Functional outcomes of motor vehicle crash head injuries in pediatric and adult occupants

Abstract

Objective: The objective of the study was to develop a disability-based metric for motor vehicle crash (MVC) injuries, with a focus on head injuries, and compare the functional outcomes between the pediatric and adult populations. Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank—Research Data System (NTDB-RDS) for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3, 4, and 5 head injuries in NASS-CDS 2000–2011. Pediatric (ages 7–18), adult (19–45), middle-aged (46–65), and older adult (66+) patients with an FIM score available who were alive at discharge and had an AIS 3, 4, or 5 injury were included in the study. The NTDB-RDS contains a truncated form of the FIM instrument, including 3 items (self-feed, locomotion, and verbal expression), each graded on a scale of 1 (full functional dependence) to 4 (full functional independence). Patients within each age group were classified as disabled or not disabled based on the FIM scale. The DR was calculated for each age group by dividing the number of patients who sustained a specific injury and were disabled by the number of patients who sustained the specific injury. To account for the impact of more severe associated coinjuries, a maximum AIS (MAIS) adjusted DR (DRMAIS) was also calculated for each injury. DR and DRMAIS ranged from 0 (0% disability risk) to 1 (100% disability risk). Results: An analysis of the most frequent FIM components associated with disabling MVC head injuries revealed that disability across all 3 items (self-feed, locomotion, and expression) was the most frequent for pediatric and adult patients. Only locomotion was the most frequent for middle-aged and older adults. The mean DRMAIS for MVC head injuries was 35% for pediatric patients, 36% for adults, 38% for middle-aged adults, and 44% for older adults. Further analysis was conducted by grouping the head injuries into 8 groups based on the structure of injury and injury type. The pediatric population possessed higher DRMAIS values for brain stem injuries as well as loss of consciousness injuries. Older adults possessed higher DRMAIS values for contusion/hemorrhage injuries, epidural hemorrhage, intracerebral hemorrhage, skull fracture, and subdural/subarachnoid hemorrhage. Conclusion: At-risk populations such as pediatric and older adult patients possessed higher DRMAIS values for different head injuries. Disability in pediatric patients is critical due to loss of quality life years. Disability risk can supplement severity metrics to improve the ability of such metrics to discriminate the severity of different injuries that do not lead to death. Understanding of age-related differences in injury outcomes when compared to adults could inform future age-specific modifications to the AIS.

Hospital Readmissions After Pediatric Trauma

“…(12, 15, 16, 18, 19) Adult and pediatric trauma differs in regard to mechanism, type of injury, and patient-specific factors. (12, 20, 21) Additionally, care networks and post-discharge resources differ significantly and are likely to influence readmission rates. (22)…”

Functional outcomes of motor vehicle crash thoracic injuries in pediatric and adult occupants

“…To supplement data on mortality rates, studies have examined the societal effect of injuries including disability and functional life-years lost to injury (Kuppa, et al, 2001; Schoell, et al, 2016). Schoell et al developed a metric quantifying the disability of specific injuries using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data Set (NTDB-RDS).…”

“…Schoell et al developed a metric quantifying the disability of specific injuries using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data Set (NTDB-RDS). Disability was quantified for the top 95% most frequently occurring MVC injuries of severity 3, 4, and 5 on the Abbreviated Injury Scale (AIS) (Schoell, et al, 2016). Pairwise comparisons demonstrated that older adults (ages 66+) had significantly greater overall disability than pediatric, adult, and middle-aged occupants (ages 7–18, 19–45, and 46–65, respectively).…”

Functional outcomes of thoracic injuries in pediatric and adult occupants

“…Disability risk (DR) was calculated using the largest aggregation of trauma registry data, the NTDB-RDS version 7.1 years 2002–2006, as described in the previous study 4,6 . Briefly, MVC cases were selected using the ICD-9 external cause of injury codes (E-codes) 810–819 with post dots of 0 or 1, and an AIS-98 to ICD-9 mapping approach was used to match each of the patient’s ICD-9 codes with its corresponding AIS code 7 .…”

“…This is especially critical for pediatric patients where mortality rates tend to be very low. In an effort to supplement data on mortality rates, a metric quantifying the disability of specific injuries was developed using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data Set (NTDB-RDS) for the top 95% most frequently occurring AIS 3, 4, and 5 MVC injuries 4 . This previously developed disability risk ranged from 0 to 90% disability for AIS 3, 4, and 5 thoracic injuries across the pediatric and adult age groups.…”