Aitken M E, Jaffe K M, DiScala C, Rivara F P
Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
Arch Phys Med Rehabil. 1999 Aug;80(8):889-95. doi: 10.1016/s0003-9993(99)90079-5.
To assess functional outcome and describe disability at discharge in children who have had trauma without significant head injury.
Retrospective cohort.
National Pediatric Trauma Registry, 1988-1994.
Patients of ages 7 to 18 years with Glasgow Coma Scale (GCS) 13 to 15 without significant anatomic head inJury.
Functional Independence Measure (FIM) at discharge was used to assess patient outcome. There were 13,649 children meeting study criteria who had sustained 34,254 injuries. Fractures constituted 30% of all injuries. As measured by FIM, 1,522 (11.2%) patients had mild disability at discharge; 1,983 (14.5%) had moderate disability. After adjustment for age and injury severity, children with lower extremity fractures were more likely to be discharged with functional limitations than those without (relative risk, 5.43; 95% confidence interval: 5.06, 5.84). Of children with moderate disability at discharge, less than 50% were referred for rehabilitation evaluation and less than 25% for physical therapy.
Functional dependence is present in a large proportion of injured children, even without significant head injury. Rehabilitation and other services may be underused in this population. Further study is required to fully assess the degree and duration of disability in these patients.
评估无严重头部损伤的创伤儿童出院时的功能结局并描述其残疾情况。
回顾性队列研究。
国家儿科创伤登记处，1988 - 1994年。
年龄7至18岁、格拉斯哥昏迷量表（GCS）评分为13至15分且无严重解剖学头部损伤的患者。
出院时采用功能独立性测量（FIM）评估患者结局。有13649名儿童符合研究标准，共遭受34254次损伤。骨折占所有损伤的30%。根据FIM测量，1522名（11.2%）患者出院时存在轻度残疾；1983名（14.5%）有中度残疾。在对年龄和损伤严重程度进行调整后，与无下肢骨折的儿童相比，下肢骨折的儿童出院时功能受限的可能性更大（相对风险为5.43；95%置信区间：5.06，5.84）。出院时存在中度残疾的儿童中，不到50%被转介进行康复评估，不到25%被转介接受物理治疗。
即使没有严重头部损伤，很大一部分受伤儿童仍存在功能依赖。该人群可能未充分利用康复及其他服务。需要进一步研究以全面评估这些患者的残疾程度和持续时间。
