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The Health-Related Quality of Life of Children With an Extremity Fracture: A One-Year Follow-up Study

Ding, Ru MS*; McCarthy, Melissa L. ScD*; Houseknecht, Eileen RN, BSN; Ziegfeld, Susan MSN, CRNP‡; Knight, Vinita Misra MPH, CSTR‡; Korehbandi, Patricia RN, MS, CHES§; Parnell, Donna RN, MNSc∥; Klotz, Patricia RN, BSN¶; CHAT Study Group

Journal of Pediatric Orthopaedics: March/April 2006 - Volume 26 - Issue 2 - pp 157-163
doi: 10.1097/01.bpo.0000218521.98244.7e
Trauma: Original Article

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 ≤ 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.

From the *Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; †Trauma Program/TraumaLink, The Children's Hospital of Philadelphia, Philadelphia, PA; ‡Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; §Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR; ∥Trauma Program, Arkansas Children's Hospital, Little Rock, AR and ¶Department of Surgery, University of Washington, Seattle, WA.

This study was funded by Grant R49/CCR319701 from the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention.

CHAT Study Group: Melissa McCarthy, ScD; Ellen MacKenzie, PhD; Dennis Durbin, MD, MS; Charles Paidas, MD; Mary Aitken, MD, MPH; Kenneth M Jaffe, MD; Beth Slomine, PhD; Andrea Dorsch, PhD; James Christensen, MD; Ronald Berk, PhD; Eileen Houseknecht, RN, BSN; Susan Ziegfeld MSN, CRNP; Vinita Misra Knight, MPH, CSTR; Patricia Korehbandi, MN, MS, CHES; Donna Parnell, RN, MNSc; and Pat Klotz, RN, BSN.

Reprints: Ru Ding, MS, Davis Building, Suite 3220, 5801 Smith Avenue, Baltimore, MD 21209 (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.