72 Overall our sample is small, especially given the skewed distribution of the responses. IROS is robust in construct and content, but evidence for reproducibility, discriminating capacity and impact of covariates is therefore still only indicative. We will need to test this further in future patient cohorts. In view of the truly generic and multicultural underlying construct, IROS should be equally valid for other medical conditions, age groups and/or in other languages or countries. It is our aim to explore these possibilities but also we encourage (and are happy to aid) others to incorporate IROS in their research or clinical setting. Conclusion IROS provides an improved scoring system to evaluate the burden of health problems after injury or critical illness. We described long-term outcome for children after severe trauma in Flanders. Although the perceived health state after 12 months was for several ‘trauma’ children compa- rable to controls, for a specific subgroup the burden of health problems was still high. More specifically, these problems were physical, as well as social or psychological in nature (emotions/behaviour, intestinal, mobility, self- care, executing tasks, societal life). For this group, the burden on family was significant. It is not easy to predict which child will have a bad long-term outcome after trauma as in our study only the health state at discharge was significantly related. Still the latter might be of importance in view of for instance trajectory assistance. Future research is needed to describe recovery patterns after severe paediatric trauma; to evaluate additional covariates and their relation to outcome and also to further explore the ICF format as a way to report that outcome. Acknowledgments We like to thank Daphne Christiaens, Anneleen Vantomme and Helena Kourdioukova, research staff of the PENTA study centre, for their participation in data collection and validation. The following Flemish hospitals (Belgium) participated in the PENTA registry: ASZ Aalst, St. Blasius Dendermonde, UZ Gent, AZ MMSJ Gent, Jan Palfijn ZH Gent, AZ St. Lucas Gent, AZ Oudenaarde, AZ MM St. Niklaas, AZ Groeninge Kortrijk, HH ZH Menen, HH ZH Roeselare, AZ St. Maarten Mechelen, AZ St. Maarten Duffel, St. Vincentius ZH Antwerpen, Klina Brasschaat, AZ Stuivenberg Antwerpen, ZH Noord-Limburg Lommel, ZOL Genk, UZ Gasthuisberg Leuven. All of the above authors were actively involved in study design or data gathering/analysis and revisions of the initial draft. They all gave final approval to the version currently submitted. No author declared any conflict of interest. The PENTA study as a whole was funded by the Flemish fund for scientific research FWO partim Levenslijn. 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