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Adult and pediatric trauma: outcomes and health-related quality of life
The Swedish Red Cross University College. Dept of Molecular Medicine and Surgery, Karolinska Institute.ORCID iD: 0000-0002-9273-9448
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 [en]
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: urn:nbn:se:rkh:diva-844Libris ID: 13608977ISBN: 978-91-7457-954-3 (print)OAI: oai:DiVA.org:rkh-844DiVA: diva2:723636
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
List of papers
1. Outcome and quality of life 5 years after major trauma.
Open this publication in new window or tab >>Outcome and quality of life 5 years after major trauma.
2005 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 59, no 1, 223-232 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: This study aimed to determine quality of life after injury and identify factors potentially associated with outcome.

METHODS: Five years after injury from blunt or penetrating trauma, patients received a questionnaire based on the SF-36 Health Survey.

RESULTS: Two hundred five patients (83%) replied. Most were men, median age 39 years, 93% injured by blunt energy, median Injury Severity Score 14 (range 9-57). Mean SF-36 scores were significantly lower than in a matched reference group. Poor outcome was associated with: in-hospital days, intensive care days, surgical procedures, in-hospital major complications, age, recurrent injury, and inadequate information. Subjects reported considerable physical (68%) and psychologic (41%) disabilities. Near half reported need of improved follow-up care. Injury severity did not predict poor health-related quality of life 5 years later.

CONCLUSION: Adequate information, sufficient pain management and follow-up by trauma specialist teams are needed. Certain factors can help identify patients in need of additional help and support.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2005
Keyword
quality of life, trauma
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-505 (URN)10.1097/01.TA.0000173832.01547.CB (DOI)16096568 (PubMedID)
Available from: 2013-02-20 Created: 2013-02-20 Last updated: 2015-10-14Bibliographically approved
2. Outcomes in Pediatric Trauma Care in the Stockholm Region
Open this publication in new window or tab >>Outcomes in Pediatric Trauma Care in the Stockholm Region
2010 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 36, no 4, 308-317 p.Article in journal (Refereed) Published
Abstract [en]

Background:

Although trauma is a leading cause of pediatric mortality and morbidity in Sweden, few studies have examined the outcome of pediatric trauma.

Objective:

Here, we describe the age and gender distribution, injury mechanisms, injury severity, and outcome of pediatric trauma in the Stockholm region.

Methods:

This retrospective study comprises all trauma patients (age ≤ 15 years) admitted to a regional pediatric trauma center and all pediatric deaths due to trauma in Stockholm in 2002. Data from the trauma registry database were verified by comparison with medical records and autopsy reports. Outcome was measured by mortality and length of stay in a pediatric intensive care unit (PICU) and acute care hospital.

Results:

In all, 432 injured children were included. The median age was 10 years and 59% were males. The median injury severity score was 4 (interquartile range [IQR] 1–9) and 50% sustained head injuries. Mortality was low (1%) and the median length of hospital stay was 2 days (IQR 1–3); 19% stayed in a PICU and, of those, 89% stayed for one day. Comparison with medical records showed that much information in the trauma registry database was either incorrect or missing.

Conclusions:

Many injuries were minor and half of the children were discharged home from the emergency department. Head injuries were the most common injury in all age groups. The most severe head injuries were seen in the youngest group and were caused by falls. Trauma team activation criteria should be improved to avoid overutilization. The quality and completeness of data in the trauma registry must be enhanced.

Keyword
pediatric trauma
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-506 (URN)10.1007/s00068-009-9080-6 (DOI)
Available from: 2013-02-20 Created: 2013-02-20 Last updated: 2015-10-14Bibliographically approved
3. Health-related quality of life of children and adolescents 6 years after pediatric trauma
Open this publication in new window or tab >>Health-related quality of life of children and adolescents 6 years after pediatric trauma
(English)Article in journal (Other academic) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-842 (URN)
Available from: 2014-06-11 Created: 2014-06-10 Last updated: 2015-10-14Bibliographically approved
4. Six years beyond pediatric trauma: child and parental ratings of children’s health-related quality of life in relation to parental mental health
Open this publication in new window or tab >>Six years beyond pediatric trauma: child and parental ratings of children’s health-related quality of life in relation to parental mental health
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.

Keyword
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:nbn:se:rkh:diva-843 (URN)10.1007/s11136-015-1002-y (DOI)26001639 (PubMedID)
Note

As manuscript in dissertation

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

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