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Cassinat J, Nygaard J, Hoggard C, Hoffmann M. Predictors of mortality and rehabilitation location in adults with prolonged coma following traumatic brain injury. PM R 2024. [PMID: 38656699 DOI: 10.1002/pmrj.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 02/15/2024] [Accepted: 02/25/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a leading cause of death and disability, often resulting in prolonged coma and disordered consciousness. There are currently gaps in understanding the factors affecting rehabilitation location and outcome after TBI. OBJECTIVE To identify the impact of demographics, comorbidities, and complications on discharge disposition in adults with prolonged coma following TBI. DESIGN Retrospective cohort study. SETTING Tertiary care hospitals and trauma centers in the United States. PARTICIPANTS Patients 18 years of age or older with TBI and prolonged coma during the years 2008 to 2015. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Demographics, clinical injury data, comorbidities, and complications were collected, and odds ratios (ORs) and descriptive analysis were calculated for mortality, long-term rehabilitation, and home discharge without services. RESULTS A total of 6929 patients with TBI and prolonged coma were included in the final analysis; 3318 (47.9%) were discharged to rehabilitation facilities, 1859 (26.8%) died, and 1752 (25.3%) were discharged home. Older patients and those with higher injury severity scores had significantly higher ORs for mortality and rehab discharge. A total of 58.3% of patients presented with at least one comorbidity. Non-White ethnicities and self-pay/uninsured patients were significantly less likely to be discharged to a rehab facility. Furthermore, comorbidities including congestive heart failure (CHF) and diabetes were associated with a significantly increased OR for mortality and rehab discharge compared to home discharge without services. CONCLUSIONS Comorbidities, age, and injury severity were the most significant risk factors for increased mortality and acute rehab discharge. Maximizing the treatment of comorbidities including CHF and diabetes has the potential to decrease mortality and adverse outcomes following TBI with prolonged coma.
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Affiliation(s)
- Joshua Cassinat
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Joseph Nygaard
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Collin Hoggard
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Michael Hoffmann
- University of Central Florida College of Medicine, Orlando, Florida, USA
- Neurology Section, Orlando VA Medical Center, Orlando, Florida, USA
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Timon C, Lee M, Feeley I, Quinlan J. Recording adverse events following orthopaedic trauma: Financial implications and validation of an adverse event assessment form in an Irish regional trauma unit. Injury 2023; 54:508-512. [PMID: 36414501 DOI: 10.1016/j.injury.2022.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/27/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND In Ireland, funding of orthopaedic trauma is based on an activity-based funding (ABF) model. Clinically similar cases are split into diagnostic-related groups (DRG), with base funding per DRG provided. Increased complexity of cases (length of stay; complications incurred; occurrence of adverse events) attracts additional remuneration to the base funding. In our institution these adverse events are recorded via retrospective chart-abstraction methods by administrative staff. Incidences which are not included from this review affect both follow up with family physicians and patient care; as well as skewing budgetary decisions that impact fiscal viability of the service. The aim of this study was to compare a prospectively implemented adverse events form with the current national retrospective chart abstraction method. Our outcomes in terms of pay-by-results financial implications. METHODS An adverse events database adapted from a similar validated model was used to prospectively record complications in 216 patients admitted via the orthopaedic trauma service. Data was contemporaneously collected via a GDPR compliant secure medical messaging platform. Results were compared with the same cohort using an existing data abstraction method. Both data sets were coded in accordance with current standards for case funding. RESULTS Overall, 49 adverse events were recorded during the study through prospective charting of adverse events, compared with 26 events documented by customary method (p<0.01).Anaemia requiring blood transfusion n = 11 22.4%) was the most common complication, followed by delirium n = 6 (12%), acute kidney injury n = 6 (12%), and pneumonia n = 5 (10.2%). Missed appropriate funding through conventional methods totalled €40,293 . CONCLUSION This pilot study demonstrates the ability to improve capture of adverse events through use of a well-designed assessment form. Proper perioperative data handling is a critical aspect of financial subsidies, enabling optimal allocation of funds.
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Affiliation(s)
- Charlie Timon
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin 24, Ireland.
| | - Matthew Lee
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin 24, Ireland
| | - Iain Feeley
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin 24, Ireland
| | - John Quinlan
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin 24, Ireland
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Truchot J, Benhamed A, Batomen B, Boucher V, Malo C, Chauny JM, de Champlain F, Émond M. Trauma team leader and early mortality: An interrupted time series analysis. Am J Emerg Med 2022; 62:32-40. [DOI: 10.1016/j.ajem.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022] Open
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Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients. Eur J Trauma Emerg Surg 2022; 49:1295-1302. [DOI: 10.1007/s00068-022-02168-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/04/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Background
In-hospital complications after trauma may result in prolonged stays, higher costs, and adverse functional outcomes. Among reported risk factors for complications are pre-existing cardiopulmonary comorbidities. Objective and quick evaluation of cardiovascular risk would be beneficial for risk assessment in trauma patients. Studies in non-trauma patients suggested an independent association between cardiovascular abnormalities visible on routine computed tomography (CT) imaging and outcomes. However, whether this applies to trauma patients is unknown.
Purpose
To assess the association between cardiopulmonary abnormalities visible on routine CT images and the development of in-hospital complications in patients in a level-1 trauma center.
Methods
All trauma patients aged 16 years or older with CT imaging of the abdomen, thorax, or spine and admitted to the UMC Utrecht in 2017 were included. Patients with an active infection upon admission or severe neurological trauma were excluded. Routine trauma CT images were analyzed for visible abnormalities: pulmonary emphysema, coronary artery calcifications, and abdominal aorta calcification severity. Drug-treated complications were scored. The discharge condition was measured on the Glasgow Outcome Scale.
Results
In total, 433 patients (median age 50 years, 67% male, 89% ASA 1–2) were analyzed. Median Injury Severity Score and Glasgow Coma Scale score were 9 and 15, respectively. Seventy-six patients suffered from at least one complication, mostly pneumonia (n = 39, 9%) or delirium (n = 19, 4%). Left main coronary artery calcification was independently associated with the development of any complication (OR 3.9, 95% CI 1.7–8.9). An increasing number of calcified coronary arteries showed a trend toward an association with complications (p = 0.07) and was significantly associated with an adverse discharge condition (p = 0.02). Pulmonary emphysema and aortic calcifications were not associated with complications.
Conclusion
Coronary artery calcification, visible on routine CT imaging, is independently associated with in-hospital complications and an adverse discharge condition in level-1 trauma patients. The findings of this study may help to identify trauma patients quickly and objectively at risk for complications in an early stage without performing additional diagnostics or interventions.
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Computed tomographic bone mineral density is independently associated with adverse in-hospital outcomes in Dutch level-1 trauma patients. Eur J Trauma Emerg Surg 2022; 49:1393-1400. [DOI: 10.1007/s00068-022-02175-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022]
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The effect of age on resilience of health-related quality of life among polytrauma patients: a cross-sectional multicenter study. Eur J Trauma Emerg Surg 2022; 49:825-835. [PMID: 36416946 PMCID: PMC10175333 DOI: 10.1007/s00068-022-02135-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose
The aim of this study was to determine the impact of age on patient-reported health-related quality of life (HRQoL) and the capacity to show resilience—i.e., the ability to adapt to stressful adverse events—after sustaining a polytrauma.
Methods
A cross-sectional multicenter cohort was conducted between 2013 and 2016 that included surviving polytrauma patients (ISS ≥ 16). HRQoL was obtained by the Short Musculoskeletal Function assessment and EuroQol (SMFA and EQ-5D-5L). The effect of age on HRQoL was tested with linear regression analysis. Next, the individual scores were compared with age- and sex-matched normative data to determine whether they showed resilience. Multivariate binary logistic regression was used to assess the effect of age on reaching the normative threshold of the surveys, correcting for several confounders.
Results
A total of 363 patients responded (57%). Overall, patients had a mean EQ-5D-5L score of 0.73. With higher age, scores on the SMFA subscales “upper extremity dysfunction,” “lower extremity dysfunction” and “daily activities” significantly dropped. Only 42% of patients were classified as being resilient, based on the EQ-5D-5L score. Patients aged 60–69 showed the highest resilience (56%), and those aged 80 + showed the lowest resilience (0%).
Conclusion
Sustaining a polytrauma leads to a serious decline in HRQoL. Aging is associated with a decline in the physical components of HRQoL. No clear relationship with age was seen on the non-physical components of quality of life. Octogenarians, and to a lesser extent septuagenarians and tricenarians, showed to be very vulnerable groups, with low rates of resilience after surviving a polytrauma.
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Siddique SM, Mehta SJ, Parsikia A, Neuman MD, Lewis JD. Hospital Performance for Gastrointestinal Bleeding Mortality, Length of Stay, and Complication Rates in the USA. Dig Dis Sci 2022; 67:4678-4686. [PMID: 35031875 PMCID: PMC10045790 DOI: 10.1007/s10620-021-07345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/22/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hospitals are held accountable for quality metrics, through public reporting programs and by payers. However, little is known about hospital performance in GIB nationally. METHODS A retrospective longitudinal analysis utilizing Vizient's database was performed to identify GIB hospitalizations across 349 hospitals from 2016 to 2018. The primary outcome was risk-adjusted mortality; secondary outcomes included risk-adjusted length of stay and complication rate. Trends in performance were characterized using quintiles, with analysis of concordance within hospitals and across hospitals over time. Pearson's correlation coefficients were performed to assess the relationship among metrics. RESULTS 28.1% of hospitals had a steadily improving risk-adjusted mortality index from 2016 to 2018, while 15.5% were steadily worsening in mortality. For LOS, 25.2% of hospitals were improving, while 22.4% deteriorated. For complication rate, 22.9% of hospitals steadily improved, while 19.2% of hospitals deteriorated. Although many hospitals improved substantially in one outcome, they did not necessarily improve in all outcomes. Of the 98 hospitals that steadily improved in mortality from 2016 to 2018, only 8 out of 98 steadily improved in all three outcomes (8.3%). Across all 3 years, mortality was weakly correlated with LOS (r = 0.22, p < 0.001), but not with the rate of complications (r = 0.08, p = 0.12). CONCLUSION Hospital performance metrics for GIB, such as mortality, length of stay, and complication rate, are weakly correlated and thus likely measure different aspects of care. While many hospitals improved over time, few hospitals improved in all three metrics. Additionally, many hospitals are deteriorating over time, and further research is needed to determine which care processes are associated with better outcomes.
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Affiliation(s)
- Shazia Mehmood Siddique
- Division of Gastroenterology, University of Pennsylvania, 3400 Civic Center Blvd, 7th floor Gastroenterology, Philadelphia, PA, 19104, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
| | - Shivan J Mehta
- Division of Gastroenterology, University of Pennsylvania, 3400 Civic Center Blvd, 7th floor Gastroenterology, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Afshin Parsikia
- Division of Gastroenterology, University of Pennsylvania, 3400 Civic Center Blvd, 7th floor Gastroenterology, Philadelphia, PA, 19104, USA
| | - Mark D Neuman
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA
| | - James D Lewis
- Division of Gastroenterology, University of Pennsylvania, 3400 Civic Center Blvd, 7th floor Gastroenterology, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA
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van den Boom N, van den Hurk AA, Kalmet P, Poeze M, Evers S. Economic evaluations in fracture research an introduction with examples of foot fractures. Injury 2022; 53:895-903. [PMID: 35034777 DOI: 10.1016/j.injury.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The incidence of foot fractures is increasing. These types of fractures represent the most expensive group of diagnoses in the emergency department. Next to this, the need for economic evaluation studies is growing fast. The aim of this article is to provide healthcare professionals with an introduction to economic evaluation studies in the field of foot fractures. TYPES OF ECONOMIC EVALUATION STUDIES Four types of economic evaluation studies exist: cost-minimization analysis (CMA), cost-benefit analysis (CBA), cost-effectiveness analysis (CEA), and cost-utility analysis (CUA). An economic evaluation study can be either trial- or model-based. COST ASSESSMENT When assessing costs in an economic evaluation study, three steps need to be made: identification of costs, measurement of costs, and valuation of costs. PERSPECTIVE OF ANALYSIS Two main perspectives exist in economic evaluation studies. When using a healthcare perspective, only the potential costs and benefits of an intervention for the healthcare sector are included. The societal perspective includes all potential costs, including societal costs. SYNTHESIS OF COSTS AND EFFECTS AND UNCERTAINTY ANALYSIS The level of cost-effectiveness can be objectively expressed using the incremental cost-effectiveness ratio (ICER). This measure can be plotted in a cost-effectiveness plane and can be compared with existing regional ceiling ratios. CONCLUSION Although this article is not a guideline for economic evaluations, we do want to present five tips to consider when performing an economic evaluation. Firstly, when measuring resource use, consult the Database of Instruments for Resource Use Measurements (DIRUM) to find an appropriate instrument. Secondly, when measuring utility values, use the EuroQol questionnaire if possible. Thirdly, when setting up an economic evaluation study, consult the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) database for the appropriate pharmacoeconomic guidelines. Fourthly, consult international guidelines to decide which study design is most appropriate. Finally, when performing an economic evaluation, consult a heath technology assessment (HTA) specialist from the start to ensure methodological quality.
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Affiliation(s)
- Nac van den Boom
- Department of Trauma Surgery, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6229 HX, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Universiteitssingel 40, Maastricht 6229 ER, the Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University. Universiteitssingel 40, Maastricht 6229 ER, the Netherlands.
| | - A A van den Hurk
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Universiteitssingel 40, Maastricht 6229 ER, the Netherlands
| | - Phs Kalmet
- Department of Trauma Surgery, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6229 HX, the Netherlands
| | - M Poeze
- Department of Trauma Surgery, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6229 HX, the Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University. Universiteitssingel 40, Maastricht 6229 ER, the Netherlands
| | - Smaa Evers
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Universiteitssingel 40, Maastricht 6229 ER, the Netherlands; Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Da Costakade 45, Utrecht 3521 VS, the Netherlands; Department of Health Services Research, Maastricht University, Duboisdomein 30, Maastricht 6229 GT, The Netherlands
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Rasouli HR, Talebi S, Ahmadpour F. Evaluation of Associated Genes with Traumatic Pain: A Systematic Review. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 21:830-840. [PMID: 34872485 DOI: 10.2174/1871527320666211206121645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/06/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The knowledge about the molecular pathway of traumatic pain relief is less documented. This systematic review study aimed to identify the genes and molecular pathways associated with various traumatic pains. METHODS The online databases such as EMBASE, MEDLINE, PubMed, Cochrane Library, International Clinical Trials Registry Platform, Clinical Trials, Google Scholar, Wiley, ISI Web of Knowledge, and Scopus were searched. Two review authors searched and screened all records' titles and abstracts, and the third expert reviewer author resolved their disagreement. The study's design, various trauma injuries, types of genes, and molecular pathways were recorded. The genes and molecular pathways data were obtained via GeneCards®: The Human Gene Database (https://www.genecards.org). RESULTS Studies on a variety of trauma injuries regarding nerve and Spinal Cord Injuries (SCIs) (12 records), Hypertrophic scar with Severe Pain (one record), severe post-traumatic musculoskeletal pain (MSP) (one record), and orthopedic trauma (one record) were included. The main molecular pathways such as the immune system, apoptosis, and death receptor signaling, T-cell antigen receptor (TCR) signaling pathway, oxidative stress, interleukin(s) mediated signaling pathway, biological oxidations, metabolic pathways (especially amino acid metabolism and amino group), focal adhesion, the proliferation of vascular, epithelial, and connective tissue cells, angiogenesis and neural development were identified. CONCLUSION The immune system, apoptosis, and metabolic pathways are crucial for understanding the roles of genes in traumatic pain. It is recommended that these identified pathways and related genes be considered therapeutical targets for pain management in patients with trauma injuries. In addition, different forms of trauma injuries require different pathways and related genes to be considered.
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Affiliation(s)
- Hamid Reza Rasouli
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Samira Talebi
- National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
| | - Fathollah Ahmadpour
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Idriss-Hassan A, Bérubé M, Belcaïd A, Clément J, Bourgeois G, Rizzo C, Neveu X, Soltana K, Thakore J, Moore L. Derivation and validation of actionable quality indicators targeting reductions in complications for injury admissions. Eur J Trauma Emerg Surg 2021; 48:1351-1361. [PMID: 33961073 DOI: 10.1007/s00068-021-01681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Approximately, one out of five patients hospitalized following injury will develop at least one hospital complication, more than three times that observed for general admissions. We currently lack actionable Quality Indicators (QI) targeting specific complications in this population. We aimed to derive and validate QI targeting hospital complications for injury admissions and develop algorithms to identify patient charts to review. METHODS We conducted a retrospective cohort study including patients with major trauma admitted to any level I or II adult trauma center an integrated Canadian trauma system (2014-2019). We used the trauma registry to develop five QI targeting deep vein thrombosis/pulmonary embolism (DVT/PE), decubitus ulcers, delirium, pneumonia and urinary tract infection (UTI). We developed algorithms to identify patient charts to revise on consultation with a group of clinical experts. RESULTS The study population included 14,592 patients of whom 5.3% developed DVT or PE, 2.7% developed a decubitus ulcer, 8.6% developed delirium, 14.7% developed pneumonia and 7.3% developed UTI. The indicators demonstrated excellent predictive performance (Area Under the Curve 0.81-0.87). We identified 4 hospitals with a higher than average incidence of at least one of the targeted complications. The algorithms identified on average 50 and 20 charts to be reviewed per year for level I and II centers, respectively. CONCLUSION In line with initiatives to improve the quality of trauma care, we propose QI targeting reductions in hospital complications for injury admissions and algorithms to generate case lists to facilitate the review of patient charts.
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Affiliation(s)
- Abakar Idriss-Hassan
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.,Institut National de Santé Publique du Québec, Québec, QC, Canada
| | - Mélanie Bérubé
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.,Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Amina Belcaïd
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.,Institut national d'excellence en santé et en services sociaux, Québec, QC, Canada
| | - Julien Clément
- Institut national d'excellence en santé et en services sociaux, Québec, QC, Canada.,Department of Surgery, Université Laval, Québec, QC, Canada
| | | | - Christine Rizzo
- Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Xavier Neveu
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Kahina Soltana
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Jaimini Thakore
- Provincial Lead, Data, Evaluation and Analytics, Trauma Services BC, British Columbia, Canada
| | - Lynne Moore
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada. .,Department of Social and Preventative Medicine, Université Laval, 2325, Rue de l'Université, Québec, QC, G1V 0A6, Canada.
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Fernando DT, Berecki-Gisolf J, Newstead S, Ansari Z. The Australian Injury Comorbidity Indices (AICIs) to predict in-hospital complications: A population-based data linkage study. PLoS One 2020; 15:e0238182. [PMID: 32915808 PMCID: PMC7485849 DOI: 10.1371/journal.pone.0238182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/08/2020] [Indexed: 12/21/2022] Open
Abstract
Background Hospital-admitted patients are at risk of experiencing certain adverse outcomes during their hospital-stay. Patients may need to be admitted to the intensive care unit or be placed on the ventilator while there is also a possibility for complications to develop. Pre-existing comorbidity could increase the risk of these outcomes. The Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Measure (ECM), originally derived for mortality outcomes among general medical populations, are widely used for assessing these in-hospital complications even among specific injury populations. This study derived indices to specifically capture the effect of comorbidity on intensive care unit and ventilator use as well as hospital-acquired complications for injury patients. Methods Retrospective data on injury hospital-admissions from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia was analysed. Results from multivariable regression analysis were used to derive the Australian Injury Comorbidity Indices (AICIs) for intensive care unit and ventilator hours and hospital-acquired complications. The AICIs, CCI and ECM were validated on data from Victoria and two other Australian states. Results Five comorbidities were significantly associated with intensive care unit hours, two with ventilator hours and fifteen with hospital-acquired complications for hospitalised injury patients. Not all diseases listed in the CCI or ECM were found to be associated with these outcomes. The AICIs performed equally well in terms of predictive ability to the long-listed ECM and in most instances outperformed the CCI. Conclusions Associations between outcomes and comorbidities vary based on the type of outcome measure. The new comorbidity indices developed in this study provide a relevant, parsimonious and up-to-date method to capture the effect of comorbidity on in-hospital complications among admitted injury patients and is better suited for use in that context compared to the CCI and ECM.
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Affiliation(s)
- Dasamal Tharanga Fernando
- Monash University Accident Research Centre, Monash University, Clayton Campus, Clayton, Victoria, Australia
- * E-mail:
| | - Janneke Berecki-Gisolf
- Monash University Accident Research Centre, Monash University, Clayton Campus, Clayton, Victoria, Australia
| | - Stuart Newstead
- Monash University Accident Research Centre, Monash University, Clayton Campus, Clayton, Victoria, Australia
| | - Zahid Ansari
- Victorian Agency for Health Information, Melbourne, Victoria, Australia
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Guttman MP, Larouche J, Lyons F, Nathens AB. Early fixation of traumatic spinal fractures and the reduction of complications in the absence of neurological injury: a retrospective cohort study from the American College of Surgeons Trauma Quality Improvement Program. J Neurosurg Spine 2020; 34:117-126. [PMID: 32858512 DOI: 10.3171/2020.5.spine191440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The optimal timing of operative stabilization of patients with traumatic spinal fractures without spinal cord injury (SCI) has not been established. The challenges of early operative intervention, which may require prone positioning in a patient with multisystem injuries, must be balanced with the disadvantages of prolonged immobilization. The authors set out to define the optimal timing of surgical repair of traumatic spinal fractures in patients without SCI and the effect of delayed repair on the incidence of major complications. METHODS A retrospective cohort study was conducted using data derived from the American College of Surgeons Trauma Quality Improvement Program. Adult trauma patients who underwent operative fixation of a spinal fracture within 7 days of admission were included. Patients with SCI were excluded. The primary outcome was the occurrence of a major complication. Secondary outcomes included death and length of stay. Restricted cubic splines were used to model the nonlinear effects of time to spinal fixation and determine a threshold beyond which stabilization was associated with a higher rate of major complications. Logistic regression and propensity score matching were then used to derive estimates for the association between delayed fixation and major complications. RESULTS The authors identified 19,310 patients treated at 389 centers who met the inclusion criteria. Modeling identified fixation beyond 24 hours as a risk for major complications. Adjusting for potential confounders using multivariable logistic regression showed that late fixation was associated with a 1.30 (95% CI 1.15-1.46) times increased odds of developing a major complication. After propensity score matching, late fixation remained associated with a 1.25 (95% CI 1.13-1.39) times increased risk of experiencing a major complication. CONCLUSIONS In the absence of clear contraindications, surgeons should strive to stabilize traumatic spinal fractures without SCI within 24 hours. Early fixation can be expected to reduce major complications by 25%-30%.
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Affiliation(s)
- Matthew P Guttman
- 1Institute of Health Policy, Management, and Evaluation, and
- Divisions of2General Surgery and
| | | | | | - Avery B Nathens
- 1Institute of Health Policy, Management, and Evaluation, and
- Divisions of2General Surgery and
- 4Sunnybrook Research Institute, Toronto, Ontario, Canada; and
- 5American College of Surgeons, Chicago, Illinois
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Trevino CM, Cooros JC, Chesney SA, deRoon-Cassini T, Carver TW, Milia DJ. A Call to Follow-Up: Results Regarding Trauma Clinic Follow-Up Patterns. J Trauma Nurs 2020; 26:290-296. [PMID: 31714489 DOI: 10.1097/jtn.0000000000000467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to assess the current practice pattern regarding posthospitalization follow-up of trauma patients among the members of the Eastern Association for the Surgery of Trauma (EAST). An anonymous online multiple-choice survey of EAST members in 2016 was conducted. Ten questions relating to the follow-up care of injured patients were presented to the Active, Senior, and Associate members of EAST. Data were screened for quantitative concerns prior to analysis. Of the 1,610 members surveyed, 289 responded (18%). Approximately 52% of respondents stated that their institution has a dedicated trauma follow-up clinic where most injured patients are seen after discharge. Less than 20% reported that nontrauma multidisciplinary providers are present in clinics. Most (89.5%) reported that follow-up is a single visit, unless a patient has long-standing issues. Only 3 respondents stated that patients are regularly seen 3+ months out from injury, and a significant minority (17.7%) acknowledged no set follow-up timeline. Only 3.6% of participants indicated that they have a psychologist embedded in the trauma team, and 11.5% reported that no system is currently in place to manage mental health. Despite more than 20 years of literature highlighting the long-term physical and mental health sequelae after trauma, these survey results demonstrate that there is a lack of standardized and multidisciplinary follow-up. Given the improvement in outcomes with the identification and treatment of these sequelae, greater attention should be paid to functional recovery, social and psychological well-being, and chronic pain.
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Affiliation(s)
- Colleen M Trevino
- Medical College of Wisconsin, Milwaukee (Drs Trevino, deRoon-Cassini, Carver, and Milia); Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Dr Cooros); and Marquette University, Milwaukee, Wisconsin (Ms Chesney)
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Incidence of post-traumatic pneumonia in poly-traumatized patients: identifying the role of traumatic brain injury and chest trauma. Eur J Trauma Emerg Surg 2019; 46:11-19. [PMID: 31270555 PMCID: PMC7223163 DOI: 10.1007/s00068-019-01179-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/24/2019] [Indexed: 11/21/2022]
Abstract
Purpose Traumatic brain injury (TBI) and chest trauma are common injuries in severely injured patients. Both entities are well known to be associated with severe post-traumatic complications, including pneumonia, a common complication with a significant impact on the further clinical course. However, the relevance of TBI, chest trauma and particularly their combination as risk factors for the development of pneumonia and its impact on outcomes are not fully elucidated. Methods A retrospective analysis of poly-traumatized patients treated between 2010 and 2015 at a level I trauma centre was performed. Inclusion criteria were: Injury Severity Score ≥ 16 and age ≥ 18 years. TBI and chest trauma were classified according to the Abbreviated Injury Scale. Complications (i.e. acute respiratory distress syndrome (ARDS), multi-organ dysfunction syndrome (MODS) and pneumonia) were documented by a review of the medical records. The primary outcome parameter was in-hospital mortality. Results Over the clinical course, 19.9% of all patients developed pneumonia, and in-hospital mortality was 25.3%. Pneumonia (OR 5.142, p = 0.001) represented the strongest independent predictor of in-hospital mortality, followed by the combination of chest injury and TBI (OR 3.784, p = 0.008) and TBI (OR 3.028, p = 0.010). Chest injury alone, the combination of chest injury and TBI, and duration of ventilation were independent predictors of pneumonia [resp. OR 4.711 (p = 0.004), OR 4.193 (p = 0.004), OR 1.002 (p < 0.001)]. Conclusions Chest trauma alone and especially its combination with TBI represent high-risk injury patterns for the development of pneumonia, which forms the strongest predictor of mortality in poly-traumatized patients.
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15
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de Munter L, Polinder S, van de Ree CLP, Kruithof N, Lansink KWW, Steyerberg EW, de Jongh MAC. Predicting health status in the first year after trauma. Br J Surg 2019; 106:701-710. [DOI: 10.1002/bjs.11132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/18/2018] [Accepted: 12/30/2018] [Indexed: 01/19/2023]
Abstract
Abstract
Background
Although mortality rates following major trauma are continuing to decline, a growing number of patients are experiencing long-term disability. The aim of this study was to identify factors associated with health status in the first year following trauma and develop prediction models based on a defined trauma population.
Methods
The Brabant Injury Outcome Surveillance (BIOS) study was a multicentre prospective observational cohort study. Adult patients with traumatic injury were included from August 2015 to November 2016 if admitted to one of the hospitals of the Noord-Brabant region in the Netherlands. Outcome measures were EuroQol Five Dimensions 5D-3L (EQ-5D™ utility and visual analogue scale (VAS)) and Health Utilities Index (HUI) 2 and 3 scores 1 week and 1, 3, 6 and 12 months after injury. Prediction models were developed using linear mixed models, with patient characteristics, preinjury health status, injury severity and frailty as possible predictors. Predictors that were significant (P < 0·050) for one of the outcome measures were included in all models. Performance was assessed using explained variance (R2).
Results
In total, 4883 patients participated in the BIOS study (50·0 per cent of the total), of whom 3366 completed the preinjury questionnaires. Preinjury health status and frailty were the strongest predictors of health status during follow-up. Age, sex, educational level, severe head or face injury, severe torso injury, injury severity, Functional Capacity Index score, co-morbidity and duration of hospital stay were also relevant in the multivariable models predicting health status. R2 ranged from 35 per cent for EQ-VAS to 48 per cent for HUI 3.
Conclusion
The most important predictors of health status in the first year after trauma in this population appeared to be preinjury health status and frailty.
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Affiliation(s)
- L de Munter
- Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - S Polinder
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - C L P van de Ree
- Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - N Kruithof
- Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - K W W Lansink
- Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, the Netherlands
| | - E W Steyerberg
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - M A C de Jongh
- Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, the Netherlands
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Berger-Estilita J, Granja C, Gonçalves H, Dias CC, Aragão I, Costa-Pereira A, Orwelius L. A new global health outcome score after trauma (GHOST) for disability, cognitive impairment, and health-related quality of life: data from a prospective cross-sectional observational study. Brain Inj 2019; 33:922-931. [PMID: 30810390 DOI: 10.1080/02699052.2019.1581257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background:Trauma patients experience morbidity related to disability and cognitive impairment that negatively impact their health-related quality of life (HRQoL). We assessed the impact of trauma on disability, cognitive impairment and HRQoL after intensive care in patients with and without traumatic brain injury (TBI) and created a predictive score to identify patients with worse outcome. Methods:We identified 262 patients with severe trauma (ISS>15) admitted to the emergency room of a level 1 trauma center. Patients above 13 years were included. After 6 months, patients were assessed for disability, cognitive impairment, and HRQoL. A global health outcome score after trauma (GHOST) was obtained through the combination of these domains. Logistic regression analysis was considered for the effect of demographic, trauma and hospital factors on global outcome. p > 0.05. Statistics performed with SPSS 23.0. Results:Patients with the worst outcomes were older and had a longer length of Intensive Care Unit (ICU) stay. The effect of gender was found in all "GHOST dimensions". TBI was not significantly associated with worse outcome. Conclusions:No significant differences were seen on disability, cognitive impairment and decreased HRQoL in patients with or without TBI. Our GHOST score showed that female gender, older age, and longer ICU stay were significantly associated with the worst outcome. Abbreviations: AIS: Abbreviated Injury Scale; EQ-5D: EuroQol 5-dimensions; EQ-5D-3L: EuroQol 5-dimensions 3-levels; GCS: Glasgow Coma Scale; GOSE: Glasgow Outcome Scale Extended; HRQoL: Health-Related Quality of Life; ICU: Intensive Care Unit; ISS: Injury Severity Score; MMS: Mini Mental State; NICE: National Institute for Health and Care Excellence; RTS: Revised Trauma Score; TBI: Traumatic brain injury; TRISS: Trauma Injury Severity Score; VAS: Visual Analogue Scale.
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Affiliation(s)
- Joana Berger-Estilita
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,b Department of Emergency and Intensive Care Medicine , Algarve University Hospital Centre , Faro , Portugal
| | - Cristina Granja
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,b Department of Emergency and Intensive Care Medicine , Algarve University Hospital Centre , Faro , Portugal.,c Department of Biomedical Sciences and Medicine , University of Algarve , Faro , Portugal
| | - Hernâni Gonçalves
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,d Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine , University of Porto , Porto , Portugal
| | - Claudia Camila Dias
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,d Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine , University of Porto , Porto , Portugal
| | - Irene Aragão
- e Intensive Care Unit, Hospital Santo Antonio , Porto University Hospital Center , Porto , Portugal
| | - Altamiro Costa-Pereira
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,d Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine , University of Porto , Porto , Portugal
| | - Lotti Orwelius
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,f Department of Intensive Care , County Council of Östergötland , Linköping , Sweden.,g Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
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17
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The Location and Timing of Failure-to-Rescue Events Across a Statewide Trauma System. J Surg Res 2018; 235:529-535. [PMID: 30691839 DOI: 10.1016/j.jss.2018.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/31/2018] [Accepted: 10/08/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Failure to rescue (FTR) refers to death after a major complication. Defining the optimal context in which to reduce FTR after injury requires knowledge of where and when FTR events occur. MATERIALS AND METHODS Retrospective observational study of patients >16 y with a minimum Abbreviated Injury Score ≥2 at all 30 level I and II Pennsylvania trauma centers (2007-2015). Location and timing of the first major complication were collected. Complication, mortality, and FTR rates were calculated by location (prehospital, emergency department, operating room, stepdown unit, interventional radiology, intensive care unit (ICU), radiology, and the surgical ward) and by postadmission day. Kruskal-Wallis and chi-squared tests were used to compare variables. RESULTS Major complications occurred in 15,388 of 178,602 (8.6%) patients. The median age was 58 y (interquartile range [IQR] 37-77 y), 78% were Caucasian, 68% were male, 89% were bluntly injured, and the median Injury Severity Score was 19 (IQR 10-29). Death occurred in 2512 of 15,388 patients with a major complication, for an FTR rate of 16.3%. Compared with non-FTR, FTR had earlier major complications (median day 2 [IQR 0-5 d] versus day 4 [IQR 2-8 d], P < 0.001). FTR rates were highest in the prehospital setting (42%), the operating room (33%), and the emergency department (32%), but the greatest number (1608 of 2512 total FTR events, 64%) occurred in the ICU. Pulmonary (32%) and cardiac (26%) complications most frequently contributed to FTR deaths. CONCLUSIONS Interventions designed to reduce FTR after injury should focus on pulmonary and cardiac complications in the ICU.
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Palmer CS, Gabbe BJ, Cameron PA. Revised Functional Capacity Index as a predictor of outcome following injury. Br J Surg 2017; 104:1874-1883. [PMID: 29023636 DOI: 10.1002/bjs.10638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/26/2017] [Accepted: 05/31/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Assessment of functional outcomes in survivors of severe injury is an identified priority for trauma systems. The predictive Functional Capacity Index (pFCI) within the 2008 Abbreviated Injury Scale dictionary (pFCI08) offers a widely available tool for predicting functional outcomes without requiring long-term follow-up. This study aimed to assess the 12-month functional outcome predictions of pFCI08 in a major trauma population, and to test the assumptions made by its developers to ensure population homogeneity. METHODS Patients with major trauma from Victoria, Australia, were followed up using routine telephone interviews. Assessment of survivors 12 months after injury included the Glasgow Outcome Scale - Extended (GOS-E). κ scores were used to measure agreement between pFCI08 and assessed GOS-E scores. RESULTS Of 20 098 patients with severe injury, 12 417 had both pFCI08 and GOS-E scoring available at 12 months. The quadratic weighted κ score across this population was 0·170; this increased to 0·244 in the subgroup of 1939 patients who met all pFCI assumptions. However, expanding the age range used in this group did not significantly affect κ scores until patients over the age of 70 years were included. DISCUSSION The pFCI08 has only a slight agreement with outcomes following major trauma. However, the age limits in the pFCI development assumptions are unnecessarily restrictive. The pFCI08 may be able to contribute to future systems predicting functional outcomes following severe injury, but is likely to explain only a small proportion of the variability in patient outcomes.
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Affiliation(s)
- C S Palmer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Trauma Service, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - B J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Farr Institute - Centre for Improving Population Health through E-Health Research (CIPHER), College of Medicine, Swansea University, Swansea, UK
| | - P A Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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Abstract
BACKGROUND Suicide is currently a topic of high priority for policy-makers, researchers and clinicians. The World Health Organization estimated 804,000 suicide deaths worldwide in 2012. Some studies that focused on patients with self-inflicted injury revealed that mortality in this group is higher than for patients who sustain unintentional injury. However little is known about the impact of psychiatric disorders on health care resources including length of hospital stay. OBJECTIVES To determine whether trauma patients with a psychiatric disorder or after attempting suicide are at higher risk of a complicated course than patients without a psychiatric disorder or accidental cause. The secondary objective was to provide an overview of the current literature on the same group of trauma patients with psychiatric comorbidity in regard to mortality rate, length of stay, hospital costs and quality of life. Our primary outcome measure, complicated course, was found to be most clinically relevant. METHODS We searched PubMed, Embase and PsycInfo electronic databases. All searches were updated to March 2016. The methodological quality was assessed using the QUIPS tool. RESULTS Our search identified 9284 articles (PubMed 3660, Embase 2590, PsycInfo 3034). Of these, 18 articles were included. Four studies investigated the association between psychiatric disorders and a complicated course after trauma, three found a significant higher risk of complications. Mortality was reviewed in 14 studies, of which seven showed significant higher risk of in-hospital mortality for trauma patients with psychiatric disorder. Eight of nine studies found significant prolonged length of stay for these patients. CONCLUSION Patients who have a psychiatric disorder or who have attempted suicide are at higher risk of increased in-hospital mortality and prolonged length of stay after sustaining injuries. These patients also tend to be at higher risk of complications after severe trauma, however future research is needed to confirm these potentially important implications. LEVEL OF EVIDENCE Systematic review, level III.
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20
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Chung JJ, Earl-Royal EC, Delgado MK, Pascual JL, Reilly PM, Wiebe DJ, Holena DN. Where We Fail: Location and Timing of Failure to Rescue in Trauma. Am Surg 2017. [DOI: 10.1177/000313481708300319] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Failure to rescue (FTR) is an outcome metric that reflects a center's ability to prevent mortality after a major complication. Identifying the timing and location of FTR events could help target efforts to reduce FTR rates. We sought to characterize the timing and location of FTR occurrences at our center, hypothesizing that FTR rates would be highest early after injury and in settings of lower intensity of care. We used data, prospectively collected from 2009 to 2013, on patients ≥16 years old with minimum Abbreviated Injury Score ≥2 from a single institution. Major complications (per Pennsylvania Trauma Systems Foundation definitions), mortality, and FTR rates were examined by location [prehospital, emergency department, operating room, intensive care unit (ICU), and interventional radiology] and by day post admission. Kruskal-Wallis and chi-squared tests were used to compare variables (P = 0.05). Major complications occurred in 899/6150 (14.6%) of patients [median age: 42, interquartile range (IQR): 25–57; 56% African American, 73% male, 76% blunt; median Injury Severity Score: 10, IQR: 5–17]. Of 899, 111 died (FTR = 12.4%). Compared with non-FTR cases, FTR cases had earlier complications (median day 1 (IQR: 0–4) versus 5 (IQR: 2–8), P < 0.001). FTR rates were highest in the prehospital (55%), emergency department (38%), and operating room (36%) settings, but the greatest number of FTR cases occurred in the ICU (52/111, 47%). FTR rates were highest early after injury, but the majority of cases occurred in the ICU. Efforts to reduce institutional FTR rates should focus on complications that occur in the ICU setting.
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Affiliation(s)
- Jennifer J. Chung
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily C. Earl-Royal
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - M. Kit Delgado
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- The Penn Injury Science Center at the University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jose L. Pascual
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick M. Reilly
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas J. Wiebe
- The Penn Injury Science Center at the University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel N. Holena
- The Penn Injury Science Center at the University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Palmer CS, Cameron PA, Gabbe BJ. A review of the revised Functional Capacity Index as a predictor of 12 month outcomes following injury. Injury 2017; 48:591-598. [PMID: 28118984 DOI: 10.1016/j.injury.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/26/2016] [Accepted: 01/01/2017] [Indexed: 02/02/2023]
Abstract
The measurement of functional outcomes following severe trauma has been widely recognised as a priority for countries with developed trauma systems. In this respect, the Functional Capacity Index (FCI), a multi-attribute index which has been incorporated into the most recent Abbreviated Injury Scale (AIS) dictionary, is potentially attractive as it offers 12-month functional outcome predictions for patients captured by existing AIS-coded datasets. This review paper outlines the development, construction and validation of the predictive form of the FCI (termed the pFCI), the modifications made which produced the currently available 'revised' pFCI, and the extent to which the revised pFCI has been validated and used. The original pFCI performed poorly in validation studies. The revised pFCI does not address many of the identified limitations of the original version, and despite the ready availability of a truncated version in the AIS dictionary, it has only been used in a handful of studies since its introduction several years ago. Additionally, there is little evidence for its validity. It is suggested that the pFCI should be better validated, whether in the narrow population group of young, healthy individuals for which it was developed, or in the wider population of severely injured patients. Methods for accounting for the presence of multiple injures (of which two have currently been used) should also be evaluated. Many factors other than anatomical injury are known to affect functional outcomes following trauma. However, it is intuitive that any model which attempts to predict the ongoing morbidity burden in a trauma population should consider the effects of the injuries sustained. Although the revised pFCI potentially offers a low-cost assessment of likely functional limitations resulting from anatomical injury, it must be more rigorously evaluated before more comprehensive predictive tools can be developed from it.
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Affiliation(s)
- Cameron S Palmer
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Trauma Service, Royal Children's Hospital Melbourne, Parkville, Australia.
| | - Peter A Cameron
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Belinda J Gabbe
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Farr Institute - CIPHER, College of Medicine, Swansea University, Swansea, United Kingdom.
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Kruithof N, de Jongh MAC, de Munter L, Lansink KWW, Polinder S. The effect of socio-economic status on non-fatal outcome after injury: A systematic review. Injury 2017; 48:578-590. [PMID: 28077211 DOI: 10.1016/j.injury.2017.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Over the past decades, the number of survivors of injuries has rapidly grown. It has become important to focus more on the determinants of non-fatal outcome. Although socio-economic status (SES) is considered to be a fundamental determinant of health in general, the role of SES as a determinant of non-fatal outcome after injury is largely unknown. METHODS An online search was conducted in November 2015 using Embase, Medline, Web of Science, Cinahl, Cochrane, Google scholar and PubMed. Studies examining the relation between SES and a physical or psychological outcome measure, or using SES as a confounder in a general trauma population were included. There were no restrictions regarding study design. The 'Quality in Prognostic Studies tool' was used to assess the methodological quality of the included studies. RESULTS The 24 included studies showed large variations in methodological quality. The number of participants ranged from 56 to 4639, and assessments of the measures ranged from immediately to 6year post-injury. Studies used a large number of variables as indicators of SES. Participant's educational level was used most frequently. The majority of the studies used a multivariable technique to analyse the relation between SES and non-fatal outcome after injury. All studies found a positive association (80% of studies significant, n=19) between increased SES and better non-fatal outcome after injury. CONCLUSION Although an adequate and valid measure of SES is lacking, the results of this review showed that SES is an important determinant of non-fatal outcome after injury. Future research should focus on the definition and measurement of SES and should further underpin the effect of SES on non-fatal outcome after injury.
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Affiliation(s)
- N Kruithof
- Elisabeth-TweeSteden Hospital, Department Trauma TopCare, Tilburg, the Netherlands.
| | - M A C de Jongh
- Elisabeth-TweeSteden Hospital, Department Trauma TopCare, Tilburg, the Netherlands; Brabant Trauma Registry, Network Emergency Care Brabant, the Netherlands
| | - L de Munter
- Elisabeth-TweeSteden Hospital, Department Trauma TopCare, Tilburg, the Netherlands
| | - K W W Lansink
- Elisabeth-TweeSteden Hospital, Department Trauma TopCare, Tilburg, the Netherlands; Brabant Trauma Registry, Network Emergency Care Brabant, the Netherlands; Elisabeth-TweeSteden Hospital, Department of Surgery, Tilburg, the Netherlands
| | - S Polinder
- Erasmus MC, Department of Public Health, Rotterdam, the Netherlands
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Frattari A, Parruti G, Erasmo R, Guerra L, Polilli E, Zocaro R, Iervese G, Fazii P, Spina T. Recurring septic shock in a patient with blunt abdominal and pelvic trauma: how mandatory is source control surgery?: a case report. J Med Case Rep 2017; 11:49. [PMID: 28222811 PMCID: PMC5320692 DOI: 10.1186/s13256-017-1206-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/07/2017] [Indexed: 12/29/2022] Open
Abstract
Background In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different tools for sepsis management may allow survival until complete source control. Case presentation A 42-year-old white man presented with traumatic hemorrhagic shock. Unstable pelvic fractures led to emergency stabilization surgery. Fever ensued with diarrhea, followed by septic shock. Two weeks later, an abdominal computed tomography scan revealed suprapubic and ischiatic abscesses at surgical sites, as well as dilated bowel. Debridement of both surgical sites, performed with vacuum-assisted closure therapy, yielded isolates of carbapenem and colistin-resistant Klebsiella pneumoniae. Antibiotic treatment was de-escalated after 21 days; 4 days later fever, leukocytosis, hypotension and acute renal failure relapsed. Blood purification techniques were started, for the removal of endotoxin and inflammatory mediators, with sequential hemodialysis. Clinical improvement ensued; blood cultures yielded Candida albicans and multidrug-resistant Acinetobacter baumannii; panresistant carbapenemase-producing Klebsiella pneumoniae grew from wound swabs. In spite of shock reversal, our patient remained febrile, with diarrhea. Control blood cultures yielded Candida albicans, Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae. His abdominal pain increased, paralleled by a right flank palpable mass. Colonoscopy revealed patchy serpiginous ulcers. At exploratory laparotomy, an inflammatory post-traumatic pseudotumor of his right colon was removed. Blood cultures turned negative after surgery. Septic shock, however, relapsed 4 days later. A blood purification cycle was repeated and combination antimicrobial therapy continued. Surgical wounds and blood cultures were persistently positive for carbapenem-resistant Klebsiella pneumoniae. Removal of pelvic synthesis media was therefore anticipated. Three weeks later, clinical, microbiological, and biochemical evidence of infection resolved. Conclusions High quality intensive assistance for sepsis episodes needs a clear plan of cure, aimed to complete infection source control, in a complex multidisciplinary interplay of specialists and intensive care physicians.
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Affiliation(s)
- Antonella Frattari
- Unit of Anaesthesia and Intensive Care, Santo Spirito Hospital, Via Fonte Romana 8, Pescara, Italy.
| | - Giustino Parruti
- Unit of Infectious Diseases, Santo Spirito Hospital, Via Fonte Romana 8, Pescara, Italy
| | - Rocco Erasmo
- Unit of Orthopedics and Traumatology, Santo Spirito Hospital, Via Fonte Romana 8, Pescara, Italy
| | - Luigi Guerra
- Unit of Orthopedics and Traumatology, Santo Spirito Hospital, Via Fonte Romana 8, Pescara, Italy
| | - Ennio Polilli
- Unit of Infectious Diseases, Santo Spirito Hospital, Via Fonte Romana 8, Pescara, Italy
| | - Rosamaria Zocaro
- Unit of Anaesthesia and Intensive Care, Santo Spirito Hospital, Via Fonte Romana 8, Pescara, Italy
| | - Giuliano Iervese
- Unit of Anaesthesia and Intensive Care, Santo Spirito Hospital, Via Fonte Romana 8, Pescara, Italy
| | - Paolo Fazii
- Unit of Microbiology, Santo Spirito Hospital, Via Fonte Romana 8, Pescara, Italy
| | - Tullio Spina
- Unit of Anaesthesia and Intensive Care, Santo Spirito Hospital, Via Fonte Romana 8, Pescara, Italy
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Examining the relationship between preinjury health and injury-related factors to discharge location and risk for injury-associated complications in patients after blunt thoracic trauma: a pilot study. J Trauma Nurs 2016; 22:136-47. [PMID: 25961480 DOI: 10.1097/jtn.0000000000000124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether preinjury health and injury-related factors were associated with posthospitalization discharge location and injury-associated complications for patients with blunt thoracic trauma. METHODS A retrospective analysis using registry data from a level 1 trauma center was conducted. A random sample of 200 patients admitted between 2009 and 2012 was included. Relationships between variables were assessed through cross-tabulation with the chi-square analysis; a P value <.05 was considered statistically significant. RESULTS Alcohol/drug use was related to hospital discharge location. Most patients with alcohol involved injuries discharged to locations other than home or long-term care facilities. Of the 59 patients who required intensive care, their length of stay was less than 3 days, and 24 required mechanical ventilation for short periods. Most blunt thoracic trauma patients were hospitalized less than 7 days. A relationship was identified between discharge location and the presence of any of the National Trauma Databank comorbid conditions and the comorbid condition of bleeding. A relationship between rib fractures and injury-associated complications was not found. The complication of pneumonia was related to length of stay and primary payment method. CONCLUSION Comorbid medical conditions and injury-related factors were associated with injury-related complications and discharge location for select variables. Further exploration with is needed to elucidate the associations more fully.
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Validation of Complications Selected by Consensus to Evaluate the Acute Phase of Adult Trauma Care: A Multicenter Cohort Study. Ann Surg 2016; 262:1123-9. [PMID: 25243558 DOI: 10.1097/sla.0000000000000963] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Evaluate the predictive validity of complications derived using expert consensus methodology to monitor the quality of trauma care. Secondary objectives were to assess the predictive validity of complications not selected by consensus and identify determinants of complications. BACKGROUND A list of complications to monitor the quality of trauma care has recently been derived using Delphi consensus methodology. However, the predictive validity of consensus complications has not yet been demonstrated. METHODS We conducted a multicenter cohort study of adults admitted to the 57 adult trauma centers of a Canadian integrated trauma system (2007-2012; n = 84,216). Multiple generalized linear models were used to assess the influence of complications on mortality and acute care length of stay (LOS) and to identify determinants of consensus complications. RESULTS The presence of at least 1 consensus complication was associated with a 2.7-fold [95% confidence interval (CI): 2.45-2.90] and 2.2-fold (95% CI: 2.11-2.19) increase in the odds of mortality and mean LOS, respectively. Nonselected complications were associated with no increase in mortality (odds ratio = 0.90, 95% CI: 0.80-1.01) and a 60% increase in LOS (geometric mean ratio = 1.60, 95% CI: 1.57-1.62). Patient-related factors and factors related to treatment explained 66% and 34% of the variation in complication rates, respectively. CONCLUSIONS In addition to the face and content validity ensured by consensus methodology, this study suggests that consensus complications have good predictive validity. Monitoring these complications as part of quality improvement activities would provide an opportunity to improve outcome and resource use for injury admissions.
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Jagnoor J, De Wolf A, Nicholas M, Maher CG, Casey P, Blyth F, Harris IA, Cameron ID. Restriction in functioning and quality of life is common in people 2 months after compensable motor vehicle crashes: prospective cohort study. Inj Epidemiol 2015; 2:8. [PMID: 27747740 PMCID: PMC5005668 DOI: 10.1186/s40621-015-0042-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/01/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We sought to identify the role of pre-injury socio-demographic and health characteristics, and injury severity in determining health-related quality-of-life outcomes for mild to moderate injuries 2 months after a motor vehicle crash in a compensable setting. METHODS People aged 17 years and older, injured with a New Injury Severity Score of 8 or less, in a motor vehicle crash in New South Wales and who had registered a claim with the Compulsory Third Party Insurance scheme from March to December 2010 were contacted to participate in the study. Information for 364 eligible participants was primarily collected through telephone interview, approximately 2 months after injury. RESULTS Substantial proportions of participants continued to have adverse outcomes approximately 2 months after their injury with mean Short Form Health Survey (SF-12) physical component score of 36.7 (SD ±10.3), SF-12 mental component score of 46.6 (SD ±11), Euro Qol (EQ) analogue scale score of 65.8 (SD ±18) and Euro Qol five dimension (EQ-5D) summary score of 0.70 (SD ±10). Key factors predicting adverse outcomes were prior chronic illness, obesity, hospitalisation and self-perceived threat to life due to injury. CONCLUSIONS This study highlights the substantial impact of apparently "minor" motor vehicle crash injuries in a compensable setting and suggests targets for studies of tertiary prevention to improve health-related quality-of-life outcomes.
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Affiliation(s)
- Jagnoor Jagnoor
- John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
| | - Annelies De Wolf
- John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
| | | | - Chris G Maher
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Petrina Casey
- John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
| | | | - Ian A Harris
- University of New South Wales, Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
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Abedzadeh-Kalahroudi M, Razi E, Sehat M, Asadi Lari M. Measurement of Disability and Its Predictors Among Trauma Patients: A Follow-up Study. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e29393. [PMID: 26566513 PMCID: PMC4636854 DOI: 10.5812/atr.29393] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/30/2015] [Accepted: 06/09/2015] [Indexed: 12/03/2022]
Abstract
Background: Globally more than a billion people, 15% of the population, lives with disability and most of disabilities are caused by injuries. Objectives: The aim of this study was to describe the prevalence of disability and its predictors at 1 and 3 months post-injury in Kashan City during 2014 - 2015. Patients and Methods: In this longitudinal follow-up study, 400 injured patients 15 - 65 years referred to Shahid Beheshti hospital in Kashan and hospitalized more than 24 hours were assessed for disability status with the WHODAS II 12-item instrument at 1 and 3-months post-injury. Patients based on their disability scores were divided into 5 groups: none, mild, moderate, severe and very severe. Work status was assessed at the 3-month follow-up with one question “Are you back at work following your injury”. Also, demographic characteristics and information about injury were gathered by a checklist. Data were analyzed using chi-square, Mann-Whitney U, Kruskal Wallis, Pearson correlation coefficient and logistic regression by SPSS software. The significance level was set at P < 0.05. Results: The mean disability scores at 1 and 3 months post-injury was 30.3 (9.2) and 18.8 (8.3), respectively and there was a statistical significant difference between disability status at 1 and 3 months after trauma (P < 0.0001). The rates of return to work in 262 employed patients at 1 and 3 months after injury were 29% and 55.4%, respectively. The disability score showed a statistically significant correlation with Injury Severity Score (ISS) (P < 0.0001), work return (P = 0.033), intensive care unit transfer (P < 0.0001), trauma type (P = 0.001) and age (P = 0.004). Also, age, ISS, duration of hospital stay and injury to extremities were predictors of disability. Conclusions: More than half of the patients were disabled after 3 months of trauma. Elderly patients, patient with severe trauma, and long hospitalization and patients with extremity injuries were high risk for disability.
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Affiliation(s)
| | - Ebrahim Razi
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mojtaba Sehat
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mojtaba Sehat, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155620634, E-mail:
| | - Mohsen Asadi Lari
- School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
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Alghnam S, Wegener ST, Bhalla K, Colantuoni E, Castillo R. Long-term outcomes of individuals injured in motor vehicle crashes: A population-based study. Injury 2015; 46:1503-8. [PMID: 26100209 DOI: 10.1016/j.injury.2015.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/21/2015] [Accepted: 06/02/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite decline in U.S. traffic fatalities, non-fatal injuries remain a main cause of reduced self-reported health. The authors used a nationally representative survey to examine the long-term (≥1 year) implications of traffic injuries on self-care, depression, mobility, pain and activity domains of a widely used measure assessing Health-Related Quality of Life (HRQOL). METHODS 30,576 participants from panels (2000-2002) of the Medical Expenditure Panel Survey (MEPS) were followed for about two years. The associations between reporting a traffic injury in the first follow-up year and the five domains of the Euroqol Health index (EQ-5D) were assessed using mixed logistic models with outcome severe/moderate problem in each domain. Models adjustment variables included age, gender, education, income, diabetes, asthma, smoking and insurance status. RESULTS 590 participants reported traffic injuries. In the first follow-up analysis, having an injury was associated with deficits in all domains of the EQ-5D. With the exception of self-care, similar findings were reported in the second follow-up (≥1 year) after injuries with strongest associations between traffic injuries and both mobility and activity (both OR=2.9, P<0.01). CONCLUSIONS Traffic injuries are significantly associated with long-term reduced HRQOL. Injured individuals may benefit from early intervention programs to prevent the development of secondary complications and reduced HRQOL.
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Affiliation(s)
- Suliman Alghnam
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, HH 598 624 N. Broadway, Baltimore, MD 21205, USA; King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, KAIMRC, KSAU-HS, Riyadh, Saudi Arabia.
| | - Stephen T Wegener
- Division of Rehabilitation Psychology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Kavi Bhalla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E8138, Baltimore, MD 21205, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E3539, Baltimore, MD 21205, USA
| | - Renan Castillo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, HH 544 624 N. Broadway, Baltimore, MD 21205, USA
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Mörsdorf P, Becker SC, Holstein JH, Burkhardt M, Pohlemann T. [Quality of life after multiple trauma]. Chirurg 2014; 85:208, 210-4. [PMID: 24519611 DOI: 10.1007/s00104-013-2601-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Multiple trauma is an independent injury pattern which, because of its complexity, is responsible for 25 % of the costs for the treatment of all injured patients. Because of the often long-lasting physical impairment and the high incidence of residual permanent handicaps, it is apparent that multiple trauma can lead to a reduction in patient quality of life. OBJECTIVES The aim of this study was to give an overview of the known data concerning the change in quality of life for multiple trauma patients. Furthermore, predictors for the reduction of quality of life after multiple trauma will be identified. MATERIALS AND METHODS A MedLine search was performed to identify studies dealing with the outcome after multiple trauma. RESULTS In addition to functional outcome parameters, the term quality of life has become more important in recent years when it comes to evaluating the outcome following injury. While the mortality after multiple trauma could be significantly reduced over the years, there is no comparable effect on the quality of life. Predictors for a worse quality of life after multiple trauma are female gender, high age, low social status, concomitant head injuries and injury to the lower extremities. CONCLUSION The fact that mortality after multiple trauma has decreased but not impairment of the quality of life makes it clear that in addition to the acute medical treatment, a follow-up treatment including not only physiotherapy but also psychotherapy is crucial for multiple trauma patients.
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Affiliation(s)
- P Mörsdorf
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66424, Homburg/Saar, Deutschland,
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Complications to evaluate adult trauma care: An expert consensus study. J Trauma Acute Care Surg 2014; 77:322-9; discussion 329-30. [PMID: 25058261 DOI: 10.1097/ta.0000000000000366] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Complications affect up to 37% of patients hospitalized for injury and increase mortality, morbidity, and costs. One of the keys to controlling complications for injury admissions is to monitor in-hospital complication rates. However, there is no consensus on which complications should be used to evaluate the quality of trauma care. The objective of this study was to develop a consensus-based list of complications that can be used to assess the acute phase of adult trauma care. METHODS We used a three-round Web-based Delphi survey among experts in the field of trauma care quality with a broad range of clinical expertise and geographic diversity. The main outcome measure was median importance rating on a 5-point Likert scale (very low to very high); complications with a median of 4 or greater and no disagreement were retained. A secondary measure was the perceived quality of information on each complication available in patient files. RESULTS Of 19 experts invited to participate, 17 completed the first (brainstorming) round and 16 (84%) completed all rounds. Of 73 complications generated in Round 1, a total of 25 were retained including adult respiratory distress syndrome, hospital-acquired pneumonia, sepsis, acute renal failure, deep vein thrombosis, pulmonary embolism, wound infection, decubitus ulcers, and delirium. Of these, 19 (76%) were perceived to have high-quality or very high-quality information in patient files by more than 50% of the panel members. CONCLUSION This study proposes a consensus-based list of 25 complications that can be used to evaluate the quality of acute adult trauma care. These complications can be used to develop an informative and actionable quality indicator to evaluate trauma care with the goal of decreasing rates of hospital complications and thus improving patient outcomes and resource use. DRG International Classification of Diseases codes are provided.
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Complications of trauma patients admitted to the ICU in level I academic trauma centers in the United States. BIOMED RESEARCH INTERNATIONAL 2014; 2014:473419. [PMID: 24995300 PMCID: PMC4065752 DOI: 10.1155/2014/473419] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 05/22/2014] [Accepted: 05/22/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aims of this study were to evaluate the complications that occur after trauma and the characteristics of individuals who develop complications, to identify potential risk factors that increase their incidence, and finally to investigate the relationship between complications and mortality. METHODS We did a population-based retrospective study of trauma patients admitted to ICUs of a level I trauma center. Logistic regression analyses were performed to determine independent predictors for complications. RESULTS Of the 11,064 patients studied, 3,451 trauma patients developed complications (31.2%). Complications occurred significantly more in younger male patients. Length of stay was correlated with the number of complications (R = 0.435, P < 0.0001). The overall death rate did not differ between patients with or without complications. The adjusted odds ratio (OR) of developing complication for patients over age 75 versus young adults was 0.7 (P < 0.0001). Among males, traumatic central nervous system (CNS) injury was an important predictor for complications (adjusted OR 1.24). CONCLUSIONS Complications after trauma were found to be associated with age, gender, and traumatic CNS injury. Although these are not modifiable factors, they may identify subjects at high risk for the development of complications, allowing for preemptive strategies for prevention.
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Koo M, Otero I, Sabaté A, Martínez R, Mauro A, García P, López S. Do the severity and the body region of injury correlate with long-term outcome in the severe traumatic patient? Braz J Anesthesiol 2014; 64:134-9. [PMID: 24794459 DOI: 10.1016/j.bjane.2013.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 03/20/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate if the Injury Severity Score (ISS) and the Abbreviated Injury Score (AIS) are correlated with the long-term quality of life in severe trauma patients. METHODS Patients injured from 2005 to 2007 with an ISS≥15 were surveyed 16-24 months after injury. The Health Assessment Questionnaire (HAQ-DI) was used for measuring the functional status and the Short Form-12 (SF-12) was used for measuring the health status divided into its two components, the PCS (Physical Component Summary) and the MCS (Mental Component Summary). The results of the questionnaires were compared with the ISS and AIS components. Results of the SF-12 were compared with the values expected from the general population. RESULTS Seventy-four patients filled the questionnaires (response rate 28%). The mean scores were: PCS 42.6±13.3; MCS 49.4±1.4; HAQ-DI 0.5±0.7. Correlation was observed with the HAQ-DI and the PCS (Spearman's Rho: -0.83; p<0.05) and no correlation between the HAQ-DI and the MCS neither between the MCS and PCS (Spearman's Rho=-0.21; and 0.01 respectively). The cutaneous-external and extremities-pelvic AIS punctuation were correlated with The PCS (Spearman's Rho: -0.39 and -0.34, p<0.05) and with the HAQ-DI (Spearman's Rho: 0.31 and 0.23; p<0.05). The physical condition compared with the regular population was worse except for the groups aged between 65-74 and 55-64. CONCLUSIONS Patients with extremities and pelvic fractures are more likely to suffer long-term disability. The severity of the external injuries influenced the long-term disability.
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Affiliation(s)
- Maylin Koo
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain.
| | - Israel Otero
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
| | - Antoni Sabaté
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
| | - Ruben Martínez
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
| | - Augusto Mauro
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
| | - Pilar García
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
| | - Silvia López
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
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De Boer AS, Schepers T, Panneman MJM, Van Beeck EF, Van Lieshout EMM. Health care consumption and costs due to foot and ankle injuries in the Netherlands, 1986-2010. BMC Musculoskelet Disord 2014; 15:128. [PMID: 24725554 PMCID: PMC3996497 DOI: 10.1186/1471-2474-15-128] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 04/09/2014] [Indexed: 11/22/2022] Open
Abstract
Background Foot and ankle injuries account for a large proportion of Emergency Department attendance. The aim of this study was to assess population-based trends in attendances due to foot and ankle injuries in the Netherlands since 1986, and to provide a detailed analysis of health care costs in these patients. Methods Age- and gender-standardized emergency attendance rates and incidence rates for hospital admission were calculated for each year of the study. Injury cases and hospital length of stay were extracted from the National Injury Surveillance System (non-hospitalized patients) and the National Medical Registration (hospitalized patients). Data were grouped into osseous and ligamentous injuries for foot and ankle separately. An incidence-based cost model was applied to calculate associated direct health care costs. Results Since 1986 the overall emergency attendance rate decreased from 858 to 640 per 100,000 person years. In non-admitted patients (90% of cases), ligamentous injuries approximately halved, whereas osseous injuries increased by 28% (foot) and 25% (ankle). The incidence rate for hospital admission increased by 35%, mainly due to an almost doubling of osseous injuries. Attendance rates showed a peak in adolescents and adults until ~45 years of age in males and (less pronounced) in females. The total number of hospital days decreased to 58,708 days in 2010. Hospital length of stay (HLOS) increased with age and was highest for osseous injuries. HLOS was unaffected by gender, apart for longer stay in elderly females with an osseous ankle injury. Health care costs per case were highest for osseous injuries of the ankle (€ 3,461). Costs were higher for females and increased with age to € 6,023 in elderly males and € 10,949 in elderly females. Main cost determinants were in-hospital care (56% of total costs), rehabilitation/nursing care (15%), and physical therapy (12%). Conclusions Since 1986, the emergency attendance rate of foot and ankle injuries in the Netherlands decreased by 25%. Throughout the years, the attendance rate of (relatively simple) ligamentous injuries strongly reduced, whereas osseous injuries nearly doubled. Attendance rates and health care costs were gender- and age-related. Main cost determinants were in-hospital care, rehabilitation/nursing care, and physical therapy.
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Affiliation(s)
| | | | | | | | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P,O, Box 2040, 3000 CA Rotterdam, The Netherlands.
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Koo M, Otero I, Sabaté A, Martínez R, Mauro A, García P, López S. A gravidade e a região da lesão corporal correlacionam com resultados a longo prazo em paciente com traumatismo grave? Braz J Anesthesiol 2014. [DOI: 10.1016/j.bjan.2013.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Curtis K, Lam M, Mitchell R, Dickson C, McDonnell K. Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis. AUST HEALTH REV 2014; 38:30-7. [DOI: 10.1071/ah13061] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 09/18/2013] [Indexed: 02/03/2023]
Abstract
Objective This research examines the existing funding model for in-hospital trauma patient episodes in New South Wales (NSW), Australia and identifies factors that cause above-average treatment costs. Accurate information on the treatment costs of injury is needed to guide health-funding strategy and prevent inadvertent underfunding of specialist trauma centres, which treat a high trauma casemix. Methods Admitted trauma patient data provided by 12 trauma centres were linked with financial data for 2008–09. Actual costs incurred by each hospital were compared with state-wide Australian Refined Diagnostic Related Groups (AR-DRG) average costs. Patient episodes where actual cost was higher than AR-DRG cost allocation were examined. Results There were 16 693 patients at a total cost of AU$178.7 million. The total costs incurred by trauma centres were $14.7 million above the NSW peer-group average cost estimates. There were 10 AR-DRG where the total cost variance was greater than $500 000. The AR-DRG with the largest proportion of patients were the upper limb injury categories, many of whom had multiple body regions injured and/or a traumatic brain injury (P < 0.001). Conclusions AR-DRG classifications do not adequately describe the trauma patient episode and are not commensurate with the expense of trauma treatment. A revision of AR-DRG used for trauma is needed. What is known about this topic? Severely injured trauma patients often have multiple injuries, in more than one body region and the determination of appropriate AR-DRG can be difficult. Pilot research suggests that the AR-DRG do not accurately represent the care that is required for these patients. What does this paper add? This is the first multicentre analysis of treatment costs and coding variance for major trauma in Australia. This research identifies the limitations of the current AR-DRGS and those that are particularly problematic. The value of linking trauma registry and financial data within each trauma centre is demonstrated. What are the implications for practitioners? Further work should be conducted between trauma services, clinical coding and finance departments to improve the accuracy of clinical coding, review funding models and ensure that AR-DRG allocation is commensurate with the expense of trauma treatment.
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Mental health following traumatic physical injury: an integrative literature review. Injury 2013; 44:1383-90. [PMID: 22409991 DOI: 10.1016/j.injury.2012.02.015] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 02/04/2012] [Accepted: 02/15/2012] [Indexed: 02/02/2023]
Abstract
AIM To investigate the state of knowledge on the relationship between physical trauma and mental health in patients admitted to hospital with traumatic physical injury. BACKGROUND Adults who sustain traumatic physical injury can experience a range of mental health problems related to the injury and subsequent changes in physical health and function. However early screening and identification of mental health problems after traumatic physical injury is inconsistent and not routine during the hospital admission process for the physically injured patient. METHODS Integrative review methods were used. Data were sourced for the period 1995-2010 from EMBASE, CINAHL, MEDLINE and PsycINFO and hand searching of key references. Abstracts were screened by 3 researchers against inclusion/exclusion criteria. Forty-one papers met the inclusion criteria. Data were retrieved, appraised for quality, analysed, and synthesised into 5 main categories. RESULTS Forty-one primary research papers on the relationship between mental health and traumatic physical injury were reviewed. Studies showed that post-traumatic stress disorder, depression and anxiety were frequent sequelae associated with traumatic physical injury. However, these conditions were poorly identified and treated in the acute hospital phase despite their effect on physical health. CONCLUSION There is limited understanding of the experience of traumatic physical injury, particularly in relation to mental health. Greater translation of research findings to practice is needed in order to promote routine screening, early identification and referral to treatment for mental health problems in this patient group.
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Mitchell RJ, Curtis K, Holland AJ, Balogh ZJ, Evans J, Wilson KL. Acute costs and predictors of higher treatment costs for major paediatric trauma in New South Wales, Australia. J Paediatr Child Health 2013; 49:557-63. [PMID: 23758194 DOI: 10.1111/jpc.12280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2013] [Indexed: 02/03/2023]
Abstract
AIMS To describe the costs of acute trauma admissions for children aged ≤15 years in trauma centres; to identify predictors of higher treatment costs and quantify differences in actual and state-wide average cost in New South Wales (NSW), Australia. METHOD Admitted trauma patient data provided by 12 trauma centres was linked with financial data for 2008-2009. Demographic, injury details and injury severity scores (ISS) were obtained from trauma registries. Individual patient costs, Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs were obtained. Actual costs incurred by each hospital were compared with state-wide AR-DRG average costs. Multivariate multiple linear regression identified predictors of cost. RESULTS There were 3493 patients with a total cost of AUD$20.2 million. Falls (AUD$6.7 million) and road trauma (AUD$4.4 million) had the highest total expenditure. The reduction in cost between ISS < 9 compared to ISS 9-12 and ISS > 12 was significant (P < 0.0001). The median cost of injury increased with every additional body region injured (P < 0.0001). For each additional day spent in hospital, there was an increased cost of AUD$1898 and patients admitted to an intensive care unit (ICU) cost AUD$7358 more than patients not admitted to ICU. The total costs incurred by trauma centres were AUD$1.4 million above the NSW peer group average cost estimates. CONCLUSIONS The high financial cost of paediatric patient treatment highlights the need to ensure prevention remains a priority in Australia. Hospitals tasked with providing trauma care should be appropriately funded and future funding models should consider trauma severity.
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Affiliation(s)
- Rebecca J Mitchell
- Transport and Road Safety Research, University of New South Wales, Sydney, NSW 2052, Australia.
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Curtis K, Chan DL, Lam MK, Mitchell R, King K, Leonard L, D'Amours S, Black D. The injury profile and acute treatment costs of major trauma in older people in New South Wales. Australas J Ageing 2013; 33:264-70. [PMID: 24520942 DOI: 10.1111/ajag.12059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To Describe injury profile and costs of older person trauma in New South Wales; quantify variations with peer group costs; and identify predictors of higher costs. METHODS Nine level 1 New South Wales trauma centres provided data on major traumas (aged ≥ 55 years) during 2008-2009 financial year. Trauma register and financial data of each institution were linked. Treatment costs were compared with peer group Australian Refined Diagnostic Related Groups costs, on which hospital funding is based. Variables examined through multivariate analyses. RESULTS Six thousand two hundred and eighty-nine patients were admitted for trauma. Most common injury mechanism was falls (74.8%) then road trauma (14.9%). Median patient cost was $7044 (Q1-3: $3405-13 930) and total treatment costs $76 694 252. Treatment costs were $5 813 975 above peer group average. Intensive care unit admission, age, injury severity score, length of stay and traumatic brain injury were independent predictors of increased costs. CONCLUSION Older person trauma attracts greater costs and length of stay. Cost increases with age and injury severity. Hospital financial information and trauma registry data provides accurate cost information that may inform future funding.
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Affiliation(s)
- Kate Curtis
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia; Department of Surgery, St George Hospital, The George Institute for Global Health, Sydney, New South Wales, Australia; St George Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Moore L, Stelfox HT, Turgeon AF. Complication rates as a trauma care performance indicator: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R195. [PMID: 23072526 PMCID: PMC3682297 DOI: 10.1186/cc11680] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/14/2012] [Indexed: 12/14/2022]
Abstract
Introduction Information on complication rates is essential to trauma quality improvement efforts. However, it is unclear which complications are the most clinically relevant. The objective of this study was to evaluate whether there is consensus on the complications that should be used to evaluate the performance of acute care trauma hospitals. Methods We searched the Medline, EMBASE, Cochrane Central, CINAHL, BIOSIS, TRIP and ProQuest databases and included studies using at least one nonfatal outcome to evaluate the performance of acute care trauma hospitals. Data were extracted in duplicate using a piloted electronic data abstraction form. Consensus was considered to be reached if a specific complication was used in ≥ 70% of studies (strong recommendation) or in ≥ 50% of studies (weak recommendation). Results Of 14,521 citations identified, 22 were eligible for inclusion. We observed important heterogeneity in the complications used to evaluate trauma care. Seventy-nine specific complications were identified but none were used in ≥ 70% of studies and only three (pulmonary embolism, deep vein thrombosis, and pneumonia) were used in ≥ 50% of studies. Only one study provided evidence for the clinical relevance of complications used and only five studies (23%) were considered of high methodological quality. Conclusion Based on the results of this review, we can make a weak recommendation on three complications that should be used to evaluate acute care trauma hospitals; pulmonary embolism, deep vein thrombosis, and pneumonia. However, considering the observed disparity in definitions, the lack of clinical justification for the complications used, and the low methodological quality of studies, further research is needed to develop a valid and reliable performance indicator based on complications that can be used to improve the quality and efficiency of trauma care.
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Curtis K, Mitchell R, Dickson C, Black D, Lam M. Do AR-DRGs adequately describe the trauma patient episode in New South Wales, Australia? Health Inf Manag 2011; 40:7-13. [PMID: 21430303 DOI: 10.1177/183335831104000102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of Diagnosis Related Groups (DRGs) may not be an accurate tool to provide reimbursement for trauma services. This study aimed to determine whether Australian Refined Diagnosis Related Groups (AR-DRGs) adequately describe the trauma patient episode and to identify AR-DRG groupings where reimbursement was not commensurate with actual cost. The AR-DRG allocated costs and actual costs of a sample of 206 trauma patient episodes were reviewed during a three-month period. Of the AR-DRG groups identified in the patient episodes, 62.8% were not commensurate with actual cost incurred, equating to an overall loss of $113,921 from under-funded acute trauma patient episodes over a three-month period. Assault-related penetrating trauma, traffic-related and sport-related incidents were all inadequately reimbursed using AR-DRGs compared with the actual cost of treatment. Cases involving female patients, patients aged 45 years or less and those with moderate injuries were similarly underfunded. AR-DRGs are not adequate to describe the extent of injuries experienced by trauma patients and there is a need to investigate alternative funding models for trauma services.
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Affiliation(s)
- Kate Curtis
- Trauma Service, St George Hospital, Gray St, Kogarah NSW 2217, Australia.
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Abstract
BACKGROUND The primary aim of this study was to assess the health-related quality of life of survivors of severe trauma 1 year after injury, specified according to all the separate dimensions of the EuroQol-5D (EQ-5D) and the Health Utilities Index (HUI). METHODS A prospective cohort study was conducted in which all severely injured trauma patients presented at a Level I trauma center were included. After 12 months, the EQ-5D, HUI2 and HUI3 were used to analyze the health status. RESULTS Follow-up assessments were obtained from 246 patients (response rate, 68%). The overall population EQ-5D (median) utility score was 0.73 (EQ-5D Dutch general population norm, 0.88). HUI2, HUI3, and EQ-5D Visual Analog Scale scores were 0.81, 0.65, and 70, respectively. Eighteen percent had at least one functional limitation 1 year after trauma, and 60% reported functional limitations on two or more domains using the EQ-5D. The female gender and comorbidity were significant independent predictors of disability. CONCLUSION Functional outcome and quality of life of survivors of severe injury have not returned to normal 1 year after trauma. The prevalence of specific limitations in this population is very high (40-70%). Female gender and comorbidity are predictors of long-term disability.
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Tøien K, Bredal IS, Skogstad L, Myhren H, Ekeberg O. Health related quality of life in trauma patients. Data from a one-year follow up study compared with the general population. Scand J Trauma Resusc Emerg Med 2011; 19:22. [PMID: 21477280 PMCID: PMC3088534 DOI: 10.1186/1757-7241-19-22] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 04/08/2011] [Indexed: 11/18/2022] Open
Abstract
Background Trauma patients have impaired health-related quality of life (HRQOL) after trauma. The aim of the study was to assess HRQOL during the first year after trauma and hospital stay in trauma patients admitted to an intensive-care unit (ICU) for >24 hours compared with non-ICU trauma patients and the general population, and to identify predictors of HRQOL. Methods A prospective one-year follow-up study of 242 trauma patients received by the trauma team of a trauma referral centre in Norway was performed. HRQOL was measured using the Medical Outcomes Study Short Form 36 (SF-36) at 3 and 12 months. Results The mean age of the cohort was 42.3 years (95% CI, 40.4-44.3 years). The median Injury Severity Score (ISS) was 10, interquartile range 16. The HRQOL improved significantly from the 3 to the 12 months follow up in the trauma patients. However their scores were significantly lower for most subscales of SF-36 compared to the general population. Significant differences between ICU and non-ICU patients at 12 months were observed only for physical functioning and role physical subscales. Optimism was an independent predictor of good HRQOL at 12 months, in all dimensions (beta, 0.95-2.45). A higher depression score at baseline predicted lower HRQOL in four of eight dimensions (beta -1.1 to -1.70). In addition, better physical functioning was predicted by lower age (beta, -0.20), and having head injury (reference) as the most severe injury vs. spine or extremity injuries (beta, -9.49 and -10.85), and better mental health by higher age (beta, 0.21) and being employed or studying before the trauma (beta, 12.27). In addition to optimism good general health was predicted by lower score for post-traumatic stress (PTS) symptoms at baseline (beta, -0.27) and lower ISS score (beta -10.59). Conclusions The HRQOL improved significantly from the 3 to the 12 months follow up in our sample. However their scores were significantly lower for most subscales of SF-36 compared to the general population. Significant differences between ICU and non-ICU patients were observed for only two subscales. Better HRQOL at 12 months was predicted mainly by optimism, low score for depression and PTS symptoms at baseline. High ISS predicted low general health exclusively.
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Affiliation(s)
- Kirsti Tøien
- Department of Research and Development, Division of Critical Care, Oslo University Hospital, Ulleval Hospital, PO Box 4956, Nydalen, NO-0424 Oslo, Norway.
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Postinjury Depression Is a Serious Complication in Adolescents After Major Trauma: Injury Severity and Injury-Event Factors Predict Depression and Long-Term Quality of Life Deficits. ACTA ACUST UNITED AC 2011; 70:923-30. [DOI: 10.1097/ta.0b013e31820cf03e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Korontzi MI, Kontovounisios C, Karaliotas CC, Lanitis S, Sgourakis G, Papakostantinou T, Karaliotas C. The current management of pancreatic trauma. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s13126-010-0056-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
BACKGROUND Complication registration is an important part of monitoring the quality of health care. The aim of this article was to describe the incidence, type, and impact of complications occurring within 6 months after the initial trauma in multitrauma patients. METHODS During a 2-year period, all trauma patients with an Injury Severity Score (ISS) ≥ 16 who were not directly transferred to other hospitals were included. We used the Dutch National Surgical Complication Registry of the Academic Medical Center, a level 1 trauma center, to assess complications within 6 months after the initial trauma. For verification, we additionally performed a chart review. Complications were graded 0 (no real health loss) to 4 (lethal). RESULTS Three hundred three multitrauma patients were included with a median ISS of 22 (interquartile range, 17-29). Within 181 patients, 358 complications occurred (60%). The most frequently occurring complications were respiratory and urinary tract infections. Most complications (73%) were grade 1 and resolved completely without operative (re-)intervention There were 27 patients (8%) with a grade 2 complication, which required operative (re-)interventions. All eight (2%) grade 3 complications which caused (potential) permanent damage or disability, were of neurologic origin. Overall mortality was 18.8% and complication associated readmission rate was 4%. Emergency interventions and high ISS tended to be associated with the occurrence of complications. In patients with complications, hospital stay was doubled from 9 to 18 days. CONCLUSIONS Multitrauma patients are at high risk for developing complications. Most frequently encountered complications were infections. The majority of complications resolved completely without a surgical intervention.
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Curtis K, Olivier J, Mitchell R, Cook A, Rankin T, Rana A, Watson WL, Nau T. Evaluation of a tiered trauma call system in a level 1 trauma centre. Injury 2011; 42:57-62. [PMID: 20553680 DOI: 10.1016/j.injury.2010.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 04/12/2010] [Accepted: 05/03/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND Appropriate triage of the trauma patient is essential to ensure prompt access to definitive care. Many trauma centres use a "tiered" trauma call protocol with the intention of providing a match between the facility's resources and the needs of the patient. This study describes the incidence and impact of undertriage on the trauma patient in the context of an Australian level 1 trauma centre with a tiered trauma call system. METHODS This was a retrospective analysis of prospective data collected through the Trauma Registry. Undertriage was defined as sustaining an injury severity score greater than 15 and receiving a non optimal response (i.e., trauma standby call or no call). The level of association between outcome measures (such as LOS in ED, time to OT) and the level of trauma call the patient received was assessed using a general linear model, controlling for injury severity and haemodynamic stability. RESULTS Between February 2004 and November 2008, 5233 patients meeting trauma criteria presented to the study hospital. There was an undertriage rate of 42% and overtriage rate of 21%. Patients were more likely to be undertriaged if they were older, self-presented, their cause of injury was assault or their head or chest were their most severely injured body region. Undertriaged patients had a significantly longer LOS in the ED (2 h) than appropriately triaged patients. CONCLUSION The implementation of a tiered trauma call system resulted in significant undertriage,especially if the patient was older, had been assaulted or had a head/chest injury. Undertriaged patients experienced delay to definitive care. This study has highlighted the importance of compliance with trauma team activation criteria, trauma monitoring and evaluation.
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Affiliation(s)
- Kate Curtis
- St George Hospital Trauma Service, Australia.
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Mitchell R, Curtis K, Watson WL, Nau T. Age differences in fall-related injury hospitalisations and trauma presentations. Australas J Ageing 2010; 29:117-25. [PMID: 20815841 DOI: 10.1111/j.1741-6612.2010.00413.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To examine fall-related hospitalised morbidity in New South Wales (NSW) and to describe the pattern of fall-related major trauma presentations at a Level 1 Trauma Centre in NSW for younger and older fallers. METHODS Fall-related injuries were identified in the NSW Admitted Patients Data Collection during 1 July 1999-30 June 2008 and the trauma registry of the NSW St George Public Hospital during 1 January 2006-6 December 2008. RESULTS There were 434 138 hospitalisations and 862 fall-related trauma presentations. Older fallers had a higher incidence of hospitalisation, being more likely to fall on the same level during general activities at home, injuring their hip or thigh. Older fallers were also more likely to have an Injury Severity Score > 9, undergo physiotherapy and stay in hospital for >1 day than younger fallers. CONCLUSION Falls, particularly for older individuals, are an important cause of serious injury, representing a considerable burden in terms of hospitalised morbidity.
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Affiliation(s)
- Rebecca Mitchell
- NSW Injury Risk Management Research Centre, Department of Aviation, University of New South Wales, Sydney, Australia.
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Predictors of Late Clinical Outcome Following Orthopedic Injuries After Multiple Trauma. ACTA ACUST UNITED AC 2010; 69:1243-51. [DOI: 10.1097/ta.0b013e3181ce1fa1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wong CNC, Yu JMK, Law SW, Lau HMC, Chan CKM. Bilateral transtibial amputation with concomitant thoracolumbar vertebral collapse in a Sichuan earthquake survivor. J Orthop Surg Res 2010; 5:43. [PMID: 20630054 PMCID: PMC2917413 DOI: 10.1186/1749-799x-5-43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 07/14/2010] [Indexed: 11/10/2022] Open
Abstract
The devastating earthquake in Sichuan, China on 12 May 2008 left thousands of survivors requiring medical care and intensive rehabilitation. In view of this great demand, the Chinese Speaking Orthopaedic Society established the "Stand Tall" project to provide voluntary services to aid amputee victims in achieving total rehabilitation and social integration. This case report highlights the multidisciplinary rehabilitation of a girl who suffered thoracolumbar vertebral collapse and underwent bilateral transtibial amputation. The rehabilitation team was involved in all stages of the care process from the pre-operative phase, through amputation, into prosthetic training, and during her life thereafter. Despite this catastrophic event, early rehabilitation and specially designed bilateral prostheses allowed her a high level of functional ability. The joint efforts of the multidisciplinary team and the advancement of new technology have revolutionized the care process for amputees.
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Affiliation(s)
- Caroline Ngar-Chi Wong
- Physiotherapy Department, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, PR China.
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Andrew NE, Gabbe BJ, Wolfe R, Cameron PA. Evaluation of Instruments for Measuring the Burden of Sport and Active Recreation Injury. Sports Med 2010; 40:141-61. [DOI: 10.2165/11319750-000000000-00000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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