Adult and pediatric trauma : outcomes and health-related quality of life

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 parent ́s 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.

List of scientific papers

I. Sluys K, Häggmark T, Iselius L. Outcome and quality of life 5 years after major trauma. J Trauma. 2005; 59(1):223-32.
https://doi.org/10.1097/01.TA.0000173832.01547.CB

II. Sluys K, Lannge M, Iselius L, Eriksson LE. Outcomes in pediatric trauma care in the Stockholm region. Eur J Trauma Emerg Surg. 2010; 36(4):308-3217.
https://doi.org/10.1007/s00068-009-9080-6

III. Sluys K, Lannge M, Iselius L, Eriksson LE. Health-related quality of life of children and adolescents 6 years after pediatric trauma. [Submitted]

IV. Sluys K, Lannge M, Iselius L, Eriksson LE. Health-related quality of life 6 years after pediatric trauma: Impact of parental mental health on child-parent reports. [Manuscript]