotional  functioning. Multiple regression analyses showed that poor parental mental health  status contributed to worse child self-report and parent proxy report of children´s  HRQL.

Conclusion: Adult major trauma patients have significant disabilities 5 years after  injury. Improved follow-up by trauma specialist teams are needed. Children´s HRQL 6  years after trauma seems to in parity or better than healthy peers. Parent´s mental health  status can possibly impact on children´s HRQL long after an injury. Further studies are  recommended to evaluate the PedsQL 4.0versions for self-report in pediatric trauma  population.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2012. 76 p.
Keyword
Trauma, Injury, Health- related quality of life, Follow- up, Pediatric, Adolescents, SF-36, PedsQL 4, 0
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-844 (URN)978-91-7457-954-3 (ISBN)
Public defence
2012-12-07, Henry Dunant, Teknikringen 1, Stockholm, 10:00 (English)
Opponent
Supervisors
Note

At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 3: Submitted (title: Health-related quality of life of children and adolescents 6 years after pediatric trauma). Paper 4: Manuscript (title: Health-related quality of life 6 years after pediatric trauma: Impact of parental mental health on child-parent reports).

Available from: 2014-06-11 Created: 2014-06-10 Last updated: 2015-10-14Bibliographically approved

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