Improved Outcomes for Injured Children

chop-cirp-graphAt the Children’s Hospital of Philadelphia Center for Injury Research and Prevention, we focus on a comprehensive approach to injury, from before-the-injury prevention to after-the-injury healing. Our group of epidemiologists, behavioral sciences and biomechanical engineers partner with academia, government and industry to advance the care of children and youth through research and action.

With these efforts, we have been able to contribute to the reduction in fatal injuries from advances in injury surveillance, vehicle crash-worthiness and outcome studies. As we continue to decrease the number of fatalities in vehicle crashes, we also need to consider nonfatal injuries.

To this end, my colleagues and I have analyzed administrative data sets to understand the burden of physical and cognitive function disability in children following moderate to severe injury that requires inpatient rehabilitation.

These initial steps have helped to describe the patterns of injury, either alone or combination, that caused the most disability upon discharge from inpatient rehabilitation and then re-entry into society. This is a particularly critical moment to understand outcomes since these children’s lives are instantly, and in many cases permanently, changed following these severe injuries. Additionally, it is important to understand the burden of non-fatalities since it is predicted that road traffic injuries will be the third leading cause of disability-adjusted life years in 2020. With increased road and traffic infrastructure, particularly in developing countries, we need to continue to promote safety standards, legislation and policy for motor vehicle occupants and pedestrians.

Comprehensive road traffic injury mitigation efforts can be categorized primary, secondary, and tertiary prevention. Primary prevention includes decreasing the crash risk through minimizing distracted driving, drowsy driving, impaired driving and reckless driving. Secondary prevention reduces the severity of injuries given a crash mechanism, and includes advances in vehicle belts, child restraints, and air bags. It is important that children are appropriately restrained, both in terms of the type of restraint chosen and the proper use of the restraint. Finally, tertiary prevention is accomplished by maximizing pre-hospital care, trauma systems, acute and rehabilitation care in order to decrease fatalities and minimize disability from injuries.

We know injury is the leading cause of death and acquired disability in children. Understanding the burden of impaired function helps inform our efforts for translating research into action. Evidence-based multi-faceted efforts can continue to shift the focus from fatal injuries to non-fatal, disabling injuries in children.

Dr. Mark Zonfrillo, Critical Epidemiologist of Pediatric Emergency Medicine and Assistant Professor of Pediatrics at the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention and Perelman School of Medicine at the University of Pennsylvania.

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