FACTORS PREDICTIVE OF POOR OUTCOME 1 YEAR POST CHILDHOOD INJURY.• 611

Abstract

Childhood injury is a major public health issue and medical concern in large, urban cities. A follow-up study was conducted with a cohort of children(N = 105) 1 year post traumatic injury, and prior to the initiation of a multidisciplinary Pediatric Injury Center (PIC), to investigate factors associated with poor outcome. The children were injured between October 1993 and June 1994 and met the following inclusion criteria: a) injury requiring hospitalization; b) skull, femur, or poly-fracture; or, c) injury from assault or physical abuse. All injured children were initially brought to the same public hospital for treatment. A physical exam was conducted 1 year post-injury as well as interviews with the children and parents. Poor outcome was defined as an injury related problem detected at the 1 year post-injury exam, requiring referral, and was handled as a dichotomous variable in the analyses. Forty percent of the children in the study population met the definition for poor outcome. Children with a poor outcome did not differ from those with a good outcome by gender (69% vs. 62% male) or race/ethnicity (55% Hispanic, 33% Black, 10% White vs. 59%, 30%, 11%). Poor outcome children were significantly older, 12 vs. 7.9 years, than children with good outcomes(p<0.0001). Other variables not associated with outcome included mechanism of injury, eye/gag/verbal/motor assessment upon injury, source of payment for injury-related medical costs, and parent demographics including age, race/ethnicity, and spoken-language. Logistic regression modeling found older age at injury (Odds Ratio (OR) = 2.4; 95% Confidence Interval (CI) = 1.5-3.9) and type of injury including abdomen (OR = 5.1; 95% CI = 1.2-23.9), upper extremity (OR = 8.0; 95% CI = 2.3-32.8) and head (OR = 4.0; 95% CI = 1.4-13.0) as significant predictors of poor outcome 1 year post-injury. Children at risk for poorer outcome following injury can be identified and for optimal recovery should receive appropriate support services.