Burden Study: Project Plan & Methods

Target population:

The sample will consist of children and youth aged 0 to 16 years with a primary injury diagnosis identified in the BC Children’s Hospital (BCCH) hospital wards and emergency department. Patients with mild injuries would typically outnumber patients with moderate or severe injuries, and hence a random sample of patients presenting with injury would therefore be heavily weighted towards the patients with milder injuries. Similarly, certain injury types (e.g., minor orthopaedic injuries) are more common than others. Therefore, in order to ensure a mix of patients with different injury types and severities, we propose to undertake quota sampling  based on severity of injury, type and anatomic location, and age group. 

Assessments:

There will be four assessments: baseline (pre-injury); 1 month post injury (acute phase); 4-6 months (rehabilitation and adaptation phase); and 12 months post injury to examine long-term consequences of injuries. Baseline data collection will include a questionnaire that will collect information on circumstances surrounding the injury and demographic information. The baseline questionnaire will be completed by parents (or primary caregivers) for children aged 10 and younger and by both children and parents (or primary caregivers) for children aged 11 years and up. 

The patient’s state of health the week prior to the injury will be collected via completion by the parent (or primary caregiver) and the child (if aged 5 years and older and deemed capable by the parent) of the Pediatric Quality of Life Inventory 4 (PedsQL; (Varni, 2003). Parents (or primary caregivers) will complete the Post Traumatic Stress Disorder Checklist to describe their own symptoms of post traumatic stress (PCL (Weathers, 1994)). Children aged 7 years and older will complete the Child Post Traumatic Stress Symptom Scale (CPSS (Foa, 2001)) to assess post traumatic stress disorder symptoms. All measures are standardized with excellent psychometric properties. 

In addition, the following data from medical records will be extracted : date and time of injury, injury circumstances, full text of diagnosis and treatment (including X-ray reports and surgical procedures), and recommended follow up. In the case of burns we will record location, degree and percentage of body affected; in the case of head injury we will record the lowest Glasgow Coma Score and length of time of loss of consciousness. 

At 1 month, 4-6 months and 12 months post recruitment, parents (or primary caregivers) for children of all ages, and children aged 5 years and older will be asked to complete a questionnaire enquiring whether they are still affected by their injury, and the PedsQL relating to the previous 4 weeks. Parents (or primary caregivers) will complete the PCL, and children 7 years and older will complete the CPSS. If participants deem that they are no longer affected by the injury and have returned to pre-injury functioning, there will be no further follow-up.

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