Experiences of suffering multiple trauma: A qualitative study

Adult patient and carer experiences of planning for hospital discharge after a major trauma event: a qualitative systematic review

PURPOSE

To identify, evaluate and synthesize qualitative literature on adult patients and carer experiences of planning for discharge from an acute setting after a major trauma event.

METHODS

The JBI approach to meta-aggregation was followed. Qualitative studies exploring patient and carer discharge planning experiences of major trauma were included in the systematic review. A comprehensive search was conducted in five databases, supplemented by grey literature. Eligible studies were appraised for methodological quality by two reviewers and data extracted using standardized JBI tools.

RESULTS

Four synthesized findings emerged using 69 findings from sixteen papers. (i) Patients and carers feel generally unprepared to manage at home after discharge, (ii) early identification of patients' post discharge needs allows for appropriate referrals and supports to be organised prior to discharge, (iii) patients and carers value participation in the discharge planning process to facilitate a considered, organized and timely discharge from hospital (iv) the timely presentation, delivery, language used, format and relevancy of information impacts how patients and carers manage their discharge.

CONCLUSION

This meta-synthesis demonstrates that patients and carers predominantly have poor experiences of discharge planning after major trauma. Adoption of patient centered principles may improve patient and carer experiences of the discharge planning process.

IMPLICATIONS FOR REHABILITATIONPatients and their carers benefit from a client-centred approach where their needs are recognised and their collaboration encouraged in important decisions, and if they are adequately prepared to reintegrate into their community.Patients can benefit from having a trauma pathway healthcare professional to provide support and advocacy services throughout their hospital admission and after discharge.Discharge planning that is organised, prepared and collaborative leads to a more positive patient experience.Discharge information should be individualised and presented in an easily accessible format for patients and carers.

Development of a Nomogram Model to Predict in-Hospital Survival in Patients with Multiple Trauma

Background

Herein, we purposed to establish a nomogram model capable of assessing the probability of in-hospital survival in patients with multiple trauma.

Methods

Our retrospective study is associated with 286 multiple trauma patients with 21 variables from 2017 to 2021 in The Second Affiliated Hospital, Hengyang Medical School, University of South China. We performed the univariate and multivariate logistic regression analyses for investigating the risk factors of multiple trauma. Further, we constructed a novel nomogram model, and this nomogram was evaluated by a calibration plot. Based on the multivariate analysis or the nomogram prediction model, we calculated the risk score of each patient for multiple trauma. Moreover, we compared the survival probability between the high-risk score and low-risk score groups. Finally, we assessed the discrimination of the risk score by using the C-index and the time-dependent receiver operating characteristics (ROC) curve.

Results

Multivariate regression analysis revealed that the age and ISS scores were the independent risk factors, while the GCS score had protective effects on in-hospital survival. The high C-index and area under the curve (AUC) of the ROC curve confirmed reasonable discrimination for the multivariate analysis and the nomogram prediction model. Further, the calibration plot indicated reasonable accuracy of the nomogram predicting 30-day and 60-day survival probabilities.

Conclusion

The nomogram model established here has good predictive efficacy for in-hospital survival of patients with multiple injuries.