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Coomer A1, Douglas H2, Simmonds J2
1Imperial College Healthcare NHS Trust, Children's Physiotherapy, London, United Kingdom, 2University College London, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
Background: Traumatic injury is a significant cause of hospital admission and healthcare cost for children in England. Changes in the delivery of acute management of trauma have improved mortality rates, however little is currently known about the long-term outcomes for the English paediatric population and how their injuries affect different domains of their lives. The development of a population-specific outcome measure to assess the long-term holistic nature of the effects of injury in children may help focus management to optimise outcomes and reduce unnecessary burden of injury. There are known differences between child and parent perceptions of a child's health-related quality of life so hearing directly from children is important.
Purpose: To explore the impact of sustaining a significant traumatic injury on different domains in a child´s life at least one-year post injury, to inform future practice and management of the patient group and guide the development of a population-specific outcome measure.
Methods: Semi-structured interviews were conducted with children and young people aged 11-18 years, who had been admitted to a Major Trauma Centre in London, UK between January 2011 and January 2015 with traumatic injuries (Injury Severity Score (ISS) >8), and who had received physiotherapy treatment. Children with head injuries were excluded due to the differences in presentation and the literature available on consequences of traumatic brain injury. A topic guide based on current literature and the International Classification of Function (ICF) framework was used for each interview. Interview transcripts and researcher's fieldnotes were analysed thematically using the principles of phenomenology. An exploratory approach to analysis was adopted as no prior hypotheses were assumed. The data was read and reread looking for key words, themes and trends.
Results: Six interviews were undertaken (2 males, 4 females). Median age at injury 11 years 6 months (range 9-13years), median time since injury 49.5 months (range 22-63months), ISS score range 9-25. The themes which children spoke about were: the impact of their injuries on their physical health and function, and resulting limitations; psychological and emotional wellbeing; the effect on relationships, interactions with others and education; timescales and expectations of recovery; and healthcare provision and follow up.
Conclusion(s): The results indicate traumatic injury has an on-going effect on several domains of a child's life over a year after injury, suggesting patients should be followed up over extended periods of time to identify new or continuing problems, and provide holistic support. The ongoing presence of pain rather than physical limitation, and the child's emotional support and approach to rehabilitation were of particular importance to their perception of recovery.
Implications: The knowledge gained supports a practical, goal focussed approach to rehabilitation following injury. It also provides guidance for clinicians on the type of advice and information to give and referrals to make during recovery, including appropriate emotional support. Moreover, the findings help inform the development of a new population-specific outcome measure. The identified themes guide which domains to measure, to monitor an individual's response to injury, assess service provision and ultimately improve future management of this patient cohort.
Keywords: Traumatic Injury, Children, Outcome Measure
Funding acknowledgements: Unfunded research
Purpose: To explore the impact of sustaining a significant traumatic injury on different domains in a child´s life at least one-year post injury, to inform future practice and management of the patient group and guide the development of a population-specific outcome measure.
Methods: Semi-structured interviews were conducted with children and young people aged 11-18 years, who had been admitted to a Major Trauma Centre in London, UK between January 2011 and January 2015 with traumatic injuries (Injury Severity Score (ISS) >8), and who had received physiotherapy treatment. Children with head injuries were excluded due to the differences in presentation and the literature available on consequences of traumatic brain injury. A topic guide based on current literature and the International Classification of Function (ICF) framework was used for each interview. Interview transcripts and researcher's fieldnotes were analysed thematically using the principles of phenomenology. An exploratory approach to analysis was adopted as no prior hypotheses were assumed. The data was read and reread looking for key words, themes and trends.
Results: Six interviews were undertaken (2 males, 4 females). Median age at injury 11 years 6 months (range 9-13years), median time since injury 49.5 months (range 22-63months), ISS score range 9-25. The themes which children spoke about were: the impact of their injuries on their physical health and function, and resulting limitations; psychological and emotional wellbeing; the effect on relationships, interactions with others and education; timescales and expectations of recovery; and healthcare provision and follow up.
Conclusion(s): The results indicate traumatic injury has an on-going effect on several domains of a child's life over a year after injury, suggesting patients should be followed up over extended periods of time to identify new or continuing problems, and provide holistic support. The ongoing presence of pain rather than physical limitation, and the child's emotional support and approach to rehabilitation were of particular importance to their perception of recovery.
Implications: The knowledge gained supports a practical, goal focussed approach to rehabilitation following injury. It also provides guidance for clinicians on the type of advice and information to give and referrals to make during recovery, including appropriate emotional support. Moreover, the findings help inform the development of a new population-specific outcome measure. The identified themes guide which domains to measure, to monitor an individual's response to injury, assess service provision and ultimately improve future management of this patient cohort.
Keywords: Traumatic Injury, Children, Outcome Measure
Funding acknowledgements: Unfunded research
Topic: Paediatrics; Musculoskeletal; Disability & rehabilitation
Ethics approval required: Yes
Institution: NHS Health Research Authority
Ethics committee: West London & GTAC Research Ethics Committee
Ethics number: 16/LO/0518
All authors, affiliations and abstracts have been published as submitted.
