Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, MO2 88 Mallett St, NSW 2006, Australia.
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, MO2 88 Mallett St, NSW 2006, Australia.
Injury. 2020 Sep;51(9):2066-2075. doi: 10.1016/j.injury.2020.04.030. Epub 2020 May 19.
Information about children treated in New South Wales (NSW), Australia following major injury has been limited to those treated at trauma centres using mortality as the main outcome measure, restricting assessment of the effectiveness of the Trauma System. This study sought to describe the detailed characteristics as well as functional and psychosocial health outcomes of all children suffering major injury in NSW.
A longitudinal study was conducted between July 2015 and November 2017 and included children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW or who died following injury. Children were identified through the three NSW Paediatric Trauma Centres (PTC), the NSW Trauma Registry, NSW Aeromedical Retrieval Registry (AirMaestro) and the National Coronial Information System (NCIS). Health-related quality of life (HRQoL) outcomes for children treated at the three PTCs were collected at baseline, 6 and 12 months using the Paediatric Quality of Life inventory (PedsQL 4.0) and EuroQol five-dimensional EQ-5D-Y.
There were 625 children, with a median (interquartile range) age of 7 (2-13) years and 71.7% were male. Around half were injured in major cities (51.2%). The median (IQR) injury severity score (ISS) was 10 (9-17). Twelve-month HRQoL measured by PedsQL remained below baseline for psychosocial health. Treatment costs increased with injury severity (p=<0.001) and polytrauma (p=<0.001). No survival benefit was demonstrated between PTC versus non-PTC definitive care. Injured females and children from rural / remote NSW were overrepresented in the deceased.
Children treated in NSW following major injury have reduced quality of life and in particular, reduced emotional well-being at 12 months post-injury. Improved psychosocial care and outpatient follow-up is required to minimise the long-term emotional impact of injury on the child.
澳大利亚新南威尔士州（NSW）接受重大伤害治疗的儿童信息仅限于使用死亡率作为主要结局指标在创伤中心治疗的儿童，这限制了对创伤系统有效性的评估。本研究旨在描述 NSW 所有遭受重大伤害的儿童的详细特征以及功能和心理社会健康结局。
一项纵向研究于 2015 年 7 月至 2017 年 11 月进行，包括需要重症监护或损伤严重程度评分（ISS）≥9 岁的 NSW 接受治疗或受伤后死亡的<16 岁儿童。儿童通过三个新南威尔士州儿科创伤中心（PTC）、新南威尔士州创伤登记处、新南威尔士州航空医疗救援登记处（AirMaestro）和国家验尸信息系统（NCIS）确定。使用儿科生活质量量表（PedsQL 4.0）和 EuroQol 五维 EQ-5D-Y 在三个 PTC 治疗的儿童中收集基线、6 个月和 12 个月的健康相关生活质量（HRQoL）结局。
共有 625 名儿童，中位（四分位距）年龄为 7（2-13）岁，71.7%为男性。约一半的儿童受伤发生在主要城市（51.2%）。中位（IQR）损伤严重程度评分（ISS）为 10（9-17）。12 个月的 PedsQL 测量的 HRQoL 仍低于基线的心理社会健康。治疗费用随损伤严重程度（p<0.001）和多发伤（p<0.001）而增加。在 PTC 与非 PTC 确定性治疗之间未显示出生存获益。受伤的女性和来自新南威尔士州农村/偏远地区的儿童在死亡者中占比过高。
在 NSW 接受重大伤害治疗的儿童生活质量降低，尤其是在受伤后 12 个月时，情绪健康状况降低。需要改善心理社会关怀和门诊随访，以尽量减少伤害对儿童的长期情绪影响。
