Title

All body region injuries are not equal: Differences in pediatric discharge functional status based on Abbreviated Injury Scale (AIS) body regions and severity scores

Authors

Lauren L. Evans, Department of Surgery, Division of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, 744 52nd Street, 4th Floor OPC2, Oakland CA 94609, United States.
Aaron R. Jensen, Department of Surgery, Division of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, 744 52nd Street, 4th Floor OPC2, Oakland CA 94609, United States. Electronic address: Aaron.Jensen@UCSF.edu.
Kathleen L. Meert, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI 48201, United States.
John M. VanBuren, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States.
Rachel Richards, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States.
Jessica S. Alvey, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States.
Joseph A. Carcillo, Department of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA.
Patrick S. McQuillen, Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA.
Peter M. Mourani, Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO.
Michael L. Nance, Division of Pediatric Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA.
Richard Holubkov, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States.
Murray M. Pollack, Department of Pediatrics, Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington DC 20010, United States.
Randall S. Burd, Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC 20010, United States.

Document Type

Journal Article

Publication Date

4-1-2022

Journal

Journal of pediatric surgery

Volume

57

Issue

4

DOI

10.1016/j.jpedsurg.2021.09.052

Keywords

Activities of daily living; Injuries and wounds; Outcomes assessment; Pediatrics; Quality of life; Trauma severity indices

Abstract

PURPOSE: Functional outcomes have been proposed for assessing quality of pediatric trauma care. Outcomes assessments often rely on Abbreviated Injury Scale (AIS) severity scores to adjust for injury characteristics, but the relationship between AIS severity and functional impairment is unknown. This study's primary aim was to quantify functional impairment associated with increasing AIS severity scores within body regions. The secondary aim was to assess differences in impairment between body regions based on AIS severity. METHODS: Children with serious (AIS≥ 3) isolated body region injuries enrolled in a multicenter prospective study were analyzed. The primary outcome was functional status at discharge measured using the Functional Status Scale (FSS). Discharge FSS was compared (1) within each body region across increasing AIS severity scores, and (2) between body regions for injuries with matching AIS scores. RESULTS: The study included 266 children, with 16% having abnormal FSS at discharge. Worse FSS was associated with increasing AIS severity only for spine injuries. Abnormal FSS was observed in a greater proportion of head injury patients with a severely impaired initial Glasgow Coma Scale (GCS) (GCS< 9) compared to those with a higher GCS score (43% versus 9%; p < 0.01). Patients with AIS 3 extremity and severe head injuries had a higher proportion of abnormal FSS at discharge than AIS 3 abdomen or non-severe head injuries. CONCLUSIONS: AIS severity does not account for variability in discharge functional impairment within or between body regions. Benchmarking based on functional status assessment requires clinical factors in addition to AIS severity for appropriate risk adjustment. LEVEL OF EVIDENCE: 1 (Prognostic and Epidemiological).

Department

Pediatrics

Share

COinS