Function and Quality of Life 5 Years Following Pediatric Major Trauma: A Population-Based Cohort Study

Objective: To evaluate trajectories and predictors of function and health-related quality of life (HRQL) in the 5 years following pediatric major trauma. Background: While increasing proportions of children survive major trauma, largely trauma center-based, 1- to 2-year follow-up studies yield conflicting evidence regarding their long-term outcomes. Methods: This population-based prospective 5-year follow-up study was designed to recruit all consecutive pediatric (<18 years) major trauma patients registered in Australia’s Victorian State Trauma Registry over a 12-month period. At 6, 12, 24, 36, 48, and 60 months postinjury, parents were interviewed to obtain children’s function and HRQL using King’s Outcome Scale for Childhood Head Injury and Pediatric Quality of Life Inventory (PedsQL), respectively. Multivariable regression models were used to investigate the associations between 5-year outcomes and potential predictors. Results: Of 199 eligible patients, 5 years of follow-up data were available for 132 of 186 (71%) survivors. Children’s function and HRQL improved throughout the follow-up period. At 5 years postinjury: 39% had fully recovered, while 39% experienced moderate to severe disability. The mean PedsQL physical score (89.0; SD:18.6) approximated population norms, while the psychosocial score was significantly lower (85.5; SD:16.9). Adverse outcomes were associated with older age, female sex, lower socioeconomic status, residence outside metropolitan areas, preexisting comorbidities, and injuries deemed intentional, compensable, or head trauma. Conclusions: A high proportion of children surviving major trauma experience moderate to severe long-term disability, with psychosocial HRQL lagging recovery of physical function. Prognostic factors are identifiable during acute admission, providing opportunities to develop clinical prediction rules and tailored interventions that mitigate inequitable risks of adverse outcomes.