The Manchester Needs Tool for Injured Children MANTIC
Research type
Research Study
Full title
Children and their family's needs, after a major trauma. Development of the: Manchester Needs Tool for Injured Children (MANTIC).
IRAS ID
227379
Contact name
Samantha Jones
Contact email
Sponsor organisation
University of Manchester
Duration of Study in the UK
2 years, 3 months, 1 days
Research summary
Major trauma is a term used to describe serious injuries which can cause death or disability. Major trauma injuries cause physical problems, and can create needs relating to the child’s behaviour, emotions, social life, physical activity, performance at school and family life. For children to make the best recovery after a major trauma injury it is important to identify their needs, to ensure referral to the right services. There are no assessment tools available to help health professionals accurately identify children’s needs following major trauma injuries. The aim of this project is to develop a questionnaire to help identify the needs of children with major trauma injuries; the Manchester Needs Tool for Injured Children (MANTIC).
The MANTIC questionnaire will be developed using four different phases.
PHASE 1 The first phase will involve interviewing participants (children with major trauma injuries and their parents or carers). Interviews will explore children’s and family’s needs following the child’s major trauma injury. The interviews will help to identify common themes for the MANTIC questionnaire.PHASE 2 Participants will then be asked about the best layout for the questionnaire and how easy questions are to read and understand. The advice obtained from this interview will help to develop a “first draft” of the MANTIC.
PHASE 3 The “first draft” of the MANTIC questionnaire will be tested with larger numbers of participants to find out if questions are relevant, important and cover children with a wide range of ages, types and severity of major trauma injuries.
PHASE 4. It is important to know that the information obtained from the MANTIC will be consistent over time. To test this, participants who say their condition has not changed, will repeat the “first draft” MANTIC 7 days later. The results from the different days will be compared to make sure they haven’t changed.
Research Summary
Background Major Trauma Centres are hospitals that specialise in treating seriously injured children. These children often go home quickly because they have family or carers to take care of them. However, they are still recovering when they go home. In fact, their needs become clearer when they return to everyday activities like school. Injuries can affect their physical health, emotions, school life, thinking, and daily routines. Despite the ongoing challenges, there is limited research on how children and families manage after leaving the hospital, and they may not receive all the help they need to make the best possible recovery. The aim of this project was to create a questionnaire, called the Manchester Needs Tool for Injured Children (MANTIC). This will help injured children, and their families report their needs during recovery. The project includes 4 different studies which all contribute to understanding their recovery needs and the development of the questionnaire.Study 1. Aim: To understand children’s injury patterns using national data A review of data for 9,851 children treated at Major Trauma Centres in England between 2012 and 2017. The aim was to understand the characteristics of children affected by traumatic injuries, the injury types, how they occur, and the recovery outcomes.
The study found that:
• Most injured children were male (69%), with infants under 1 year, particularly those around 36 days old, being the most frequently injured. In this age category the main cause of the injuries was suspected child abuse.
• Most injuries happened at home, often from falls less than 2 meters high, and were more common after school, on weekends, and during the summer.
• While most injuries were moderate and not life-threatening, the limbs and head were the most injured body parts.
• Nearly 93% of children went home after treatment at the hospital, and 72.8% made a good recovery. However, 3.1% of children died, with infants being the most likely to die from their injuries.
Conclusion: The study suggests that accident prevention should focus on preventing abuse in infants and that Major Trauma Centres need to be prepared for busy times, such as after school, weekends, and the summer.Study 2: Aim: A reviewing of the evidence to find out if there is a questionnaire or assessment to identify the needs of injured children and their families.
A review of existing evidence was conducted to determine whether any questionnaires or assessments exist to identify the recovery needs of children after traumatic injuries. Two independent researchers gathered data from 12 studies, involving 932 participants, including 105 injured adolescents and 827 family members or professionals. Many of the studies focused on children with traumatic brain injuries. The review identified two main types of needs: person-related needs (adolescent-specific, cognitive, emotional, social, and physical needs) and service-related needs (information, education, and support during care transitions). Many of these needs were found to be unmet, especially for emotional support, information, and access to community services. The review also found that no existing assessments or questionnaires fully capture the range of needs that children and families experience following a traumatic injury.
Conclusion: Key gaps in care, include a lack of emotional support, difficulties accessing services, and poor information sharing.Studies 3a,3b,3c. Aim: To interview injured children and their families to find out about their needs The researcher conducted interviews with 32 participants, including 13 injured children and their families. The interviews took place within 12 months of the return home from the hospital. The interviews were analysed by the researcher to identify key topics.
a.The Impact: Injured children struggled with changes in their appearance, limits on physical activity, and new physical or emotional symptoms that developed after they went home. They also faced social challenges due to concerns about their appearance and difficulty rejoining friendships. Both children and parents often experienced post-traumatic stress symptoms, and parents had to take on more responsibilities, which impacted family roles and their ability to work or handle daily tasks.
b. The Recovery Needs: As children recovered, families identified a need for clear, consistent, and timely information about the injury and recovery process. They wanted to feel supported by healthcare professionals during and after the hospital stay. Continued contact after discharge was needed for advice and reassurance. Access to services, including therapy, needed to be flexible, easy to use, and well-coordinated to ensure a smooth recovery. Having a central contact point for ongoing care was considered very important.
c. The Educational Needs: Injured children also faced challenges returning to school. Schools needed more information about the child's injury and the adjustments required for the child to participate in activities safely. Communication between schools, families, and healthcare professionals was essential for a smooth return to school. During their recovery injured children needed continued access to education, flexible learning schedules, and support to help them reintegrate socially and participate in physical activities.
Conclusion: Injured children and their families need accessible, coordinated, and family-centered support services throughout the entire recovery process, from hospital discharge to school return. A central point of contact and better communication between professionals and families can help manage the recovery journey more effectively.
Study 4. Aim: to develop a questionnaire entitled: The Manchester Needs Tool for Injured Children
The questionnaire entitled: The Manchester Needs Tool for Injured Children (MANTIC) was developed to enable injured children and their families to report their needs during recovery.
The development process involved two main stages based on guidance about questionnaire development from the food and drug administration agency.
Stage 1: The interviews from studies 3a,b,c were used to understand the key topics about the recovery needs and experiences of injured children and their families. From the topics a draft questionnaire was developed. This included 64 questions grouped into the following categories: physical needs, mental health needs, family needs, information needs, service needs, practical and equipment needs, discharge planning, educational needs, child/young person's social and emotional needs, and parent/carer needs. Parents and public advisors gave feedback on the draft questionnaire. They suggested changes to make it easier to understand and more relevant. This included four options which people can use to show how much they agree with a statement.
Stage 2: The researchers checked how well the MANTIC questionnaire worked by testing it with 144 children and families. They looked at the following points:
Reliability: They checked if the results would be similar if the same people completed the questionnaire at different times. This showed that the questionnaire was consistently measuring the same things.
Validity: They tested if the MANTIC accurately captured the needs of the children and families by comparing it with another well-established questionnaire assessing quality of life. The results showed that children with greater needs had poorer quality of life, which supported that the MANTIC was valid.
Consistency: They examined if the items within each section of the questionnaire were related to each other. This showed that the questions in each section were measuring similar ideas, ensuring the sections were meaningful.In conclusion, the MANTIC is an effective and clinical useful tool for identifying the needs of injured children and their families. It is available for use in hospitals and research and can help healthcare providers better understand and support children’s physical, emotional, and social needs as they recover.
REC name
North West - Greater Manchester South Research Ethics Committee
REC reference
17/NW/0615
Date of REC Opinion
5 Jan 2018
REC opinion
Further Information Favourable Opinion