Physical Disability After Injury-Related Inpatient Rehabilitation in Children

Zonfrillo, Mark R.; Durbin, Dennis R.; Winston, Flaura Koplin; Zhao, Huaqing; Stineman, Margaret G.

doi:10.1542/peds.2012-1418

Cited by 36 publications

(24 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1, path o). For example, physical recovery from injury is associated with pre-existing emotional health, child gender (females at risk for worse recovery) and severity of physical trauma (Polinder et al, 2005; Zonfrillo, Durbin, Winston, Zhao, & Stineman, 2013). While it is beyond the scope of this paper to detail every potential relationship across time points, we include these post-trauma factors to encourage future research to improve understanding of the development of PTSS and to increase screening and intervention effectiveness.…”

Section: Proposed Model and Supporting Evidencementioning

confidence: 99%

Posttraumatic Stress Following Acute Medical Trauma in Children: A Proposed Model of Bio-Psycho-Social Processes During the Peri-Trauma Period

Marsac

Kassam‐Adams

Delahanty

et al. 2014

Clin Child Fam Psychol Rev

View full text Add to dashboard Cite

Millions of children worldwide experience acute medical events. Children’s responses to these events range from transient distress to significant posttraumatic stress disorder symptoms (PTSS). While many models suggest explanations for the development and maintenance of PTSS in adults, very few have focused on children. Current models of child PTSS are primarily restricted to the post-trauma period, thus neglecting the critical peri-trauma period when screening and preventive interventions may be most easily implemented. Research on PTSS in response to pediatric medical trauma typically examines predictors in isolation, often overlooking potentially important interactions. This paper proposes a new model utilizing the bio-psycho-social framework and focusing on peri-trauma processes of acute medical events. Understanding the relationships among bio-psycho-social factors during peri-trauma can inform early identification of at-risk children, preventive interventions, and clinical care. Recommendations for future research, including the need to examine PTSS in the context of multiple influences, are discussed.

show abstract

Section: Proposed Model and Supporting Evidencementioning

confidence: 99%

Posttraumatic Stress Following Acute Medical Trauma in Children: A Proposed Model of Bio-Psycho-Social Processes During the Peri-Trauma Period

Marsac

Kassam‐Adams

Delahanty

et al. 2014

Clin Child Fam Psychol Rev

View full text Add to dashboard Cite

show abstract

“…These 4 categories were created to characterize the outcomes of children with clinically meaningful subgroups of disabling injuries from multitrauma, as defined by the center-assigned IRF-PAI impairment codes, and were retained after finding differences between these groups in our study of physical functionality. 3 …”

Section: Methodsmentioning

confidence: 99%

“…3 Other prior research has focused on cognitive disability following various injuries in children. One large meta-analysis of 28 studies from 1988-2007 summarized neurocognitive outcomes for children after TBI and found that children with moderate TBI (defined as an initial Glasgow Coma Scale score of 9-12) and severe TBI (Glasgow Coma Scale score of 3-8) had more intellectual, executive functioning, and memory deficits compared with patients with mild TBI.…”

mentioning

confidence: 99%

Residual Cognitive Disability after Completion of Inpatient Rehabilitation among Injured Children

Zonfrillo

Durbin

Winston

et al. 2014

The Journal of Pediatrics

Self Cite

View full text Add to dashboard Cite

Objective To determine the prevalence and nature of residual cognitive disability after inpatient rehabilitation for children aged 7-18 years with traumatic injuries. Study design This retrospective cohort study included children aged 7-18 years in the Uniform Data System for Medical Rehabilitation who underwent inpatient rehabilitation for traumatic injuries in 523 facilities from 2002-2011. Traumatic injuries were identified by standardized Medicare Inpatient Rehabilitation Facility–Patient Assessment Instrument codes. Cognitive outcomes were measured by the Functional Independence Measure instrument. A validated, categorical staging system derived from responses to the items in the cognitive domain of the functional independence measure was used and consisted of clinically relevant levels of cognitive achievement from stage 1 (total cognitive disability) to stage 7 (completely independent cognitive function). Results There were 13 798 injured children who completed inpatient rehabilitation during the 10-year period. On admission to inpatient rehabilitation, patients with traumatic brain injury (TBI) had more cognitive disability (median stage 2) than those with spinal cord injury or other injuries (median stage 5). Cognitive functioning improved for all patients, but children with TBI still tended to have significant residual cognitive disability (median stage on discharge, 4). Conclusions Injured children gained cognitive functionality throughout inpatient rehabilitation. Those with TBI had more severe cognitive disability on admission and more residual disability on discharge. This is important not only for patient and family expectation setting but also for resource and service planning, as discharge from inpatient rehabilitation is a critical milestone for reintegration into society for children with serious injury.

show abstract

“…There have been numerous studies involving functional outcomes in both children and adults following trauma (Aitken et al 1999; Andersen et al 2010; Gabbe et al 2011; Scarboro et al 2005; Willis et al 2006; Winthrop et al 2005; Zonfrillo et al 2013, 2014). Various instruments were used to assess functional outcomes including the Child Health Questionnaire, Glasgow Outcome Scale, the Pediatric Quality of Life Inventory, Functional Independence Measure (FIM), and Medical Outcomes Study 36-Item Short Form Survey (Gabbe et al 2011; McCarthy 2007).…”

Section: Introductionmentioning

confidence: 99%

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

Schoell

Weaver

Talton

et al. 2016

Traffic Injury Prevention

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Physical Disability After Injury-Related Inpatient Rehabilitation in Children

Cited by 36 publications

References 47 publications

Posttraumatic Stress Following Acute Medical Trauma in Children: A Proposed Model of Bio-Psycho-Social Processes During the Peri-Trauma Period

Posttraumatic Stress Following Acute Medical Trauma in Children: A Proposed Model of Bio-Psycho-Social Processes During the Peri-Trauma Period

Residual Cognitive Disability after Completion of Inpatient Rehabilitation among Injured Children

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

Contact Info

Product

Resources

About