368 Injury: International Journal of the Care of the Injured Vol. 27, No. 5, 1996

to complete the SF-36 medical outcome score. The average Injury Severity Score (ES) of the eligible patients was 16.7 (range, 5-34). The patients’ co-morbidities were consistent with a multiply injured population typical of a level I trauma centre. The average age of the patients was 32 years and 3 months (range, 19-65 years), and there were 27 men and 19 women. Fractures were classified by the Tile classification and there were 13 type B and 33 type C pelvic fractures. Operative stabilization was performed at an average of 67 h after injury.

There was a 76 per cent response to the outcome survey. The ISS and fracture classification of the non-responding patients were not significantly different to the responding patients (P~0.05, Student’s unpaired f-test) who had completed the SF-36 outcome score. The incidence of head injury and co- morbidities in the responding and non-responding groups were comparable apart from a lower incidence of smoking and alcohol consumption in the responding group (PC 0.05, Student’s unpaired f-test). The outcome measure showed that there was a 14 per cent impairment in physical outcome score ( f 8.7 per cent for 95 per cent confidence limits) and a 5.5 per cent impairment in mental outcome score ( f 7.7 per cent for 95 per cent confidence limits) compared to the US normal population normative database.

The physical and mental outcome of multiply injured patients with pelvic fractures can be objectively measured. Aggressive early operative treatment of this group of patients may yield improved outcomes.

B. A. Bashir, M. Patterson, D. A. Boot, D. Lloyd (War- rington, UK) Long-term outcome in children after severe blunt

trauma: A s-year clinical follow up of severely injured children in Mersey Region Our main objective was to assess the long-term outcome in children after severe blunt injuries. A 5-year clinical follow-up was conducted on children aged 15 years or less when they sustained their injuries, who were resident in Mersey region and surrounding areas, and left hospital alive after sustaining severe blunt injuries (IS&> 15) between 19 May 1989 and 19 April 1990. All parents and children were interviewed and physical examinations carried out on all patients.

We found that 41 per cent of our 29 patients made a full recovery 5 years after injury; 31 per cent of the children remained with moderate or severe disabilities. Head injuries were responsible for most of the severe disabilities, and limb injuries for most of the moderate ones. Schooling of all severely injured children was affected, though 52 per cent had only mild schooling problems and 13 per cent needed transfer to special schools. Recovery continued in some patients even 3-5 years after injury. We found severely injured children have a similar chance of recovery to that of the adult population 5 years after injury. Over half of the parents (53 per cent) criticized the level of help given to their children in the community after discharge, and 96 per cent of the patients received no formal rehabilitation after discharge.

We recommend the implementation of early formal rehabil- itation programmes for severely injured children with schooling of the children as an integral part. Finally, we recommend further studies on the long-term outcome in children after severe blunt injuries as it still lacks scientific evaluation.

C. M. Airey, S. Chell, A. S. Rigby, M. Chambers, A. Tennant, J. Connelly (Leeds, UK, and York, UK) The prevalence of disability among survivors of major traumatic injury Most trauma outcome studies define the consequence of injury in terms of survival or death and ignore the subsequent issues of quality of life for the survivors. We are currently examining

long-term outcomes for a cohort of 367 patients who have been identified as surviving serious injury (Injury Severity Score > 15) occurring within the former Yorkshire Health region during the 12 months from October 1988 to September 1989. The assessment is based on face-to-face interviews and uses question- naire schedules derived from OPCS disability surveys which produce disability-severity categories ranging from I (least severe disability) to 10 (most severe).

Nineteen individuals had died during the intervening period, three in further trauma episodes, An additional 24 refused to participate in the study. To date, 222 interviews have been carried out. The demographic characteristics of this sub-group are representative of the full cohort. Their median age is 31 (7-98) years, 163 (76 per cent) are men and road traffic accidents were the chief cause of injury (69 per cent) whose severity scores ranged from 16 to 54 with a median score of 22. Approximately one-half of the cases were under the principal care of neurosur- geons, a third under the care of orthopaedic surgeons and 2 per cent were cared for by general surgeons. The remaining cases were referrals to thoracic, bums or spinal injuries units. At 5 to 6 years after injury 43 (19 per cent) had no residual disability whilst a further 69 (31 per cent) reported only minimal levels. Seventy-four patients (33 per cent) were classed as having moderate to severe disability. There were 32 individuals (14 per cent) who had the most severe disabilities, half requiring 24 h carer assistance or residential care. Both ISS and Injury Impair- ment Score were associated with OPCS disability severity category (OR (95 per cent CI) = 3.2 (1.1-9.0) and 6.8 (1.6-28.9) respectively).

This study highlights the significant prevalence of long-term disability following major traumatic injury. Further efforts are required to evaluate morbidity as an outcome measure on a national basis, as well as mortality, in order to assess the full effects of changes in trauma management.

D. A. Boot, M. Patterson, 1. J. Braithwaite, N. Mkandawire (Warrington, UK) Musculoskeletal recovery after serious frauma: are we tying hard enough? We examined and interviewed 157 out of a total of 212 victims of serious trauma (Injury Severity Score> 15) 4-5 years after their accident. There was a high prevalence (80 per cent) of persistent musculoskeletal problems. Orthopaedic pelvic and limb injuries accounted for 63 per cent of the severe and 72 per cent of the moderate disabilities. The Bull disability score was used.

The 35 patients with pelvic injuries recovered poorly, 66 per cent having persisting problems. Twenty-one patients (60 per cent) had continuing pain, which was moderate or severe in 14 patients (40 per cent); 26 per cent of patients had moderate or severe walking problems.

The 42 patients with lower limb injuries also had a high incidence (93 per cent) of persisting problems; 38 patients (90 per cent) had persisting pain which was moderate or severe in 55 per cent; 21 patients (50 per cent) had some walking difficulty which was moderate or severe in 15 patients (33 per cent). Moderate or severe interference with work due to the lower limb injury (possibly preventing) was present in 13 patients (52 per cent); and with sport in 15 patients (36 per cent). Upper limb problems were less common, occurring in 34 per cent of patients.

In summary, a high prevalence of long-term pelvic and lower limb pain and disabilities has been shown in victims of serious trauma 4-5 years after injury. This reflects orthopaedic treat- ment in a defined region of the UK in 1989 and 1990.

These results raise the question about whether more aggres- sive early treatment could improve these disappointing clinical results.