Functional outcomes of thoracic injuries in pediatric and adult occupants

ABSTRACT

Objective: To develop a disability metric for motor vehicle crash (MVC) thoracic injuries and compare functional outcomes between pediatric and adult populations.

Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank (NTDB) for the top 95% most frequently occurring AIS 2, 3, 4, and 5 thoracic injuries in NASS-CDS 2000–2011. The NTDB contains a truncated form of the FIM score, including three items (self-feed, locomotion, and verbal expression), each graded from full functional dependence to full functional independence. Pediatric (ages 7–18 years), adult (19–45), middle-aged adult (46–65), and older adult (66+) MVC occupants were classified as disabled or not disabled based on the FIM scale. The DR was calculated for each injury within each age group by dividing the number of patients who were disabled that sustained the specific injury by the number of patients who sustained the specific injury. To account for the impact of more severe co-injuries, a maximum Abbreviated Injury Scale (MAIS) adjusted DR (DR_MAIS) was also calculated. DR and DR_MAIS could range from 0 (0% disability risk) to 1 (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, rib fracture, 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.

Conclusions: 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 impact future age-specific modifications to AIS.

KEYWORDS:

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

Acknowledgments

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.

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.

Additional information

Funding

In addition to the National Science Foundation (NSF) Center for Child Injury Prevention Studies at the Children's Hospital of Philadelphia (CHOP), 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.