Title: How to assess met and unmet needs in children with major trauma: Development of the Manchester Needs Tool for Injured Children (MANTIC).
Funder: Health Education England

Abstract: Background Major trauma is a term used to describe serious injuries that could cause significant disability or death and is the most common cause of death in children aged over 1 year in the UK. In 2012 the acute phase of major trauma care for children and adults was reconfigured nationally. This improved acute care and reduced mortality. However, the reconfiguration did not include rehabilitation and long-term care, and there is growing recognition that these phases of the care may be sub-optimal to meet injured children's needs and to maximise their experience and outcomes. The starting point for providing effective rehabilitation following traumatic injury is early identification of the injured child's holistic needs. This needs to cover a wide range of types and severity of injury and needs (including physical, emotional, educational, psychological and functional needs). I completed a systematic review in preparation for this application which demonstrated that no needs assessment tools for severely injured children are available. I will address this gap by developing a psychometrically robust Needs Assessment Tool (Manchester Needs Tool for Injured Children - MANTIC) to support health professionals to identify the needs of severely injured children. Aims To develop a psychometrically robust needs assessment tool (MANTIC) for children with major trauma. To explore the frequency and severity of the needs, and to what extent these needs are met. Research Question How to measure the needs of children with major trauma injuries? Plan of investigation A systematic review has already been completed.WP1 Development of draft item list Explore met and unmet needs via face-to-face semi-structured interviews with 30 children with major trauma injuries, their parents or carers. Conducted within 2 weeks to 9 months of the child's discharge home from a major trauma centre. From the interviews a draft list of items for the prototype MANTIC will be identified.WP2 Cognitive de-briefing interviews The draft list of items will be used to conduct cognitive de-briefing interviews with 10 participants from WP1 to obtain feedback on; readability, response format, layout and instructions. The feedback will be used to delete or modify items from the draft list and produce a prototype MANTIC. WP3 Psychometric testing of the prototype MANTICThe prototype MANTIC will be distributed to 545 parents or carers of children with major trauma within 2 weeks to 9 months of the child's discharge from the major trauma centre. A ~20% response rate is anticipated, so 108 completed responses are expected to test construct validity; using hierarchical reduction (floor and ceiling effects) and Rasch (statistical analysis) of items which survive hierarchical reduction. Concurrent validity will be tested by assessing correlations between the final MANTIC items and measures of quality of life and functional independence (the PedsQL and WeeFIM). WP4 Test of test retest reliability to test if items are stable over a short period Alongside the prototype MANTIC used in WP3, another copy, plus a Global rating of change question will be distributed to participants in a separate envelope for completion on day 7. Minimum of 60 responses will be used to assess for test retest reliability in participants with an unchanged Global Health Score.Summary of Potential Benefits to Patients and the NHS The MANTIC will enable health professionals to accurately identify the injured child's and their family's needs and signpost them to appropriate services. This will facilitate effective individual treatment plans and timely referral to to post-acute services. Information about the scope and nature of patients' needs and whether they are met will be useful for service planning, development and bench marking.

Lay abstract: Major trauma is a term used to describe serious injuries which can cause death or disability. Following emergency care, it is important for health professionals to identify the overall needs of children with major trauma injuries to ensure they receive appropriate rehabilitation to make the best recovery. Major trauma injuries cause physical problems, and can also create needs relating to the child's behaviour, emotions, social life, physical activity, performance at school and family life. At present, there are no assessment tools available to help health professionals accurately identify children's overall needs following major trauma injuries. The aim of this project is to develop an assessment tool that will help health professionals identify the needs of children with major trauma injuries. The name of the assessment is the Manchester Needs Tool for Injured Children (MANTIC). The aims of this study are to Develop an assessment which will accurately identify the most important needs of children with major trauma injuries. Determine if their needs are being met. Plan of Investigation Participants in this study will be children with major trauma injuries aged 1 to 15 years and their parents or carers. The study has four stages. Stage 1. I will conduct face to face interviews with 30 participants to explore the child's and family's needs following a major trauma injury. Interviews will be completed within 2 weeks to 9 months of the child's discharge from hospital so all stages of recovery are covered. The common topics will then be used to develop questions for the MANTIC. Stage 2. Ten participants from the first interviews will be requested to complete a second interview to determine the best layout for the questionnaire, and how easy the questions are to read and understand. The advice obtained from this interview will help to develop a first draft of the MANTIC. Stage 3. This stage will test the first draft of the MANTIC with a larger number of participants to find out if all the questions are relevant and important, and cover children with a wide range of ages, types and severity of major trauma injuries. The first draft of the MANTIC will be completed by 108 participants within 2 weeks to 9 months of discharge from a Major Trauma Centre. Stage 4. It is important to know that the information obtained from the MANTIC will be consistent over time. This means that if the condition of the child with major trauma injuries does not change, the information produced from the MANTIC will remain the same. To test this, 60 participants who say their condition has not changed, will repeat the first draft MANTIC 7 days later. The results will be compared to make sure they haven't changed. Benefits to patients and the NHS The MANTIC will help health professionals identify the needs of children with major trauma injuries. It will be suitable for children with a wide range of ages, types and severity of major trauma, and can be used at any point in their recovery. This will help to ensure that children are referred to appropriate health, educational and social care services at the right time. Health professionals will also be able to give advice which matches the child's needs. This will help to improve their rehabilitation experience and outcomes, so that they are more satisfied with their care and make a greater recovery. It is expected that this will reduce the chance of children developing long term problems, resulting in cost savings for the NHS and social care. The MANTIC can be used to assess if services meet children's needs. This information can be used to improve services in the future.

Research activity codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: INJURIES AND ACCIDENTS