Principal Investigator: Mark Zonfrillo, MD, Children’s Hospital of Philadelphia

Below is an executive summary of this project. Please note that this summary describes results and interpretation that may not be final. Final interpretation of results will be in the peer-reviewed literature.

While injury remains the leading cause of death for children ages 1 year and older in the U.S., 95 percent of pediatric patients with moderate to severe trauma survive. These non-fatal, yet serious injuries can have significant short-term and long-term consequences on these young patients’ functionality and quality of life. There is great value in understanding the epidemiology of injury-related disability in order to inform primary, secondary, and tertiary prevention efforts. The ultimate objective of rehabilitation for injured children is to maximize function and enable their return to home, school, and community

This retrospective 10-year study of 13,798 patients ages 7 to 18 years old that underwent inpatient rehabilitation for a broad range of traumatic injuries at 523 facilities across the country was the first contemporary assessment of physical disability following rehabilitation. Patients were identified from the Uniform Data System for Medical Rehabilitation (UDSMR) and functional outcome was measured with the Functional Independence Measure (FIM) instrument, composed of items in motor and cognitive domains. Although the FIM measures both physical and cognitive functionality, this study focused solely on the physical grade at discharge, ranging from Grade 1 (the patient needs total assistance) to Grade 7 (the patient has full functional independence).

While most children (70 percent) at admission to rehabilitation were at Grade 1, there was an overall improvement in their FIM score by discharge, with a most frequent Grade of 4 out of a possible 7. This suggests that only the most severely injured children are being referred to inpatient rehabilitation and somewhat less severely injured children may not be receiving this level of care. Among the most severely injured, children with spinal cord injuries accounted for 21 percent of patients, had longer lengths of stay (30-day median), and greater residual physical disabilities at discharge (Grade 2 median) as compared to children with traumatic brain injury and other forms of trauma who had a 15-day median length of stay and a median Grade of 4 at discharge.

Results of this study were published in the January 2013 issue of Pediatrics. Future work should consider assessment of functionality from more specific patterns of injuries and disparities in outcomes for age, gender, and socioeconomic status, as well as understanding influences of primary prevention efforts, pre-hospital care, emergency acute care, and intensive care on functional outcomes following trauma.

Co-investigators

Dennis R. Durbin, MD, MSCE, Children’s Hospital of Philadelphia; Margaret G. Stineman, MD, The University of Pennsylvania

Student

Melanie Ward, University of Michigan

IAB Mentors

Uwe Meissner, Technical Advisor; John Combest, Nissan Technical Center North America Inc.; Dan Robertston, Toyota North America Inc.