The health-related quality of life of children with an extremity fracture: a one-year follow-up study.

PURPOSE: To document the health-related quality of life (HRQOL) of children with an extremity fracture at 3 and 12 months postinjury and to determine whether it varies significantly by fracture region and site. METHODS: Children hospitalized for an extremity fracture at 4 pediatric trauma centers were studied. A baseline, 3-month, and 12-month telephone interview were completed by a primary caregiver to measure the child's HRQOL using the Pediatric Quality of Life Inventory (PedsQL). HRQOL was modeled as a function of injury, patient, and family characteristics using a longitudinal regression model. RESULT: Of the 100 children enrolled, 52 sustained a lower extremity fracture (LEF) and 48 an upper extremity fracture (UEF). Postinjury HRQOL scores were significantly poorer than preinjury scores for all subjects (P = 0.05). In addition, a significant proportion of subjects reported impaired physical and psychosocial HRQOL at 3 (44% and 46%, respectively) and 12 months (23% and 33%, respectively) postinjury. At 3 months postinjury, children with an LEF had significantly poorer HRQOL outcomes compared to children with a UEF. By 12 months postinjury, the physical function of children with a tibia and/or fibula fracture remained significantly lower than children with a UEF (P < or = 0.05). CONCLUSIONS: Children hospitalized for an extremity fracture suffered dramatic declines in physical and psychosocial well-being during the first 3 months postinjury. By 1 year postinjury, most children recovered; however, children with a tibia and/or fibula fracture still reported significantly poorer physical functioning.

Experiences from the development of a comprehensive family support program for pediatric trauma and rehabilitation patients.

This report discusses the successes and problems associated with the development of a family support system designed to improve outcomes in a pediatric trauma population. Studies have demonstrated lowered health-related quality of life among injured children during rehabilitation, along with substantial parental stress. By developing comprehensive support services for families, we may decrease parental burden and improve parents ability to care for their children, thus improving health outcomes for them. Through analysis of data from a longitudinal study of injured children, focus group interviews with affected families, and consultation with a multidisciplinary team, interventions were developed. The resulting program consists of 3 main components: (1) efforts to increase coordination of discharge care, (2) establishment of educational protocols, and (3) implementation of support groups and a peer support program for families. Patient satisfaction and reported use of program materials is high; efforts to improve education, regarding transitions to school and other activities, are continuing. Early evaluation of the program suggests that it is effectively addressing family needs; evaluation of the programs long-term effect is ongoing. We are able to discuss successes and barriers to program implementation and make recommendations for others considering such an undertaking.