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Multicenter Study
. 2022 Apr;57(4):739-746.
doi: 10.1016/j.jpedsurg.2021.09.052. Epub 2021 Oct 9.

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

Lauren L Evans  1 , Aaron R Jensen  2 , Kathleen L Meert  3 , John M VanBuren  4 , Rachel Richards  4 , Jessica S Alvey  4 , Joseph A Carcillo  5 , Patrick S McQuillen  6 , Peter M Mourani  7 , Michael L Nance  8 , Richard Holubkov  4 , Murray M Pollack  9 , Randall S Burd  10
Affiliations
Multicenter Study

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

Lauren L Evans et al. J Pediatr Surg. 2022 Apr.

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).

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

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Conflict of interest statement

Declaration of Competing Interest None of the authors have any personal or financial conflicts to disclose.

Figures

Fig. 1.
Fig. 1.
STROBE diagram showing patient selection.
Fig. 2.
Fig. 2.
Percentage of abnormal functional status by body region and AIS post-dot severity scores for injured children at discharge. †Severe head injury defined as initial GCS total < 9 or GCS motor < 5.
See this image and copyright information in PMC

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