Age-based differences in the disability of extremity injuries in pediatric and adult occupants

Abstract

Objective: The objective was to develop a disability-based metric for motor vehicle crash (MVC) upper and lower extremity injuries and compare functional outcomes between children and adults.Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3 extremity injuries (22 unique injuries). Pediatric (7-18 years), young adult (19-45 years), middle-aged (46-65 years), and older adult (66+ years) MVC occupants with an FIM score and at least one of the 22 extremity injuries were included. DR was calculated for each injury as the proportion of occupants who were disabled of those sustaining the injury. A maximum AIS-adjusted disability risk (DR_MAIS) was also calculated for each injury, excluding occupants with AIS 4+ co-injuries.Results: Locomotion impairment was the most frequent disability type across all ages. DR and DR_MAIS of the extremity injuries ranged from 0.06 to 1.00 (6%-100% disability risk). Disability risk increased with age, with DR_MAIS increasing from 25.9% ± 8.6% (mean ± SD) in pediatric subjects to 30.4% ± 6.3% in young adults, 39.5% ± 6.6% in middle-aged adults, and 60.5 ± 13.3% in older adults. DR_MAIS for upper extremity fractures differed significantly between age groups, with higher disability in older adults, followed by middle-aged adults. DR_MAIS for pelvis, hip, shaft, knee, and other lower extremity fractures differed significantly between age groups, with older adult DR_MAIS being significantly higher for each fracture type. DR_MAIS for hip and lower extremity shaft fractures was also significantly higher in middle-aged occupants compared to pediatric and young adult occupants. The maximum AIS-adjusted mortality risk (MR_MAIS, proportion of fatalities among occupants sustaining an MAIS 3 injury) was not correlated with DR_MAIS for extremity injuries in pediatric, young adult, middle-aged, and older adult occupants (all R² < 0.01). Disability associated with each extremity injury was higher than mortality risk.Conclusions: Older adults had significantly greater disability for MVC extremity injuries. Lower disability rates in children may stem from their increased physiological capacity for bone healing and relative lack of bone disease. The disability metrics developed can supplement AIS and other severity-based metrics by accounting for the age-specific functional implications of MVC extremity injuries.

Keywords: Upper extremity; children; disability; fracture; lower extremity; older adults.

Figure 1.

DR_MAIS for AIS 3 extremity injuries for pediatric versus adult occupants. DR_MAIS for each injury in the pediatric group is plotted against the DR_MAIS of that injury for the young adult, middle-aged, and older adult age groups. The equivalency line is plotted as a dashed line.

Figure 2.

DR_MAIS by age group for upper extremity, pelvis, hip, lower extremity shaft, knee, and other lower extremity fractures. Disability is greatest for older adults and lowest for pediatric patients.

Figure 3.

MAIS-adjusted disability risk (DR_MAIS) versus MAIS-adjusted mortality risk (MR_MAIS) for the top 95% AIS 3 extremity injuries by age group. The equivalency line is plotted as a dashed line.