Little is known about the degree of disability, quality of life, and psychological well-being after major trauma in adolescents aged 12 to 17 years. This is a proposal to determine by prospective epidemiologic study the incidence and determinants of functional limitation after major trauma in adolescent children aged 12 to 17 years. Using the computerized San Diego County Regional Trauma System Registry (TREG) trauma patient data base (Appendix I), we propose to determine the incidence and predictors of functional limitation after major trauma in approximately 525 male and female adolescents aged 12 to 17 years admitted prospectively to six trauma centers in San Diego County. Functional limitation after major trauma will be measured using the Quality of Well-being (QWB) scale at six time points; at discharge, and 3, 6, 12, 18, and 24 months after discharge. Multiple possible predictors of functional limitation after major trauma that will be determined include: (1) injury severity and body area(s) injured, injury event-related factors including mechanism, (2) clinical course and treatment of the trauma, (3) sociodemographic characteristics, (4) social support and (5) post-injury psychological sequelae including depression and post-traumatic stress disorder. The proposed project is designed to provide an ideal opportunity to itegrate with the existing enrollment protocol of the TRP study, which successfully recruited adult research subjects from four of the six Trauma Center hospitals targeted for enrollment of adolescents. Significantly, this proposal will provide a large outcome database on approximately 525 male and female adolescents aged 12 to 17 years that will allow us to determine not only the incidence of functional limitation after major trauma but also the strength and independence of predictors of functional limitation. Understanding the factors which lead to functional limitation in adolescents will allow physicians and health care personnel to target high risk patients for appropriate intervention and therapy. It will also provide necessary data for the effective delivery of rehabilitative and support services to adolescent trauma victims. The true efficacy of trauma care systems in this country can only be demonstrated by addressing whether these systems return trauma victims to active functional roles in society.
