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.