Risk Factors for Residual Medical Needs after Pediatric Trauma Injury

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PROJECT SUMMARY Approximately 300,000 children are hospitalized for nonfatal, traumatic injuries each year. Trauma has the potential to lead to a life-long decrease in the quality of a child's life and place them at increased risk for disability and early mortality. Trauma survivors can experience lasting deficits in physical and mental health, leading to secondary conditions including pain, musculoskeletal dysfunction, cognitive impairment, psychosocial difficulties, and sleep disturbances. These conditions can further lead to decreased participation in physical activities, poor school performance, and substance use. To date, little knowledge exists about the health care needs of pediatric survivors of traumatic injury, which are likely distinct from the adult population. There is a critical need to develop an evidence base to inform later guidelines for physicians to improve follow- up care after childhood injury. The long-term goal of this research is to determine unmet health needs of the pediatric trauma population and to design healthcare interventions that improve functional outcomes and reduce disability. Improving these long-term outcomes requires better follow-up data acquisition: both acquiring unbiased pre-injury baseline measurements and assessing post-acute care services. A major obstacle to improving long-term outcomes of children with traumatic injury is the lack of reliable, longitudinal data on pediatric patients after hospital discharge. The objective of this proposal is to identify patterns of healthcare utilization for two years following injury and to assess parent-perceived health needs of injured children. The aims of this exploratory study are to 1) identify long-term patterns of healthcare utilization in children after a critical injury, 2) determine whether injured children are receiving recommended follow-up care after leaving the hospital, 3) characterize parents' real-world barriers to post-acute care after traumatic injury, and 4) determine whether parents report unmet health needs of children beyond the acute phase of recovery. This research is significant because the proposed studies lay the foundation for improved follow-up care that will not only help achieve better outcomes for injured children, but may also prevent future health problems as adults. We anticipate that these findings will provide evidence to support the integration of acute and post- acute services into a “seamless system of care” for injured patients and will provide data essential to developing patient-centered guidelines for post-acute care after childhood trauma.