Improving Outcomes for Seriously Injured Children

October 24, 2013

When we think about trauma and prevention we often focus on death as the outcome. However, functional disability from trauma is far more common than death and can cause long-term physical and cognitive impairment despite inpatient rehabilitation. In fact, 95 percent of children and young adults survive moderate to severe trauma. How can we best measure these impairments in a standardized manner? What happens to these patients when they leave the hospital and inpatient rehabilitation? Are we doing all we can to ensure these children recover to reach their fullest potential?

A few years ago I realized that it would be critical to more thoroughly explore the answers to these questions in order to understand the full spectrum of injury burden in children. Thus, with initial pilot funding from the Center for Child Injury Prevention Studies (CChIPS) and a career development award from the National Institutes of Health, I initiated a line of research at CIRP@CHOP to describe the mechanisms behind various types of pediatric traumatic injuries, as well as differences between injury patterns and various outcomes. With this information and further research into the demographics of serious pediatric injury recovery, we hope to develop a systematic approach to improve the level of care offered to these patients -- from the ICU to inpatient rehabilitation to post-care coordinated with the child’s primary care provider.

Most recently, we completed a retrospective cohort study of nearly 14,000 children, ages 7 to 18 years, who received inpatient rehabilitation for traumatic injuries in 523 facilities from 2002-2011 to determine both the prevalence and nature of their residual deficits after discharge using the Functional Independence Measure (FIM). While all injury groups showed cognitive and physical improvement after rehabilitation, those with traumatic brain injury (TBI) -- who were admitted with severe cognitive disability -- only improved to moderate disability upon returning home. Children with spinal cord injuries had longer lengths of stay and more physical disability at discharge, requiring help with daily tasks, such as dressing and eating.

When the majority of children with moderate to severe injuries such as traumatic brain injury and spinal cord injury leave inpatient rehabilitation with significant physical and cognitive deficits, improving their quality of life becomes paramount. Understanding the residual effects of these disabilities is the first step. The next step is making sure that clinical care decisions are grounded in evidence to address these long-term needs. Helping families cope after the injury and locate further rehabilitative services for their child’s continued recovery will help improve outcomes. This can be accomplished with a comprehensive approach, led by the child’s primary care provider.

Future research at CIRP@CHOP will map the factors related to poor outcomes for these injured patients. We hope to influence prevention efforts throughout their path of care. These efforts include identifying at-risk patients and promoting safe behaviors.

Disabling trauma is life-changing for children and their families. With continued research into the patterns of injury-related disability and best practices for acute care and rehabilitation, we can maximize prevention, treatment, and recovery of these potential injuries.