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Maclennan B, Wyeth E, Derrett S. Health-related quality of life following trauma: Prevalence of problems and factors associated with six-month outcomes in a New Zealand cohort. Injury 2024; 55:111468. [PMID: 38452699 DOI: 10.1016/j.injury.2024.111468] [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: 10/18/2023] [Revised: 02/01/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
Injury is a leading cause of health loss in Aotearoa me Te Waipounamu (New Zealand; NZ). The NZ Trauma Registry was established in 2015 to monitor outcomes in those experiencing severe injury and to identify ways of improving the quality of care for these patients. Few NZ studies have assessed outcomes in trauma patients using patient-reported outcome measures (PROMs) despite increasing recognition that the impacts of injury are better understood through PROMs. Our aim was to estimate the prevalence of self-reported problems with health-related quality of life (HRQoL) outcomes six months post-injury, and identify factors associated with these, in a cohort of Māori (the Indigenous population of NZ) and non-Māori individuals who had experienced major trauma. HRQoL outcomes were measured according to the five dimensions of the EQ-5D-5L. This information, along with sociodemographic data, was collected via structured telephone interviews. Participants (n = 870), aged 16 years or more, were recruited following admission to a trauma hospital in one of three (of NZ's four) trauma regions. Multivariable models were developed using modified Poisson Regression to identify factors associated with outcomes for both Māori and non-Māori patients. The prevalence and severity of problems across each of the five EQ-5D-5L dimensions was similar for Māori and non-Māori except for Anxiety/Depression. The prevalence and severity of problems with Anxiety/Depression was greater for Māori. Factors associated with HRQoL problems at six-months were also largely similar for each cohort. Those commonly associated with outcomes were age, hospital length of stay, adequacy of household income, and participants' expectations regarding recovery from injury. Further research examining recovery expectations in trauma patients to determine which factors contribute to formulating recovery expectations, and the potential impact of recovery expectations on treatment and rehabilitation, would be of value. Should expectations, at least in part, influence HRQoL outcomes, then routinely collecting data on patients' recovery expectations, adequacy of household income and potential barriers to treatment and rehabilitation, could help inform post-hospital treatment plans, and identify those who may require additional support following discharge from hospital.
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Affiliation(s)
- Brett Maclennan
- Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Division of Health Sciences, University of Otago, New Zealand
| | - Emma Wyeth
- Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Division of Health Sciences, University of Otago, New Zealand.
| | - Sarah Derrett
- Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Division of Health Sciences, University of Otago, New Zealand
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Breeding T, Martinez B, Katz J, Nasef H, Santos RG, Zito T, Elkbuli A. The Association Between Gender and Clinical Outcomes in Patients With Moderate to Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. J Surg Res 2024; 295:791-799. [PMID: 38157731 DOI: 10.1016/j.jss.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Traumatic brain injuries (TBIs) are a significant cause of morbidity and mortality in the United States. but have a disproportionate impact on patients based on gender. This systematic review and meta-analysis aim to compare gender differences in clinical outcomes between male and female adult trauma patients with moderate and severe TBI. METHODS Studies assessing gender differences in outcomes following TBIs on PubMed, Google Scholar, EMBASE, and ProQuest were searched. Meta-analysis was performed for outcomes including in-hospital mortality, hospital length of stay, intensive care unit length of stay, and Glasgow outcome scale (GOS) at 6 mo. RESULTS Eight studies were included for analysis with 26,408 female and 63,393 male patients. Meta-analysis demonstrated that males had a significantly lower risk of mortality than females (RR: 0.88; 95% CI 0.78, 0.99; P = 0.0001). Females had a shorter hospital length of stay (mean difference -1.4 d; 95% CI - 1.6 d, -1.2 d). No significant differences were identified in intensive care unit length of stay (mean difference -3.0 d; 95% CI -7.0 d, 1.1 d; P = 0.94) or GOS at 6 mo (mean difference 0.2 d; 95% CI -0.9 d, 1.4 d; P = 1). CONCLUSIONS Compared to male patients, female patients with moderate and severe TBI had a significantly higher in-hospital mortality risk. There were no significant differences in long-term outcomes between genders based on GOS at 6 mo. These findings warrant further investigation into the etiology of these gender disparities and their impact on additional clinical outcome measures.
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Affiliation(s)
- Tessa Breeding
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Brian Martinez
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Joshua Katz
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Hazem Nasef
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Radleigh G Santos
- Department of Mathematics, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Tracy Zito
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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Lotfalla A, Halm JA, Schepers T, Giannakópoulos GF. Parameters influencing health-related quality of life after severe trauma: a systematic review (part II). Eur J Trauma Emerg Surg 2024; 50:93-106. [PMID: 37188975 PMCID: PMC10923745 DOI: 10.1007/s00068-023-02276-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION It is increasingly recognized that health-related quality of life (HRQoL) is a relevant outcome to study in populations comprising severely injured patients. Although some studies have readily demonstrated a compromised HRQoL in those patients, evidence regarding factors that predict HRQoL is scarce. This hinders attempts to prepare patient-specific plans that may aid in revalidation and improved life satisfaction. In this review, we present identified predictors of HRQoL in patients that have suffered severe trauma. METHODS The search strategy included a database search until the 1st of January 2022 in the Cochrane Library, EMBASE, PubMed, and Web of Science, and reference checking. Studies were eligible for inclusion when (HR)QoL was studied in patients with major, multiple, or severe injury and/or polytrauma, as defined by authors by means of an Injury Severity Score (ISS) cut-off value. The results will be discussed in a narrative manner. RESULTS A total of 1583 articles were reviewed. Of those, 90 were included and used for analysis. In total, 23 possible predictors were identified. The following parameters predicted reduced HRQoL in severely injured patients and came forward in at least more than three studies: higher age, female gender, lower extremity injuries, higher rate of injury severity, lower achieved educational level, presence of (pre-existing) comorbidities and mental illness, longer duration of hospital stay, and high level of disability. CONCLUSION Age, gender, injured body region, and severity of injury were found to be good predictors of health-related quality of life in severely injured patients. A patient-centered approach, based on individual, demographic, and disease-specific predictors, is highly recommended.
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Affiliation(s)
- Annesimone Lotfalla
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Jens Anthony Halm
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Georgios Fredericus Giannakópoulos
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Moksnes HØ, Schäfer C, Rasmussen MS, Soberg HL, Røise O, Anke A, Røe C, Næss PA, Gaarder C, Helseth E, Dahl HM, Hestnes M, Brunborg C, Andelic N, Hellstrøm T. Functional Outcomes at 6 and 12 Months Post-Injury in a Trauma Centre Population with Moderate-to-Severe Traumatic Injuries. J Clin Med 2023; 12:5300. [PMID: 37629342 PMCID: PMC10455533 DOI: 10.3390/jcm12165300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
This study aims to evaluate the global functional outcomes after moderate-to-severe traumatic injury at 6 and 12 months and to examine the sociodemographic and injury-related factors that predict these outcomes. A prospective cohort study was conducted in which trauma patients of all ages with a New Injury Severity Score > 9 who were discharged alive from two regional trauma centres in Norway over a one-year period (2020) were included. The Glasgow Outcome Scale Extended (GOSE) score was used to analyse the functional outcomes. Regression analyses were performed to investigate the predictors of the GOSE score. Follow-up assessments were obtained from approximately 85% of the 601 included patients at both time points. The mean (SD) GOSE score was 6.1 (1.6) at 6 months and 6.4 (1.6) at 12 months, which corresponds to an upper-moderate disability. One-half of the patients had a persistent disability at 12 months post-injury. The statistically significant predictors of a low GOSE score at both time points were more pre-injury comorbidity, a higher number of injuries, and higher estimated rehabilitation needs, whereas a thorax injury with an Abbreviated Injury Scale ≥ 3 predicted higher GOSE scores. A high Glasgow Coma Scale score at admission predicted a higher GOSE score at 6 months. This study strengthens the evidence base for the functional outcomes and predictors in this population.
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Affiliation(s)
- Håkon Øgreid Moksnes
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
| | - Christoph Schäfer
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, P.O. Box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Rehabilitation, University Hospital of North Norway, P.O. Box 100, N-9038 Tromsø, Norway
| | - Mari Storli Rasmussen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, N-0130 Oslo, Norway
| | - Helene Lundgaard Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, N-0130 Oslo, Norway
| | - Olav Røise
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway;
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
| | - Audny Anke
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, P.O. Box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Rehabilitation, University Hospital of North Norway, P.O. Box 100, N-9038 Tromsø, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
| | - Pål Aksel Næss
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Traumatology, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Christine Gaarder
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Traumatology, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Neurosurgery, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Hilde Margrete Dahl
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Child Neurology, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Morten Hestnes
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway;
- Oslo University Hospital Trauma Registry, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway;
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
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Kalbas Y, Halvachizadeh S, Kumabe Y, Luidl AT, Steel JL, Zelle BA, Cinelli P, Pape HC, Pfeifer R. Post-traumatic growth in polytraumatized patients after 20+ years: a long-term follow-up study of 337 patients treated at a level 1 trauma center. Eur J Trauma Emerg Surg 2022; 49:1279-1286. [PMID: 35763055 DOI: 10.1007/s00068-022-02022-w] [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: 03/25/2022] [Accepted: 05/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE There is limited research on the long-term psychiatric outcomes of polytraumatized patients. Existing studies focus mainly on the negative sequelae. Post-traumatic growth (PTG) describes positive personal development after severe physical or mental distress. In this study, we investigated post-traumatic growth in polytraumatized patients at least 20 years after trauma. METHODS Patients treated for polytrauma at a German level 1 trauma center between 1971 and 1990, were contacted 20+ years later. A questionnaire with 37 questions from the stress-related growth scale (SRGS) and the post-traumatic growth inventory (PGI) was administered. PTG was quantified in five specific areas. PTG and patient demographics were then analyzed using logistic regression. RESULTS Eligible questionnaires were returned by 337 patients. 96.5% of patients reported improvements regarding at least one of the 37 questions. Approximately, a third of patients noticed distinct improvements regarding their relationship to others (29.2%), appreciation of life (36.2%) and attitudes towards new possibilities (32.5%). Patient demographics were significant predictors for the development of PTG: Older (p < 0.001), female (p = 0.042) and married patients (p = 0.047) showed a greater expression of PTG. We also saw significantly more PTG in patients with higher injury severity (p = 0.033). CONCLUSION 20 years after polytrauma, patients report improvements in their relationship with others, appreciation of life and attitude towards new possibilities. Women and married patients show higher expression of PTG. Furthermore, there is higher expression of PTG with higher age and injury severity. Post-traumatic growth should be identified and fostered in clinical practice. LEVEL OF EVIDENCE III-prospective long-term follow-up study.
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Affiliation(s)
- Yannik Kalbas
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland.
| | - Sascha Halvachizadeh
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Yohei Kumabe
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | | | - Jennifer Lynne Steel
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Boris A Zelle
- Department of Orthopaedics, UT Health San Antonio, Joe R. & Teresa Lozano Long School of Medicine, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Paolo Cinelli
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
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Improving Post-Injury Care: Key Family Caregiver Perspectives of Critical Illness After Injury. Crit Care Explor 2022; 4:e0685. [PMID: 35558737 PMCID: PMC9084436 DOI: 10.1097/cce.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
There is little research about how caregiver experiences evolve from ICU admission to patient recovery, especially among caregivers for patients who have traumatic injuries. In this study, we characterize diverse caregiver experiences during and after ICU admission for injury.
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Ding K, Sur PJ, Mbianyor MA, Carvalho M, Oke R, Dissak-Delon FN, Signe-Tanjong M, Mfopait FY, Essomba F, Mbuh GE, Etoundi Mballa GA, Christie SA, Juillard C, Chichom Mefire A. Mobile telephone follow-up assessment of postdischarge death and disability due to trauma in Cameroon: a prospective cohort study. BMJ Open 2022; 12:e056433. [PMID: 35383070 PMCID: PMC8984008 DOI: 10.1136/bmjopen-2021-056433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES In Cameroon, long-term outcomes after discharge from trauma are largely unknown, limiting our ability to identify opportunities to reduce the burden of injury. In this study, we evaluated injury-related death and disability in Cameroonian trauma patients over a 6-month period after hospital discharge. DESIGN Prospective cohort study. SETTING Four hospitals in the Littoral and Southwest regions of Cameroon. PARTICIPANTS A total of 1914 patients entered the study, 1304 were successfully contacted. Inclusion criteria were patients discharged after being treated for traumatic injury at each of four participating hospitals during a 20-month period. Those who did not possess a cellular phone or were unable to provide a phone number were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The Glasgow Outcome Scale-Extended (GOSE) was administered to trauma patients at 2 weeks, 1 month, 3 months and 6 months post discharge. Median GOSE scores for each timepoint were compared and regression analyses were performed to determine associations with death and disability. RESULTS Of 71 deaths recorded, 90% occurred by 2 weeks post discharge. At 6 months, 22% of patients still experienced severe disability. Median (IQR) GOSE scores at the four timepoints were 4 (3-7), 5 (4-8), 7 (4-8) and 7 (5-8), respectively, (p<0.01). Older age was associated with greater odds of postdischarge disability (OR: 1.23, 95% CI: 1.07 to 1.41) and mortality (OR: 2.15, 95% CI: 1.52 to 3.04), while higher education was associated with decreased odds of disability (OR: 0.65, 95% CI: 0.58 to 0.73) and mortality (OR: 0.38, 95% CI: 0.31 to 0.47). Open fractures (OR: 1.73, 95% CI: 1.38 to 2.18) and closed fractures (OR: 1.83, 95% CI: 1.42 to 2.36) were associated with greater postdischarge disability, while higher Injury Severity Score (OR: 2.44, 95% CI: 2.13 to 2.79) and neurological injuries (OR: 4.40, 95% CI: 3.25 to 5.96) were associated with greater odds of postdischarge mortality. CONCLUSION Mobile follow-up data show significant morbidity and mortality, particularly for orthopaedic and neurologic injuries, up to 6 months following trauma discharge. These results highlight the need for reliable follow-up systems in Cameroon.
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Affiliation(s)
- Kevin Ding
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, USA
| | - Patrick J Sur
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, USA
- Riverside School of Medicine, University of California, Riverside, California, USA
| | | | - Melissa Carvalho
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, USA
| | - Rasheedat Oke
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, USA
| | | | | | - Florentine Y Mfopait
- Department of Surgery, University of Buea Faculty of Health Sciences, Buea, Cameroon
| | - Frank Essomba
- Department of Surgery, University of Buea Faculty of Health Sciences, Buea, Cameroon
| | - Golda E Mbuh
- Department of Surgery, University of Buea Faculty of Health Sciences, Buea, Cameroon
| | | | - S Ariane Christie
- Department of Trauma and Acute Care Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Catherine Juillard
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, USA
| | - Alain Chichom Mefire
- Department of Surgery, University of Buea Faculty of Health Sciences, Buea, Cameroon
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8
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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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9
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Kopka M, Fritz JA, Hiemstra LA, Kerslake S. Female and Younger Orthopaedic Sport Medicine Patients Are More Negatively Affected by COVID-19-Related Health Care Closures. Arthrosc Sports Med Rehabil 2021; 3:e1329-e1335. [PMID: 34254056 PMCID: PMC8264518 DOI: 10.1016/j.asmr.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To determine if sex or age influence whether COVID-19 health care closures affect the health, recovery, and access to resources of pre- and post-operative orthopaedic sport medicine patients. Methods Electronic questionnaires assessing physical and emotional health, the value of virtual care, and access to resources were distributed to patients with postponed (PP) orthopaedic restorative surgeries and those within three-months post-operative (PO) at the time of the COVID-19 health care closures. The EQ-5D-3L was included as a standardized measure of general health. Chi-square tests compared responses between sexes and age groups. Unpaired t-tests compared the EQ VAS by sex, and a one-way analysis of variance (ANOVA) compared the EQ VAS by age. Results Females in the PO group were more likely to report that their recovery was delayed (49.5% vs 36%) and that closures had negatively affected their recovery (p = 0.013). Females in the PP group reported more symptoms of pain/discomfort on the EQ-5D-3L (p = 0.023). In the PP group, patients aged 25 to 44 years were most likely to identify pain as a concern (p = 0.54). In the PO group, patients younger than 45 years reported a significantly lower mean EQ VAS health state ( p = 0.017). For the final analysis, there were 115 subjects in the PP group and 198 in the PO group. Conclusion This study demonstrated significant sex- and age-specific differences in health and recovery among orthopaedic sport medicine patients as a result of the COVID-19 health care closures. Females reported significantly more pain, anxiety, and delay in their rehabilitation, while younger patients reported greater negative impacts and worse overall health state. Level of Evidence IV.
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Affiliation(s)
| | | | - Laurie A Hiemstra
- Banff Sport Medicine, Banff, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
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10
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Moore EE, Moore HB, Kornblith LZ, Neal MD, Hoffman M, Mutch NJ, Schöchl H, Hunt BJ, Sauaia A. Trauma-induced coagulopathy. Nat Rev Dis Primers 2021; 7:30. [PMID: 33927200 PMCID: PMC9107773 DOI: 10.1038/s41572-021-00264-3] [Citation(s) in RCA: 244] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 12/12/2022]
Abstract
Uncontrolled haemorrhage is a major preventable cause of death in patients with traumatic injury. Trauma-induced coagulopathy (TIC) describes abnormal coagulation processes that are attributable to trauma. In the early hours of TIC development, hypocoagulability is typically present, resulting in bleeding, whereas later TIC is characterized by a hypercoagulable state associated with venous thromboembolism and multiple organ failure. Several pathophysiological mechanisms underlie TIC; tissue injury and shock synergistically provoke endothelial, immune system, platelet and clotting activation, which are accentuated by the 'lethal triad' (coagulopathy, hypothermia and acidosis). Traumatic brain injury also has a distinct role in TIC. Haemostatic abnormalities include fibrinogen depletion, inadequate thrombin generation, impaired platelet function and dysregulated fibrinolysis. Laboratory diagnosis is based on coagulation abnormalities detected by conventional or viscoelastic haemostatic assays; however, it does not always match the clinical condition. Management priorities are stopping blood loss and reversing shock by restoring circulating blood volume, to prevent or reduce the risk of worsening TIC. Various blood products can be used in resuscitation; however, there is no international agreement on the optimal composition of transfusion components. Tranexamic acid is used in pre-hospital settings selectively in the USA and more widely in Europe and other locations. Survivors of TIC experience high rates of morbidity, which affects short-term and long-term quality of life and functional outcome.
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Affiliation(s)
- Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA.
- Department of Surgery, University of Colorado Denver, Aurora, CO, USA.
| | - Hunter B Moore
- Department of Surgery, University of Colorado Denver, Aurora, CO, USA
| | - Lucy Z Kornblith
- Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Matthew D Neal
- Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Maureane Hoffman
- Duke University School of Medicine, Transfusion Service, Durham VA Medical Center, Durham, NC, USA
| | - Nicola J Mutch
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Herbert Schöchl
- Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg and Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria
| | | | - Angela Sauaia
- Department of Surgery, University of Colorado Denver, Aurora, CO, USA
- Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
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Herrera-Escobar JP, El Moheb M, Ranjit A, Weed C, Brasel K, Kasotakis G, Kaafarani HMA, Velmahos G, Nehra D, Haider AH, Jarman M, Salim A. Sex differences in long-term outcomes after traumatic injury: A mediation analysis. Am J Surg 2021; 222:842-848. [PMID: 33541687 DOI: 10.1016/j.amjsurg.2021.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND We sought to examine the association and potential mediators between sex and long-term trauma outcomes. METHODS Moderately-to-severely injured patients admitted to 3 level-1 trauma centers were contacted between 6 and 12-months post-injury to assess for functional limitations, use of pain medications, and posttraumatic stress disorder (PTSD). Multivariable adjusted regression analyses were used to compare long-term outcomes by sex. Potential mediators of the relationship between sex and outcomes was explored using mediation analysis. RESULTS 2607 patients were followed, of which 45% were female. Compared to male, female patients were more likely to have functional limitations (OR: 1.45; 95% CI: 1.31-1.60), take pain medications (OR: 1.17; 95% CI: 1.02-1.38), and screen positive for PTSD (OR: 1.60; 95% CI: 1.46-1.76) post-injury. Age, extremity injury, previous psychiatric illness, and pre-injury unemployment, partially mediated the effect of female sex on long-term outcomes. CONCLUSIONS There are significant sex differences in long-term trauma outcomes, which are partially driven by patient and injury-related factors.
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Affiliation(s)
- Juan P Herrera-Escobar
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Mohamad El Moheb
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anju Ranjit
- Department of Obstetrics and Gynecology, Howard University Hospital, Washington, D.C, USA
| | - Christina Weed
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Karen Brasel
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - George Kasotakis
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Haytham M A Kaafarani
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George Velmahos
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Adil H Haider
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Aga Khan University School of Medicine, Karachi, Pakistan
| | - Molly Jarman
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Relationship between health status and functional outcome during two years after a severe trauma. Injury 2020; 51:2953-2961. [PMID: 33008635 DOI: 10.1016/j.injury.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/03/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND With the improved survival rates after trauma, the population of patients with disabilities increased. The knowledge about functional outcome and the relationship between health status and functional outcome is limited. The aim of the present prospective cohort study was to describe the functional outcome and health status over time, and the relationship between both. METHODS Adult severely injured patients (ISS≥16) were included if hospitalised in Noord-Brabant within 48 h after injury between August 2015 and December 2016. The functional outcome (Glasgow Outcome Scale Extended - GOSE) and health status (EQ-5D) were measured at 1, 3, 6, 12 and 24 months after injury. Logistic and linear mixed models were used to examine functional outcome and health status over time. Measurements were divided into short- (1-3 months), mid- (6-12 months) and long-term (24 months). RESULTS In total 239 severely injured patients were included. Functional outcome and health status improved over time. Prognostic factors during two years were a longer hospital length of stay, female gender and Glasgow Coma Scale. Besides age was a prognostic factor for health status and education level for functional outcome. A higher ASA classification was a long-term prognostic factor for a lower functional outcome and a lower health status. The patients with a good functional recovery showed a significant higher EQ-5D utility score and patients with a poor functional recovery reported significant more problems in the EQ-5 domains. CONCLUSION There is a good relationship between the functional outcome and the health status during two years after a severe injury. It appears reliable to use functional outcome in terms of physical impairments in daily clinic to determine patients at risk for both a lower functional outcome and a lower health status over time.
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Factors Associated With Long-term Outcomes After Injury: Results of the Functional Outcomes and Recovery After Trauma Emergencies (FORTE) Multicenter Cohort Study. Ann Surg 2020; 271:1165-1173. [PMID: 30550382 DOI: 10.1097/sla.0000000000003101] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine factors associated with patient-reported outcomes, 6 to 12 months after moderate to severe injury. SUMMARY OF BACKGROUND DATA Due to limitations of trauma registries, we have an incomplete understanding of factors that impact long-term patient-reported outcomes after injury. As 96% of patients survive their injuries, several entities including the National Academies of Science, Engineering and Medicine have called for a mechanism to routinely follow trauma patients and determine factors associated with survival, patient-reported outcomes, and reintegration into society after trauma. METHODS Over 30 months, major trauma patients [Injury Severity Score (ISS) ≥9] admitted to 3 Level-I trauma centers in Boston were assessed via telephone between 6 and 12 months after injury. Outcome measures evaluated long-term functional, physical, and mental-health outcomes. Multiple regression models were utilized to identify patient and injury factors associated with outcomes. RESULTS We successfully followed 1736 patients (65% of patients contacted). More than half (62%) reported current physical limitations, 37% needed help for at least 1 activity of daily living, 20% screened positive for posttraumatic stress disorder (PTSD), all SF-12 physical health subdomain scores were significantly below US norms, and 41% of patients who were working previously were unable to return to work. Age, sex, and education were associated with long-term outcomes, while almost none of the traditional measures of injury severity were. CONCLUSION The long-term sequelae of trauma are more significant than previously expected. Collection of postdischarge outcomes identified patient factors, such as female sex and low education, associated with worse recovery. This suggests that social support systems are potentially at the core of recovery rather than traditional measures of injury severity.
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Spronk I, Van Loey NEE, Sewalt C, Nieboer D, Renneberg B, Moi AL, Oster C, Orwelius L, van Baar ME, Polinder S. Recovery of health-related quality of life after burn injuries: An individual participant data meta-analysis. PLoS One 2020; 15:e0226653. [PMID: 31923272 PMCID: PMC6953837 DOI: 10.1371/journal.pone.0226653] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/29/2019] [Indexed: 01/23/2023] Open
Abstract
Background A prominent outcome measure within burn care is health related quality of life (HRQL). Until now, no model for long-term recovery of HRQL exists for adult burn patients which requires large samples with repeated measurements. Re-use and the combination of existing data is a way to achieve larger data samples that enable the estimation of long-term recovery models. The aim of this secondary data analysis was to assess the recovery of HRQL after a burn injury over time. Methods and findings Data from ten European studies on generic HRQL assessed in adult burn patients (either with the EQ-5D or SF-36) from five different countries were merged into one dataset. SF-36 outcomes were transformed into EQ-5D outcomes. A 24-month recovery of HRQL (EQ-5D utility) was modeled using a linear mixed-effects model and adjusted for important patient and burn characteristics. Subgroups of patients with mild and intermediate burns (≤20% total body surface area (TBSA) burned) and with major burns (>20% TBSA burned) were compared. The combined database included 1687 patients with a mean age of 43 (SD 15) years and a median %TBSA burned of 9% (IQR 4–18). There was large improvement in HRQL up to six months after burns, and HRQL remained relatively stable afterwards (studied up to 24 months post burn). However, the estimated EQ-5D utility scores remained below the norm scores of the general population. In this large sample, females, patients with a long hospital stay and patients with major burns had a delayed and worse recovery. The proportion of patients that reported problems for the EQ-5D dimensions ranged from 100% (pain/discomfort at baseline in patients with major burns) to 10% (self-care ≥3 months after injury in patients with mild and intermediate burns). After 24 months, both subgroups of burn patients did not reach the level of the general population in the dimensions pain/discomfort and anxiety/depression, and patients with major burns in the dimension usual activities. A main limitation of the study includes that the variables in the model were limited to age, gender, %TBSA, LOS and time since burn as these were the only variables available in all datasets. Conclusions The 24-month recovery model can be used in clinical practice to inform patients on expected HRQL outcomes and provide clinicians insights into the expected recovery of HRQL. In this way, a delayed recovery can be recognized in an early stage and timely interventions can be started in order to improve patient outcomes. However, external validation of the developed model is needed before implementation into clinical practice. Furthermore, our study showed the benefit of secondary data usage within the field of burns.
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Affiliation(s)
- Inge Spronk
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, Netherlands
- * E-mail:
| | - Nancy E. E. Van Loey
- Association of Dutch Burn Centres, Department Behavioural Research, Beverwijk, the Netherlands
- Utrecht University, Department Clinical Psychology, Utrecht, the Netherlands
| | - Charlie Sewalt
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Daan Nieboer
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Babette Renneberg
- Freie Universität Berlin, Department of Clinical Psychology and Psychotherapy, Berlin, Germany
| | - Asgjerd Litleré Moi
- Western Norway University of Applied Sciences, Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Bergen, Norway
- National Burn Centre, Haukeland University Hospital, Department of Plastic, Hand and Reconstructive Surgery, Bergen, Norway
| | - Caisa Oster
- Uppsala University, Department of Neuroscience, Psychiatry, Sweden
| | - Lotti Orwelius
- Linköping University, Department of Anaesthesiology and Intensive Care, and Department of Clinical and Experimental Medicine, Linköping, Sweden
| | - Margriet E. van Baar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - Suzanne Polinder
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
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Spronk I, Polinder S, van Loey NE, van der Vlies CH, Pijpe A, Haagsma JA, van Baar ME. Health related quality of life 5–7 years after minor and severe burn injuries: a multicentre cross-sectional study. Burns 2019; 45:1291-1299. [DOI: 10.1016/j.burns.2019.03.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/26/2019] [Indexed: 10/26/2022]
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The Importance of Sex Differences on Outcome after Major Trauma: Clinical Outcome in Women Versus Men. J Clin Med 2019; 8:jcm8081263. [PMID: 31434292 PMCID: PMC6722913 DOI: 10.3390/jcm8081263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate epidemiological and clinically relevant sex-related differences in polytraumatized patients at a Level 1 Trauma Center. Methods: 646 adult patients (210 females and 436 males) who were classified as polytraumatized (at the point of admission) and treated at our Level I Trauma Center were reviewed and included in this study. Demographic data as well as mechanism of injury, injury severity, injury pattern, frequency of preclinical intubation, hemodynamic variables on admission, time of mechanical ventilation and of intensive care unit (ICU) treatment, as well as the incidence of acute respiratory distress syndrome (ARDS), multi organ failure (MOF), and mortality were extracted and analyzed. Results: A total of 210 female and 436 male patients formed the basis of this report. Females showed a higher mean age (44.6 vs. 38.3 years; p < 0.0001) than their male counterparts. Women were more likely to be injured as passengers or by suicidal falls whereas men were more likely to suffer trauma as motorcyclists. Following ICU treatment, female patients resided significantly longer at the casualty ward than men (27.1 days vs. 20.4 days, p = 0.013) although there was no significant difference regarding injury severity, hemodynamic variables on admission, and incidence of MOF, ARDS, and mortality. Conclusion: The positive correlation of higher age and longer in-hospital stay in female trauma victims seems to show women at risk for a prolonged in-hospital rehabilitation time. A better understanding of the impact of major trauma in women (but also men) will be an important component of efforts to improve trauma care and long-term outcome.
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Gross T, Morell S, Amsler F. Gender-Specific Improvements in Outcome 1 and 2 Years After Major Trauma. J Surg Res 2019; 235:459-469. [DOI: 10.1016/j.jss.2018.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 08/29/2018] [Accepted: 10/17/2018] [Indexed: 12/01/2022]
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Allemann F, Heining S, Zelle B, Probst C, Pape HC. Risk factors for complications and adverse outcomes in polytrauma patients with associated upper extremity injuries. Patient Saf Surg 2019; 13:7. [PMID: 30740144 PMCID: PMC6360674 DOI: 10.1186/s13037-019-0187-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background In terms of upper extremity fractures by patients with multiple injuires, a lot of studies have assessed the functional outcome following trauma to have less favorable outcomes in regards to functional recovery. We tested the hypothesis that differences in clinical outcome occur between shaft and articular injuries of the upper extremity, when patients that sustained neurologic deficits (e.g. brachial plexus lesions) are excluded. Methods We involved Patients with isolated or combined upper extremity fracture, ISS > 16 in a level one trauma center. The follow up was at least 10 years after the initial injury. Both clinical examination (range of motion, instability, contractures, peripheral nerve damage) and radiographic analysis were carried out. We evaluated also the development of heterotopic ossifications. To analyse patients were subdivided into 3 different subgroups (articular [IA], shaft [IS], and combined [C]). Results A statistically significant difference was found when ROM was compared between Group IS and C (p = 0.012), for contractures between Groups IA and C (p = 0.009) and full muscle elbow forces between Groups IS and C (p = 0.005) and Group IA and IS (p = 0.021). There was a significantly increased incidence in heterotopic ossifications when articular involvement was present. This applied for the isolated (p < 0.02) and the combined group (Group C vs Group IS, p = 0.003).When Brooker type I/II in group IA and Brooker types III/IV were combined, there was a significant difference (p < 0.001). In group IA (n = 1) and in group C (n = 6), HO developed or worsened after revision surgery, all of which were performed for malunion or nonunion. Conclusions In this study, patients with isolated shaft fractures of the upper extremity tend to have a more favorable outcome in comparison with combined to isolated articular fractures in terms of range of motion, pain and the ability to use the arm for everyday activities.In the clinical practice of the treatment of polytraumatized patients with upper extremity injuries, we feel that the relevance of these injuries should not be underestimated. They are especially prone to development of heterotopic ossifications, thus requiring prophylactic measures, if necessary. As their incidence increases with the rate of reoperations, we feel that even during initial care, meticulous surgery is required to avoiding the necessity of revision surgeries. Similar to injuries below the knee, upper extremity injuries, should be treated to avoid any functional disability.
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Affiliation(s)
- Florin Allemann
- 1Department of Trauma, Universitaetsspital, University of Zurich, Raemistr.100, 8091 Zurich, Switzerland
| | - Sandro Heining
- 1Department of Trauma, Universitaetsspital, University of Zurich, Raemistr.100, 8091 Zurich, Switzerland
| | - Boris Zelle
- 2University of Texas Science Center at San Antonio, Floyd Curl Dr., 7703, San Antonio, TX 78229 USA
| | - Christian Probst
- Department of Trauma, Cologne-Merheim Med. Center, Ostmerheimerstr. 200, 51109 Koln, Germany
| | - Hans-Christoph Pape
- 1Department of Trauma, Universitaetsspital, University of Zurich, Raemistr.100, 8091 Zurich, Switzerland
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Predictors of health-related quality of life after burn injuries: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:160. [PMID: 29898757 PMCID: PMC6000969 DOI: 10.1186/s13054-018-2071-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/17/2018] [Indexed: 01/08/2023]
Abstract
Background Identifying predictors of health-related quality of life (HRQL) following burns is essential for optimization of rehabilitation for burn survivors. This study aimed to systematically review predictors of HRQL in burn patients. Methods Medline, Embase, Web of Science, Cochrane, CINAHL, and Google Scholar were reviewed from inception to October 2016 for studies that investigated at least one predictor of HRQL after burns. The Quality in Prognostic Studies tool was used to assess risk of bias of included studies. Results Thirty-two studies were included. Severity of burns, postburn depression, post-traumatic stress symptoms, avoidance coping, less emotional or social support, higher levels of neuroticism, and unemployment postburn were found to predict a poorer HRQL after burns in multivariable analyses. In addition, weaker predictors included female gender, pain, and a postburn substance use disorder. Risk of bias was generally low in outcome measurement and high in study attrition and study confounding. Conclusions HRQL after burns is affected by the severity of burns and the psychological response to the trauma. Both constructs provide unique information and knowledge that are necessary for optimized rehabilitation. Therefore, both physical and psychological problems require attention months to years after the burn trauma. Electronic supplementary material The online version of this article (10.1186/s13054-018-2071-4) contains supplementary material, which is available to authorized users.
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Reduced Quality of Life, Fatigue, and Societal Participation After Polytrauma. Int Surg 2018. [DOI: 10.9738/intsurg-d-17-00104.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective:
This cross-sectional study analyzed associations between and determinants for health-related quality of life (HRQoL), fatigue, and societal participation in polytrauma patients.
Summary of background data:
More polytrauma patients survive their injuries, often resulting in long-term disabilities. HRQoL is therefore an important outcome of trauma care. Fatigue and societal participation may be related to HRQoL. Also, their relation to severe injuries has not been studied to date.
Methods:
A total of 283 polytrauma patients (injury severity score ≥ 16) admitted to the Dutch level 1 Trauma Centre West were analyzed. HRQoL was measured by the physical component summary (PCS) and mental component summary (MCS) scores of the SF-36, fatigue by the multidimensional fatigue inventory, and societal participation by the Utrecht scale for evaluation of rehabilitation-participation. Age, sex, comorbidity, injury pattern, injury severity, and time since trauma were analyzed as potential determinants.
Results:
A total of 122 patients (43%) responded after a median follow-up of 15 (range, 10–23) months after polytrauma; 44% reported reduced physical health (PCS < 45) and 47% reported reduced mental health (MCS < 45). HRQoL was highly correlated with all fatigue and participation subscales. Severe head injury was associated with worse mental health. Female patients reported more general and mental fatigue and were less satisfied with their ability to perform daily activities. Patients with pre-existing comorbidity experienced worse physical health, more fatigue, and reduced societal participation.
Conclusions:
One to 2 years after trauma, polytrauma patients report reduced HRQoL, which is associated with more fatigue and reduced societal participation. Trauma rehabilitation strategies should focus on early recognition of reduced HRQoL, fatigue, and societal participation and facilitate early intervention to improve these outcomes.
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Falkenberg L, Zeckey C, Mommsen P, Winkelmann M, Zelle BA, Panzica M, Pape HC, Krettek C, Probst C. Long-term outcome in 324 polytrauma patients: what factors are associated with posttraumatic stress disorder and depressive disorder symptoms? Eur J Med Res 2017; 22:44. [PMID: 29084612 PMCID: PMC5663112 DOI: 10.1186/s40001-017-0282-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/28/2017] [Indexed: 12/14/2022] Open
Abstract
Background Physical impairment is well-known to last for many years after a severe injury, and there is a high impact on the quality of the survivor’s life. The purpose of this study was to examine if this is also true for psychological impairment with symptoms of posttraumatic stress disorder or depression after polytrauma. Design Retrospective cohort outcome study. Setting Level I trauma centre. Population 637 polytrauma trauma patients who were treated at our Level I trauma centre between 1973 and 1990. Minimum follow-up was 10 years after the injury. Methods Patients were asked to fill in a questionnaire, including parts of the Posttraumatic Stress Diagnostic Scale, the Impact of Event Scale-Revised and the German Hospital Anxiety and Depression Scale, to evaluate mental health. Clinical outcome was assessed before by standardised scores. Results Three hundred and twenty-four questionnaires were evaluated. One hundred and forty-nine (45.9%) patients presented with symptoms of mental impairment. Quality of life was significantly higher in the mentally healthy group, while the impaired group achieved a lower rehabilitation status. Conclusions Mental impairment can be found in multiple trauma victims, even after 10 years or more. Treating physicians should not only focus on early physical rehabilitation but also focus on early mental rehabilitation to prevent long-term problems in both physical and mental disability.
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Affiliation(s)
- Lisa Falkenberg
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Christian Zeckey
- Trauma Department, Hannover Medical School, Hannover, Germany. .,Department of General, Trauma and Reconstructive Surgery, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Philipp Mommsen
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Boris A Zelle
- Division of Orthopaedic Traumatology, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Martin Panzica
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Christian Probst
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
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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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Al-Tarrah K, Moiemen N, Lord JM. The influence of sex steroid hormones on the response to trauma and burn injury. BURNS & TRAUMA 2017; 5:29. [PMID: 28920065 PMCID: PMC5597997 DOI: 10.1186/s41038-017-0093-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 07/19/2017] [Indexed: 12/24/2022]
Abstract
Trauma and related sequelae result in disturbance of homeostatic mechanisms frequently leading to cellular dysfunction and ultimately organ and system failure. Regardless of the type and severity of injury, gender dimorphism in outcomes following trauma have been reported, with females having lower mortality than males, suggesting that sex steroid hormones (SSH) play an important role in the response of body systems to trauma. In addition, several clinical and experimental studies have demonstrated the effects of SSH on the clinical course and outcomes following injury. Animal studies have reported the ability of SSH to modulate immune, inflammatory, metabolic and organ responses following traumatic injury. This indicates that homeostatic mechanisms, via direct and indirect pathways, can be maintained by SSH at local and systemic levels and hence result in more favourable prognosis. Here, we discuss the role and mechanisms by which SSH modulates the response of the body to injury by maintaining various processes and organ functions. Such properties of sex hormones represent potential novel therapeutic strategies and further our understanding of current therapies used following injury such as oxandrolone in burn-injured patients.
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Affiliation(s)
- K Al-Tarrah
- Institute of Inflammation and Ageing, Birmingham University Medical School, B15 2TT, Birmingham, UK.,Scar Free Foundation Centre for Burns Research, University Hospital Birmingham Foundation Trust, B15 2WB, Birmingham, UK
| | - N Moiemen
- Scar Free Foundation Centre for Burns Research, University Hospital Birmingham Foundation Trust, B15 2WB, Birmingham, UK
| | - J M Lord
- Institute of Inflammation and Ageing, Birmingham University Medical School, B15 2TT, Birmingham, UK
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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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Larsen P, Goethgen CB, Rasmussen S, Iyer AB, Elsoe R. One-year development of QOL following orthopaedic polytrauma: a prospective observational cohort study of 53 patients. Arch Orthop Trauma Surg 2016; 136:1539-1546. [PMID: 27501705 DOI: 10.1007/s00402-016-2550-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Most studies of polytrauma examined highly mixed patient groups. The objective of the present study was to report the development of patient-reported quality of life (QOL), in a patient group with musculoskeletal polytrauma, excluding patients with major thoracic, abdominal, and brain injuries. MATERIALS AND METHODS The study design was a 1-year cohort follow-up study. Recordings of injury severity were measured with the ISS and NISS. Patient-reported QOL was measured with the questionnaires Eq5d-5L and SF-36 and compared to age-matched reference populations. Moreover, patients return to work status was measured. Data were collected prospectively at discharge, 3, 6, and 12 months. RESULTS 53 patients were included. The mean age was 42.3 years, ranging from 17 to 78 years. Twelve months after trauma admission, the mean Eq5d-5L index was 0.601 (95 % CI 0.546-0.657). A progressive increasing Eq5d-5L index and SF-36 PCS was observed between the discharge and the 12-month follow-up (p < 0.001). The development in QOL from 6 to 12 months almost shows identically scores. Throughout the study period, patients reported significant worse QOL compared with the established reference population. 32 % of patients have resumed earlier employment status at 1-year follow-up. CONCLUSIONS Throughout the 12-month observational period, patients reported worse QOL compared to the age-matched reference population. The development of QOL from 6- to 12-month time points almost showed identically scores with only little improvement. At the end of 1-year follow-up, 32 % of patients had resumed prior employment status.
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Affiliation(s)
- Peter Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg University, 18-22 Hobrovej., 9000, Aalborg, Denmark.
| | - Charlotte B Goethgen
- Clinic for Neuro- and Orthopedic Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Sten Rasmussen
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Annika B Iyer
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg University, 18-22 Hobrovej., 9000, Aalborg, Denmark
| | - Rasmus Elsoe
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
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Gabbe BJ, Cleland H, Watterson D, Schrale R, McRae S, Taggart S, Darton A, Wood F, Edgar DW. Predictors of moderate to severe fatigue 12 months following admission to hospital for burn: Results from the Burns Registry of Australia and New Zealand (BRANZ) Long Term Outcomes project. Burns 2016; 42:1652-1661. [PMID: 28341091 DOI: 10.1016/j.burns.2016.08.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/23/2016] [Accepted: 08/31/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Fatigue has been identified as an outcome of concern following burn but is rarely captured in outcomes studies. We aimed to: (i) describe the prevalence, and predictors, of moderate to severe fatigue in the first 12 months following burn, and (ii) establish the association between fatigue and health-related quality of life and work outcomes. METHODS Adult burns patients, admitted >24h, were recruited from five BRANZ sites. Participants were followed-up at 1-, 6-, and 12-months after injury using the Brief Fatigue Inventory (BFI), 36-item Short Form Health Survey (SF-36) and the Sickness Impact Profile (SIP)-work scale. Moderate to severe fatigue was defined as a global BFI score of 4-10. Multivariable mixed effects regression modelling was used to identify demographic, socioeconomic, burn size and severity predictors of moderate/severe fatigue at follow-up. RESULTS The mean±SD age of the 328 participants was 42.1±16.7years, 70% were male, 47% were flame burns, and the mean±SD %TBSA was 8.7±11.2. The prevalence of moderate/severe fatigue decreased from 37% at 1-month, to 32% at 6-months and 26% at 12-months. The adjusted odds of moderate/severe fatigue were 2.62 (95% CI: 1.27, 5.42) times higher for women compared to men, and 2.64 (95% CI: 1.03, 6.79) times higher in patients with a %TBSA≥20. Compared to patients in major cities, the adjusted odds of reporting moderate/severe fatigue were 2.48 fold higher (95% CI: 1.17, 5.24) for patients residing in inner regional areas, and 3.60 fold (95% CI: 1.43, 9.05) higher for patients living in remote/very remote areas. At each time point, the physical and mental health summary scores, and each sub-scale score, of the SF-36 were significantly lower in patients reporting moderate/severe fatigue. Patients experiencing moderate to severe fatigue reported higher work-related disability on the SIP work scale at each time point after injury. DISCUSSION AND CONCLUSION More than a quarter of participants reported moderate to severe fatigue on the BFI at 12-months and fatigue was strongly associated with poorer health-related quality of life and greater work-related disability.
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Affiliation(s)
- Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Farr Institute, College of Medicine, Swansea University, Singleton Park, Swansea, Wales SA28PP, United Kingdom.
| | - Heather Cleland
- Victorian Adult Burns Service, The Alfred, Commercial Road, Melbourne 3004, Australia; Department of Surgery, Monash University, The Alfred Centre, Commercial Road, Melbourne 3004, Australia
| | - Dina Watterson
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Allied Health, Alfred Health, Commercial Road, Melbourne 3004, Australia
| | - Rebecca Schrale
- Tasmanian Burns Unit, Royal Hobart Hospital, Burns & Surgical Specialities Unit 5A, GPO Box 1061, Hobart 7001, Australia
| | - Sally McRae
- Burns Unit, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Susan Taggart
- Burns Unit, Concord Repatriation General Hospital, Hospital Road, Concord 2139, Australia
| | - Anne Darton
- Statewide Burn Injury Service, Agency for Clinical Innovation, Royal North Shore Hospital, Reserve Road, St Leonards, 2065, Australia
| | - Fiona Wood
- State Adult Burn Unit, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, 6150, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, 6150, Australia; Burn Injury Research Node, The University of Notre Dame, 19 Mouat Street, Fremantle 6959, Australia
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Effect of Hospital Length of Stay on Functional Independence Measure Score in Trauma Patients. Am J Phys Med Rehabil 2016; 95:597-607. [DOI: 10.1097/phm.0000000000000453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
OBJECTIVE To describe the long-term outcomes of major trauma patients and factors associated with the rate of recovery. BACKGROUND As injury-related mortality decreases, there is increased focus on improving the quality of survival and reducing nonfatal injury burden. METHODS Adult major trauma survivors to discharge, injured between July 2007 and June 2012 in Victoria, Australia, were followed up at 6, 12, and 24 months after injury to measure function (Glasgow Outcome Scale-Extended) and return to work/study. Random-effects regression models were fitted to identify predictors of outcome and differences in the rate of change in each outcome between patient subgroups. RESULTS Among the 8844 survivors, 8128 (92%) were followed up. Also, 23% had achieved a good functional recovery, and 70% had returned to work/study at 24 months. The adjusted odds of reporting better function at 12 months was 27% (adjusted odds ratio 1.27, 95% confidence interval [CI] 1.19-1.36) higher compared with 6 months, and 9% (adjusted odds ratio 1.09, 95% CI, 1.02-1.17) higher at 24 months compared with 12 months. The adjusted relative risk (RR) of returning to work was 14% higher at 12 months compared with 6 months (adjusted RR 1.14, 95% CI, 1.12-1.16) and 8% (adjusted RR 1.08, 95% CI, 1.06-1.10) higher at 24 months compared with 12 months. CONCLUSIONS Improvement in outcomes over the study period was observed, although ongoing disability was common at 24 months. Recovery trajectories differed by patient characteristics, providing valuable information for informing prognostication and service planning, and improving our understanding of the burden of nonfatal injury.
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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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Perkins ZB, Yet B, Glasgow S, Cole E, Marsh W, Brohi K, Rasmussen TE, Tai NRM. Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma. Br J Surg 2015; 102:436-50. [DOI: 10.1002/bjs.9689] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/16/2014] [Accepted: 09/29/2014] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Lower extremity vascular trauma (LEVT) is a major cause of amputation. A clear understanding of prognostic factors for amputation is important to inform surgical decision-making, patient counselling and risk stratification. The aim was to develop an understanding of prognostic factors for amputation following surgical repair of LEVT.
Methods
A systematic review was conducted to identify potential prognostic factors. Bayesian meta-analysis was used to calculate an absolute (pooled proportion) and relative (pooled odds ratio, OR) measure of the amputation risk for each factor.
Results
Forty-five studies, totalling 3187 discrete LEVT repairs, were included. The overall amputation rate was 10·0 (95 per cent credible interval 7·4 to 13·1) per cent. Significant prognostic factors for secondary amputation included: associated major soft tissue injury (26 versus 8 per cent for no soft tissue injury; OR 5·80), compartment syndrome (28 versus 6 per cent; OR 5·11), multiple arterial injuries (18 versus 9 per cent; OR 4·85), duration of ischaemia exceeding 6 h (24 versus 5 per cent; OR 4·40), associated fracture (14 versus 2 per cent; OR 4·30), mechanism of injury (blast 19 per cent, blunt 16 per cent, penetrating 5 per cent), anatomical site of injury (iliac 18 per cent, popliteal 14 per cent, tibial 10 per cent, femoral 4 per cent), age over 55 years (16 versus 9 per cent; OR 3·03) and sex (men 7 per cent versus women 8 per cent; OR 0·64). Shock and nerve or venous injuries were not significant prognostic factors for secondary amputation.
Conclusion
A significant proportion of patients who undergo lower extremity vascular trauma repair will require secondary amputation. This meta-analysis describes significant prognostic factors needed to inform surgical judgement, risk assessment and patient counselling.
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Affiliation(s)
- Z B Perkins
- Centre for Trauma Sciences, Queen Mary, University of London, London, UK
| | - B Yet
- Department of Computer Science, Queen Mary, University of London, London, UK
| | - S Glasgow
- Centre for Trauma Sciences, Queen Mary, University of London, London, UK
| | - E Cole
- Centre for Trauma Sciences, Queen Mary, University of London, London, UK
| | - W Marsh
- Department of Computer Science, Queen Mary, University of London, London, UK
| | - K Brohi
- Centre for Trauma Sciences, Queen Mary, University of London, London, UK
| | - T E Rasmussen
- US Army Medical Research and Materiel Command, Fort Detrick, Maryland, USA
| | - N R M Tai
- Centre for Trauma Sciences, Queen Mary, University of London, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
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Sethuraman KN, Marcolini EG, McCunn M, Hansoti B, Vaca FE, Napolitano LM. Gender-specific issues in traumatic injury and resuscitation: consensus-based recommendations for future research. Acad Emerg Med 2014; 21:1386-94. [PMID: 25420732 DOI: 10.1111/acem.12536] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/26/2014] [Accepted: 07/29/2014] [Indexed: 02/03/2023]
Abstract
Traumatic injury remains an unacceptably high contributor to morbidity and mortality rates across the United States. Gender-specific research in trauma and emergency resuscitation has become a rising priority. In concert with the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," a consensus-building group consisting of experts in emergency medicine, critical care, traumatology, anesthesiology, and public health convened to generate research recommendations and priority questions to be answered and thus move the field forward. Nominal group technique was used for the consensus-building process and a combination of face-to-face meetings, monthly conference calls, e-mail discussions, and preconference surveys were used to refine the research questions. The resulting research agenda focuses on opportunities to improve patient outcomes by expanding research in sex- and gender-specific emergency care in the field of traumatic injury and resuscitation.
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Affiliation(s)
- Kinjal N. Sethuraman
- Department of Emergency Medicine and the Division of Hyperbaric Medicine; R Adams Cowley Shock Trauma Center; University of Maryland School of Medicine; Baltimore MD
| | | | - Maureen McCunn
- Department of Anesthesiology; Divisions of Trauma Anesthesiology and Surgical Critical Care; Baltimore MD
| | - Bhakti Hansoti
- Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
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Wasiak J, Lee S, Paul E, Mahar P, Pfitzer B, Spinks A, Cleland H, Gabbe B. Predictors of health status and health-related quality of life 12 months after severe burn. Burns 2014; 40:568-74. [DOI: 10.1016/j.burns.2014.01.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/26/2013] [Accepted: 01/22/2014] [Indexed: 11/29/2022]
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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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Posttraumatic stress disorder following traumatic injury at 6 months: associations with alcohol use and depression. J Trauma Acute Care Surg 2014; 76:517-22. [PMID: 24458060 DOI: 10.1097/ta.0000000000000110] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is progressively recognized as a psychological morbidity in injured patients. Participants in a longitudinal study were identified as PTSD positive or PTSD negative at 6 months following injury. Risky alcohol use, depression, demographic, and injury-related variables were explored. METHODS This prospective cohort included patients 18 years or older, admitted to our Level I trauma center. Outcome measures included PTSD Checklist-Civilian Version (PCL-C), Alcohol Use Disorders Identification Test (AUDIT-C), and Patient Health Questionnaire (PHQ-8). Demographic and injury variables were collected. RESULTS A total of 211 participants enrolled in the study, and 118 participants completed measures at both baseline and 6 months. Of the participants, 25.4% (n = 30) screened positive for PTSD at 6 months. The entire sample showed a decline in risky alcohol use at 6 months (p = 0.0043). All PTSD-positive participants at 6 months were also positive for depression (p < 0.0001). For the entire sample, there was a 10% increase in depression from baseline to 6 months (p = 0.03). However, for those participants who were PTSD positive at 6 months, there was a 53% increase in depression from baseline (p = 0.0002) as compared with the group at 6 months without PTSD. Statistically significant differences were found between PTSD-positive and PTSD-negative participants regarding age (40.1 [15.9] vs. 50.9 [18.2], p = 0.0047), male (77% vs. 50%, p = 0.0109), penetrating injury (30% vs. 4%, p < 0.0001), PTSD history (17% vs. 4%, p = 0.0246), or other psychiatric condition (63% vs. 19%, p ≤ 0.001). CONCLUSION PTSD was not associated with risky alcohol use at 6 months. Surprisingly, risky alcohol use declined in both groups. Incidence of PTSD (25.4%, n = 30) and risky alcohol use (25%, n = 29) were equal at 6 months. Although the American College of Surgeons' Committee on Trauma requires brief screening and intervention for risky alcohol use owing to societal impact, reinjury rates, and cost effectiveness, our study suggests that screening for psychological conditions may be equally important. LEVEL OF EVIDENCE Prognostic study, level III.
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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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What outcomes are important for patients after pelvic trauma? Subjective responses and psychometric analysis of three published pelvic-specific outcome instruments. J Orthop Trauma 2014; 28:23-7. [PMID: 23571293 DOI: 10.1097/bot.0b013e3182945fe9] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The measurement of functional outcomes in pelvic fracture patients remains difficult for authors. The authors aimed to test the construct validity, respondent burden, floor and ceiling effects, and patient perception of 3 previously published pelvic outcome questionnaires. DESIGN Prospective case series. SETTING Level I Trauma Center. PATIENTS Those with surgically treated Orthopaedic Trauma Association (OTA) B and C pelvic ring disruption at greater than 12 months after treatment. INTERVENTION None. MAIN OUTCOME MEASUREMENT Majeed Pelvic Score, Orlando Pelvic Score, Iowa Pelvis Score, Short Form-36, and Short Musculoskeletal Functional Assessment (SMFA). RESULTS The authors recruited 38 patients, 15 OTA C and 23 OTA B fractures, who had a mean of 57 months from surgery (13-115 months). Patients cited recreational/mobility difficulty (30), emotional stress and family strain (24), employment and financial difficulty (17), sleep disturbance and anxiety (9), and sexual function (6) as the most important consequences of their injuries. Each of the 3 pelvic outcome questionnaires showed a high correlation with the Physical Component Score of the SF-36, and both indices of the SMFA. None had a high correlation with the Mental Component Score of the SF-36, indicating that these scores do not capture psychologic distress and well-being, social functioning, and overall vitality. All 3 questionnaires demonstrated ceiling effects, with 21%, 18%, and 15% of respondents reporting the highest possible scores on the Iowa, Majeed, and Orlando scores, respectively. The time for completion was 3.6 ± 0.4 minutes for the Iowa score, 7.4 ± 0.4 for the Orlando score (not including radiographic assessment), and 2.6 ± 0.2 for the Majeed score. Fifteen patients preferred the Iowa score, 12 the Orlando score, and 11 the Majeed instrument. CONCLUSIONS Three previously published pelvic outcome instruments were found to have strong construct validity based on correlation with the Physical Component Score of the SF-36 and both indices of the SMFA. Subjects identified mental and emotional outcomes as important consequences of their injury; however, none of the pelvic questionnaires measure these domains, as they all correlate poorly with the Mental Component Score of the SF-36. Ceiling effects limit the utility of the all 3 current instruments, and their reliability and responsiveness over time remain unknown. No currently available outcome instrument seems to captures all of the important consequences of these injuries.
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Gabbe BJ, Harrison JE, Lyons RA, Edwards ER, Cameron PA. Comparison of measures of comorbidity for predicting disability 12-months post-injury. BMC Health Serv Res 2013; 13:30. [PMID: 23351376 PMCID: PMC3562274 DOI: 10.1186/1472-6963-13-30] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 01/23/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Understanding the factors that impact on disability is necessary to inform trauma care and enable adequate risk adjustment for benchmarking and monitoring. A key consideration is how to adjust for pre-existing conditions when assessing injury outcomes, and whether the inclusion of comorbidity is needed in addition to adjustment for age. This study compared different approaches to modelling the impact of comorbidity, collected as part of the routine hospital episode data, on disability outcomes following orthopaedic injury. METHODS 12-month Glasgow Outcome Scale - Extended (GOS-E) outcomes for 13,519 survivors to discharge were drawn from the Victorian Orthopaedic Trauma Outcomes Registry, a prospective cohort study of admitted orthopaedic injury patients. ICD-10-AM comorbidity codes were mapped to four comorbidity indices. Cases with a GOS-E score of 7-8 were considered "recovered". A split dataset approach was used with cases randomly assigned to development or test datasets. Logistic regression models were fitted with "recovery" as the outcome and the performance of the models based on each comorbidity index (adjusted for injury and age) measured using calibration (Hosmer-Lemshow (H-L) statistics and calibration curves) and discrimination (Area under the Receiver Operating Characteristic (AUC)) statistics. RESULTS All comorbidity indices improved model fit over models with age and injuries sustained alone. None of the models demonstrated acceptable model calibration (H-L statistic p < 0.05 for all models). There was little difference between the discrimination of the indices for predicting recovery: Charlson Comorbidity Index (AUC 0.70, 95% CI: 0.68, 0.71); number of ICD-10 chapters represented (AUC 0.70, 95% CI: 0.69, 0.72); number of six frequent chronic conditions represented (AUC 0.70, 95% CI: 0.69, 0.71); and the Functional Comorbidity Index (AUC 0.69, 95% CI: 0.68, 0.71). CONCLUSIONS The presence of ICD-10 recorded comorbid conditions is an important predictor of long term functional outcome following orthopaedic injury and adjustment for comorbidity is indicated when assessing risk-adjusted functional outcomes over time or across jurisdictions.
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Affiliation(s)
- Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria, 3004, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- College of Medicine, Swansea University, Swansea, United Kingdom
| | - James E Harrison
- Research Centre for Injury Studies, Flinders University, Adelaide, Australia
| | - Ronan A Lyons
- College of Medicine, Swansea University, Swansea, United Kingdom
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria, 3004, Australia
- Department of Orthopaedic Surgery, The Alfred, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria, 3004, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
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Martin-Herz SP, Zatzick DF, McMahon RJ. Health-related quality of life in children and adolescents following traumatic injury: a review. Clin Child Fam Psychol Rev 2012; 15:192-214. [PMID: 22527775 DOI: 10.1007/s10567-012-0115-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This paper comprehensively reviews the published literature investigating health-related quality of life (HRQOL) following general traumatic injury in individuals between birth and 18 years. Studies were not considered if they primarily compared medical treatment options, evaluated physical function but not other aspects of HRQOL, or focused on non-traumatic wounds. Specific injury types (e.g., burn injury) were also not included. A total of 16 studies met criteria. Participants were age 1-18 years, with 12 studies considering children 5 years of age or older. Males were overrepresented. Injury severity averaged mostly in the moderate range. HRQOL deficits were noted in injured samples in all studies except the two with the longest time to follow-up (6-11 years). Some improvement was seen 6 months to 2 years after injury. Factors associated with HRQOL deficits were investigated, with acute and posttraumatic stress disorder symptoms showing the strongest relationship. Research to date in this area is impressive, particularly the number of studies using prospective longitudinal investigations and validated measures. Challenges remain regarding methodologic differences, assessment of preinjury status, retention of participants, and management of missing data. Suggested future directions include extension of follow-up duration, utilization of pediatric self-report when possible, inclusion of younger children, and development of intervention programs.
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Kawasaki T, Chaudry IH. The effects of estrogen on various organs: therapeutic approach for sepsis, trauma, and reperfusion injury. Part 1: central nervous system, lung, and heart. J Anesth 2012; 26:883-91. [DOI: 10.1007/s00540-012-1425-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
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Improved Functional Outcomes for Major Trauma Patients in a Regionalized, Inclusive Trauma System. Ann Surg 2012; 255:1009-15. [DOI: 10.1097/sla.0b013e31824c4b91] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVES Residual dysfunction after pelvic trauma has been previously described, but limited functional outcome data are available in the female population after high-energy pelvic ring injury. The purposes of this study were to determine functional outcomes and to characterize factors predictive of outcome. DESIGN Prospective collection of functional outcomes data. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Eighty-seven women with mean age of 33.5 years and mean Injury Severity Score of 23.1 were included. The Orthopaedic Trauma Association classification included 32 B-type and 55 C-type fractures. Four were open fractures and six had bladder ruptures. INTERVENTION Forty-nine patients were treated operatively and 38 nonoperatively. MAIN OUTCOME MEASUREMENTS Musculoskeletal Functional Assessment (MFA) questionnaires were completed after a minimum of 16 months and a mean of 41 months of follow-up. RESULTS The mean MFA score was 33. Only 15 women (17.2%) had MFA scores comparable with an uninjured reference value (9.3), and 34 (39.1%) had better than the reference value for prior hip injury (25.5). Anteroposterior compression injuries had worse scores versus other patterns (48.3 vs 31.0, P = 0.01), and trends toward worse outcomes were noted after symphyseal disruption (P = 0.11) and transsymphyseal plating (P = 0.09). Sacral fracture or sacroiliac injury, amount of initial or final displacement, and type of posterior ring treatment were not associated with MFA scores. Mean scores were 32.3 after surgery and 34.0 after nonoperative management (P = 0.67). Functional outcomes were not related to age or Injury Severity Score, but isolated pelvis fractures had better MFA scores (21.1 vs 35.5, P = 0.008) and worse MFA scores (41.7 vs 29.1, P = 0.004) were seen with other lower extremity fractures. Those with bladder ruptures (n = 6) also had poor outcomes, mean MFA 50.0 (P = 0.078). CONCLUSIONS Wide variation is seen in functional outcome of women after high-energy pelvic ring fracture as measured by the MFA with mean scores demonstrating substantial residual dysfunction. Better outcomes were noted after isolated fractures and in women who had not sustained other fractures in their lower extremities. History of bladder rupture or anteroposterior compression injury was associated with poor MFA scores. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Factors affecting the likelihood of presentation to the emergency department of trauma patients after discharge. Ann Emerg Med 2011; 58:431-7. [PMID: 21689864 DOI: 10.1016/j.annemergmed.2011.04.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 03/23/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE We determine the rate at which trauma patients re-present to the emergency department (ED) after discharge from the hospital and determine whether re-presentation is related to race, insurance, and socioeconomic factors such as neighborhood income level. METHODS Trauma patients admitted to a Level I trauma center between January 1, 1997, and December 31, 2007, were identified with the hospital's trauma registry. These patients were linked to administrative data to obtain information about re-presentation to the hospital. Neighborhood income was obtained with census block data; multiple imputation was implemented to account for missing income data. Logistic regression analysis was used to determine the predictors of re-presentation. RESULTS There were 6,675 patients who were included in the study. A total of 886 patients (13.3%) returned to the ED within 30 days of discharge from the hospital. Uninsured patients (odds ratio [OR]=1.64; 95% confidence interval [CI] 1.30 to 2.06) and publicly insured patients (OR=1.60; 95% CI 1.20 to 2.14) were more likely to re-present to the ED than those with commercial insurance. Residing in a neighborhood with a median household income less than $20,000 was associated with a higher odds of re-presentation (OR=1.77; 95% CI 1.37 to 2.29). Only 13.2% of patients who came to the ED were readmitted to the hospital. CONCLUSION A substantial number of trauma patients return to the ED within 30 days of being discharged, but only a small proportion of these patients required readmission. Re-presentation is associated with being uninsured or underinsured and with lower neighborhood income level.
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Iverson KM, Hendricks AM, Kimerling R, Krengel M, Meterko M, Stolzmann KL, Baker E, Pogoda TK, Vasterling JJ, Lew HL. Psychiatric diagnoses and neurobehavioral symptom severity among OEF/OIF VA patients with deployment-related traumatic brain injury: a gender comparison. Womens Health Issues 2011; 21:S210-7. [PMID: 21724143 DOI: 10.1016/j.whi.2011.04.019] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 04/19/2011] [Accepted: 04/20/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) has substantial negative implications for the post-deployment adjustment of veterans who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF); however, most research on veterans has focused on males. This study investigated gender differences in psychiatric diagnoses and neurobehavioral symptom severity among OEF/OIF veterans with deployment-related TBI. METHODS This population-based study examined psychiatric diagnoses and self-reported neurobehavioral symptom severity from administrative records for 12,605 United States OEF/OIF veterans evaluated as having deployment-related TBI. Men (n = 11,951) and women (n = 654) who were evaluated to have deployment-related TBI during a standardized comprehensive TBI evaluation in Department of Veterans Affairs facilities were compared on the presence of psychiatric diagnoses and severity of neurobehavioral symptoms. FINDINGS Posttraumatic stress disorder (PTSD) was the most common psychiatric condition for both genders, although women were less likely than men to have a PTSD diagnosis. In contrast, relative to men, women were 2 times more likely to have a depression diagnosis, 1.3 times more likely to have a non-PTSD anxiety disorder, and 1.5 times more likely to have PTSD with comorbid depression. Multivariate analyses indicated that blast exposure during deployment may account for some of these differences. Additionally, women reported significantly more severe symptoms across a range of neurobehavioral domains. CONCLUSION Although PTSD was the most common condition for both men and women, it is also critical for providers to identify and treat other conditions, especially depression and neurobehavioral symptoms, among women veterans with deployment-related TBI.
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division of National Center for Posttraumatic Stress Disorder, Boston, Massachusetts 02130, USA.
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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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Measuring depression and PTSD after trauma: common scales and checklists. Injury 2011; 42:288-300. [PMID: 21216400 PMCID: PMC3295610 DOI: 10.1016/j.injury.2010.11.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 11/12/2010] [Indexed: 02/02/2023]
Abstract
Traumatic injury is an important public health problem secondary to high levels of morbidity and mortality. Injured survivors face several physical, emotional, and financial repercussions that can significantly impact their lives as well as their family. Depression and posttraumatic stress disorder (PTSD) are the most common psychiatric sequelae associated with traumatic injury. Factors affecting the prevalence of these psychiatric symptoms include: concomitant TBI, the timing of assessment of depression and PTSD, the type of injury, premorbid, sociodemographic, and cultural factors, and co-morbid medical conditions and medication side effects. The appropriate assessment of depression and PTSD is critical to an understanding of the potential consequences of these disorders as well as the development of appropriate behavioural and pharmacological treatments. The reliability and validity of screening instruments and structured clinical interviews used to assess depression and PTSD must be considered. Common self-report instruments and structured clinical interviews used to assess depression and PTSD and their reliability and validity are described. Future changes in diagnostic criteria for depression and PTSD and recent initiatives by the National Institute of Health regarding patient-reported outcomes may result in new methods of assessing these psychiatric sequelae of traumatic injury.
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Chossegros L, Hours M, Charnay P, Bernard M, Fort E, Boisson D, Sancho PO, Yao SN, Laumon B. Predictive factors of chronic post-traumatic stress disorder 6 months after a road traffic accident. ACCIDENT; ANALYSIS AND PREVENTION 2011; 43:471-477. [PMID: 21094346 DOI: 10.1016/j.aap.2010.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/28/2010] [Accepted: 10/01/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND This study sets out to identify risk factors for post-traumatic stress disorder (PTSD) after a road traffic accident with a view to improving prevention. METHODS The study used a prospective cohort of road traffic accident casualties. All subjects over 15 years of age were recruited in the course of an interview conducted while they were receiving care in a hospital of the Rhône area administrative département. Six months after their accident, they answered a self-administered postal questionnaire that included the Post-traumatic Check-List Scale (PCLS) in order to evaluate PTSD. Multivariate logistic regression analysis was conducted to compare those subjects with a PCLS score of 44 or over with those with a lower score, in order to identify factors that might be associated with PTSD. RESULTS 592 subjects (out of 1168) returned the 6-month questionnaire and 541 completed the PCLS test. One hundred subjects had a PCLS score ≥ 44, suggesting PTSD, and 441 subjects did not. The factors associated with PTSD were initial injury severity, post-traumatic amnesia, the feeling of not being responsible for their accident and persistent pain 6 months after it. A lower odds-ratio was associated with users of two-wheel than four-wheel motor vehicles (OR=0.4; 0.2-0.9). CONCLUSION Besides predictive factors for PTSD (injury severity, post-traumatic amnesia and the feeling of not being responsible for their accident), our study suggested a reduced risk of PTSD among two-wheel motor vehicle users.
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Affiliation(s)
- Laetitia Chossegros
- Transport Work and Environmental Epidemiology Research and Surveillance Unit - UMRESTTE (UMR T9405) Université de Lyon, INRETS, InVS 69500 Bron, France.
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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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