Equity in functional and health related quality of life outcomes following injury in children-a systematic review

Injury burden is greater in children from vulnerable and disenfranchised populations. This systematic review aimed to describe injury related Health Related Quality of Life (HRQoL) and function outcomes in children through a health equity lens. A systematic review was conducted focussed on HRQoL and functional outcomes in children (<= 16 years) following injury. We applied PRISMA-E 2012 guidelines, the RTI (Research Triangle Institute) item bank for risk of bias and measured equity using PROGRESS-PLUS with a narrative synthesis. Of 3013 articles, 24 were eligible for inclusion. Most assessed outcomes following traumatic brain injury or burns over a 12-month period. Reduced functional and HRQoL levels pre-injury or baseline, longer hospitalisation, and lower socioeconomic status were linked to poorer long-term outcomes. Measures of equity in methodology, reporting and discussion were limited. Equity variables, such as prior disability, were points for participant exclusion. Ethnicity was often reported only in dominant cultural terms. The equity impact of injury in children remains largely unexplored. Worse injury outcomes were reported in low socioeconomic families, but the relationship to other equity variables was not routinely reported. This could significantly inhibit development of targeted preventative programs and health care for those most in need. Injury research agendas need reform, we provide guidance for research teams to assist in including equity in their research and outcomes.