Functional outcomes of motor vehicle crash thoracic injuries in pediatric and adult occupants

ABSTRACT

Objective: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations.

Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2–5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7–18, 19–45, 46–65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DR_MAIS) was also calculated for each injury. DR and DR_MAIS could range from 0 to 100% disability risk.

Results: The mean DR_MAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DR_MAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DR_MAIS value for flail chest compared to the other age groups.

Conclusion: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS.

KEYWORDS:

• Disability
• functional outcome
• motor vehicle crash
• thoracic injuries
• pediatric trauma
• elderly

Additional information

Funding

The authors acknowledge the National Science Foundation (NSF) Center for Child Injury Prevention Studies at the Children's Hospital of Philadelphia (CHOP) for sponsoring this study and its Industry Advisory Board (IAB) members for their support, valuable input and advice. This publication was also supported by the National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health and Human Development, grant K08HD073241. The views presented are those of the authors and not necessarily the views of CHOP, the NSF, the IAB members, or the NIH. NTDB data were provided by the Committee on Trauma, American College of Surgeons (ACS). NTDB Version 7.1 Chicago, IL (2007). The content reproduced from the NTDB remains the full and exclusive copyrighted property of the American College of Surgeons. ACS is not responsible for any claims arising from works based on the original data, text, tables, or figures.