Health-related quality of life and functional outcome measures for Paediatric Polytrauma: a Systematic Review and Narrative Synthesis.

BACKGROUND Paediatric polytrauma is a major cause of mortality and morbidity worldwide, with varied long term sequalae. To improve care, a better understanding of the outcome tools used following polytrauma is needed. OBJECTIVES 1) Identify the outcome tools used to assess functional and health-related quality of life (HQOL) outcomes in paediatric polytrauma. 2) Describe the tool domains and validity. DATA SOURCES MEDLINE, CINAHL, PsycINFO, Web of Science, AMED, and EMBASE. STUDY ELIGIBILITY Paediatric participants aged 0-17 years of age, experienced polytrauma or severe trauma based on ISS/AIS score, functional outcome tool used (e.g., physical, psychological, QOL), excluded study designs: editorials, narrative and systematic reviews. STUDY APPRAISAL Modified Down's and Black tool. SYNTHESIS METHODS Narrative synthesis. RESULTS Twenty-two papers were included encompassing 16,905 participants and 34 different outcome tools. Ten tools were validated in children of which four were polytrauma specific; 18 validated in adults of which eight were trauma specific, and six previously un-validated. The tools were a mixture of patient reported (7/10 validated in children and 13/18 validated in adults) and clinician reported (3/10 validated in children and 2/13 validated in adults). Paediatric tool domains assessed were function, mobility, ADLs, pain, school, cognition, emotional domains, mental health, behavior, and high-risk behaviours. Using adult validated tools to assess children may not capture the children's true function and HQOL. LIMITATIONS English language publications, potential risk of bias of included studies. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Lack of consistency in the outcome tools used following polytrauma in children. Adult validated measures may not accurately capture paediatric outcomes after polytrauma. To fully understand the impact of paediatric polytrauma and make comparisons between studies, development of a core outcome set is required. LEVEL OF EVIDENCE Level lll. STUDY REGISTRATION PROSPERO database ref: CRD42019135704.