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538 Long-term trajectories and predictors of disability in children surviving serious injury
  1. Shanthi Ameratunga1,2,
  2. James E Harrison3,
  3. Peter Cameron2,
  4. Jennie Ponsford4,
  5. Sandra Reeder2,
  6. Ronan A Lyons2,5,
  7. Warwick J Teague6,7,8,
  8. Andrew Nunn9,10,11,
  9. Belinda J Gabbe2,5
  1. 1University of Auckland, Auckland, New Zealand
  2. 2School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
  3. 3Flinders Institute for Health and Medical Research, Flinders University, Adelaide, Australia
  4. 4School of Psychological Sciences and Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
  5. 5Health Data Research UK, Swansea University, Swansea, UK
  6. 6Dept of Paediatric Surgery, The Royal Children’s Hospital, Melbourne, Australia
  7. 7Murdoch Children’s Research Institute, Melbourne, Australia
  8. 8Department of Paediatrics, University of Melbourne, Melbourne, Australia
  9. 9Victorian Spinal Cord Service, Austin Health, Melbourne, Australia
  10. 10Prosthetics and Orthotics Service, Alfred Health, Melbourne, Australia
  11. 11Information technology and Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Australia


Background With improvements in injury control and advanced trauma care, increasing proportions of children survive major trauma, but population-based data on their long-term health and disability are scant. We investigated these outcomes in the five years following serious childhood injury in Victoria, Australia.

Methods Using the Victorian State Trauma Registry, this population-based prospective cohort study identified children (<18 years) admitted for major trauma over a 12-month period. Their functional recovery (KOSCHI or Glasgow Outcome Scale-Extended) and health-related quality of life (PedsQL) were assessed at 6, 12, 24, 36, 48 and 60-months post-injury. Multivariable regression models investigated factors associated with outcomes.

Results Of the 186 participants, 71% were retained to 60 months post-injury. Participants’ functional status improved throughout the follow-up period but their psychosocial health remained low compared with their physical recovery. Even at five years post-injury, only 39% had fully recovered while 39% experienced moderate to severe disability. Factors associated with adverse outcomes included older age at injury, female sex, socio-economic disadvantage, remote/regional (cf. urban) residence, pre-existing comorbidities, and injuries deemed compensable, intentional, or involving head trauma.

Conclusion A high proportion (39%) of children surviving serious injury experience moderate to severe disability even five-years post-injury and their psychosocial recovery substantially lags improvements in physical function. Adverse outcomes are inequitably distributed by factors identifiable early in the course.

Learning Outcome The prolonged duration of disability following major childhood trauma highlights the need to strengthen injury control systems across the continuum of care, from prevention to equity focused post-trauma care and support.

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