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Enting M, de Jongh MAC, Joosen MCW, Bakker M, van der Kruijssen DTF, Geuze RE, Kupper N. The cross-sectional and longitudinal interconnectedness of physical, psychological and role functioning following physical trauma: A network analysis. J Psychosom Res 2024; 184:111833. [PMID: 38959575 DOI: 10.1016/j.jpsychores.2024.111833] [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: 12/20/2023] [Revised: 03/26/2024] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Surviving physical trauma can have a large impact on one's daily life. Patients are at increased risk for poor physical health, psychological complaints, and problems in role functioning - which is often experienced simultaneously. The present study explores the interconnectedness of physical, psychological, and role functioning during the first two years post-injury, both cross-sectionally and longitudinally from a network perspective. METHODS 3785 trauma patients (Mage = 64.2 years, SDage = 18.9 years, 50.5% female) completed questionnaires on physical, psychological, and role functioning across six measurement occasions during the first two years post-injury. The Injury Severity Score (ISS) was retrieved from the local trauma registry. Mixed graphical network models and cross-lagged network models were estimated to examine which items of recovery played a central role and were mostly related to other items in cross-sectional and longitudinal networks respectively. RESULTS The cross-sectional networks showed especially strong interconnections between impairments of physical and role functioning and also within post-traumatic stress symptoms. The longitudinal networks extended these results by showing that pain, impaired mobility, limitations in self-care, anxiety/depressive symptoms, and several post-traumatic stress symptoms were strong predictors for impairments in functioning at later stages of recovery. CONCLUSION Our findings showed that impairments in physical, psychological, and role functioning experienced by trauma patients are largely intertwined across the two years following injury. Monitoring physical impairments and psychological complaints early in recovery might help to more promptly provide the best fitting aftercare for trauma patients, which can improve recovery on the long-term.
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Affiliation(s)
- Manon Enting
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Well-Being, the Netherlands; Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands.
| | | | - Margot C W Joosen
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Well-Being, the Netherlands
| | - Marjan Bakker
- Department of Methodology and Statistics, Tilburg University, the Netherlands
| | | | - Ruth E Geuze
- Department of Orthopedics, ETZ Hospital, Tilburg, the Netherlands
| | - Nina Kupper
- Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
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Razani O, Nasiri M, Yarahmadi F, Zonoori S, Shamsi A, Abbasi M, Asadi M. Alleviating severity of limb trauma pain with coadministration of topical sesame oil and standard treatments: A GRADE-assessed systematic review and meta-analysis of randomised controlled trials. Int Wound J 2024; 21:e14907. [PMID: 38822706 PMCID: PMC11143441 DOI: 10.1111/iwj.14907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 06/03/2024] Open
Abstract
Recent randomised controlled trials (RCTs) have investigated the analgesic activity of sesame oil among patients with limb trauma; nevertheless, their findings are inconsistent. Hence, this review aimed to clarify the impact of topical administration of sesame oil on acute pain of adult outpatients with minor limb trauma. The online databases (e.g., Scopus, PubMed, Web of Science) were searched up to 31 January 2024. The RCTs were included if they compared the effect of applying standard treatments plus topical sesame oil to administering standard treatments alone or with a placebo/sham treatment. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the Cochrane Collaboration's risk of bias tool were applied to address the evidence quality and the study's methodological rigour, respectively. Four RCTs had the inclusion criteria, and their findings were pooled in a meta-analysis employing a random-effects approach. According to the pooled analysis, the reduction in mean change of the pain score from baseline to the second/third intervention day was significantly higher in favour of clients who received standard care plus daily massage of the trauma site with sesame oil compared to those who received a control condition (weighted mean difference: -1.10; 95% confidence interval [-1.62, -0.57]; p < 0.001). However, the evidence quality was moderate, and only two studies had good methodological rigour. Hence, more high-quality studies are needed to make a solid evidence-based conclusion about the favourable consequence of topical sesame oil on alleviating acute traumatic limb pain.
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Affiliation(s)
- Omolbanin Razani
- Department of NursingDoroud Branch, Islamic Azad UniversityDoroudIran
| | - Morteza Nasiri
- Department of AnesthesiaSchool of Allied Medical Sciences, Tehran University of Medical SciencesTehranIran
| | - Fatemeh Yarahmadi
- Department of NursingBroujerd School of Nursing, Lorestan University of Medical SciencesKhorramabadIran
| | - Sahar Zonoori
- Department of NursingBroujerd School of Nursing, Lorestan University of Medical SciencesKhorramabadIran
| | - Afzal Shamsi
- Department of AnesthesiaSchool of Allied Medical Sciences, Tehran University of Medical SciencesTehranIran
- Nursing and Midwifery Care Research CenterTehran University of Medical SciencesTehranIran
| | - Mohammad Abbasi
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyIran University of Medical SciencesTehranIran
| | - Masoomeh Asadi
- Department of Operating Room NursingAbadan University of Medical SciencesAbadanIran
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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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Kitcharanant N, Atthakomol P, Khorana J, Phinyo P, Unnanuntana A. Prognostic Factors for Functional Recovery at 1-Year Following Fragility Hip Fractures. Clin Orthop Surg 2024; 16:7-15. [PMID: 38304218 PMCID: PMC10825251 DOI: 10.4055/cios23177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/30/2023] [Accepted: 09/08/2023] [Indexed: 02/03/2024] Open
Abstract
Background The main objective of treating fragility hip fractures is to maximize the patients' ability to return to their basic activities of daily living (ADL) levels. This study explored prognostic factors associated with the ability to recover pre-fracture ADL levels at 1 year after fragility hip fractures. Methods We retrospectively recruited patients admitted with fragility hip fractures between July 2016 and September 2018. Details of the following were extracted from electronic medical records: age, sex, body mass index; pre-fracture Charlson Comorbidity Index (CCI), Barthel index, and EuroQol-Visual Analog Scale (EQ-VAS) scores; pre-fracture ambulatory status; and fracture type and treatment. The primary endpoint was the ability to return to the pre-fracture ADL status at 1 year. Multivariable logistic regression analysis assessed the prognostic ability of predictors. Results Of 405 patients, 284 (70.1%) managed to return to their pre-fracture ADL status. Multivariable logistic regression analysis demonstrated that the predictor with the most apparent effect size was pre-fracture EQ-VAS scores ≥ 65 (multivariable odds ratio [mOR], 12.90; p = 0.03). Other influential predictors were CCI scores < 5 (mOR, 1.96; p = 0.01) and surgical treatment for the hip fracture. Conclusions Three prognostic factors can predict a hip fracture patient's ability to return to the pre-fracture ambulatory status at 1 year. They are the patient's CCI score, operative treatment for the hip fracture, and the pre-fracture EQ-VAS score. This information could be used to develop a clinical prediction model based on the prognostic factors.
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Affiliation(s)
- Nitchanant Kitcharanant
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pichitchai Atthakomol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jiraporn Khorana
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Zaskey M, Seely KD, Hansen M, Collins HE, Burns A, Burns B. Outcomes after stairway falls in a rural Appalachian trauma center. Surgery 2023; 174:626-630. [PMID: 37380572 DOI: 10.1016/j.surg.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/09/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Injuries due to falls represent one of the most common etiologies of traumatic injury in the United States. Stairway-related falls in particular can lead to significant morbidity, mortality, and concomitant long-term disability and economic costs. Our study aims to evaluate the outcomes of patients presenting to a rural academic trauma center after experiencing a fall down stairs. METHODS This was a single institution retrospective analysis of data extracted from our trauma registry. The study was considered exempt by Ballad Health Institutional Review Board. The data included patients aged 18 years or older who presented to the emergency department after a fall down stairs between January 1, 2017, and June 17, 2022. Patients who experienced falls other than those involving stairs were excluded. RESULTS Of the 439 patients evaluated for falls down stairs, 259 (58.9%) were aged ≥65 years. Compared with younger patients, older patients required significantly longer hospital admissions (4.8 vs 3.6 days, P < .003), had significantly higher injury severity scores (9.1 vs 6.8, P < .05), and were more likely to be discharged to a posthospital care facility (51% vs 14.9%, P < .05). There was no difference in length of intensive care unit stay (3.8 vs 3.6 days, P < .72), ventilator days (3.3 vs 3.3 days, P < .97), or mortality (7% vs 3%, P < .08). When considering sex, male patients had significantly worse outcomes in injury severity score (9.0 vs 7.6, P < .02) and mortality (10% vs 2%, P < .0002) but no difference in hospital (4.5 vs 4.0 days, P < .20), intensive care unit (3.8 vs 3.5 days, P < .59) or ventilator days (2.8 vs 4.3 days, P < .27) when compared with female patients. CONCLUSION Patients aged 65 years or older who experience a fall down stairs are more severely injured and require more posthospital care. Our findings demonstrate that males have an elevated risk of mortality and increased injury severity compared to female patients. Previous findings from our institution examining injuries from falls, including a sub-analysis on ground-level falls, have shown similar sex disparity. This study shows the necessity of preventing stair-related falls, especially in the older population.
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Affiliation(s)
- Michael Zaskey
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Kevin D Seely
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO.
| | | | | | | | - Bracken Burns
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN
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Schwab S, Sidler D, Haidar F, Kuhn C, Schaub S, Koller M, Mellac K, Stürzinger U, Tischhauser B, Binet I, Golshayan D, Müller T, Elmer A, Franscini N, Krügel N, Fehr T, Immer F. Clinical prediction model for prognosis in kidney transplant recipients (KIDMO): study protocol. Diagn Progn Res 2023; 7:6. [PMID: 36879332 PMCID: PMC9990297 DOI: 10.1186/s41512-022-00139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/22/2022] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Many potential prognostic factors for predicting kidney transplantation outcomes have been identified. However, in Switzerland, no widely accepted prognostic model or risk score for transplantation outcomes is being routinely used in clinical practice yet. We aim to develop three prediction models for the prognosis of graft survival, quality of life, and graft function following transplantation in Switzerland. METHODS The clinical kidney prediction models (KIDMO) are developed with data from a national multi-center cohort study (Swiss Transplant Cohort Study; STCS) and the Swiss Organ Allocation System (SOAS). The primary outcome is the kidney graft survival (with death of recipient as competing risk); the secondary outcomes are the quality of life (patient-reported health status) at 12 months and estimated glomerular filtration rate (eGFR) slope. Organ donor, transplantation, and recipient-related clinical information will be used as predictors at the time of organ allocation. We will use a Fine & Gray subdistribution model and linear mixed-effects models for the primary and the two secondary outcomes, respectively. Model optimism, calibration, discrimination, and heterogeneity between transplant centres will be assessed using bootstrapping, internal-external cross-validation, and methods from meta-analysis. DISCUSSION Thorough evaluation of the existing risk scores for the kidney graft survival or patient-reported outcomes has been lacking in the Swiss transplant setting. In order to be useful in clinical practice, a prognostic score needs to be valid, reliable, clinically relevant, and preferably integrated into the decision-making process to improve long-term patient outcomes and support informed decisions for clinicians and their patients. The state-of-the-art methodology by taking into account competing risks and variable selection using expert knowledge is applied to data from a nationwide prospective multi-center cohort study. Ideally, healthcare providers together with patients can predetermine the risk they are willing to accept from a deceased-donor kidney, with graft survival, quality of life, and graft function estimates available for their consideration. STUDY REGISTRATION Open Science Framework ID: z6mvj.
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Affiliation(s)
| | - Daniel Sidler
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Fadi Haidar
- Department of Medicine, Division of Nephrology, University Hospital of Geneva, Geneva, Switzerland
| | - Christian Kuhn
- Nephrology and Transplantation Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stefan Schaub
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Michael Koller
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Katell Mellac
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Ueli Stürzinger
- STCS Patient Advisory Board, University Hospital Basel, Basel, Switzerland
| | - Bruno Tischhauser
- STCS Patient Advisory Board, University Hospital Basel, Basel, Switzerland
| | - Isabelle Binet
- Nephrology and Transplantation Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Déla Golshayan
- Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Thomas Müller
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Thomas Fehr
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
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Comparing health status after major trauma across different levels of trauma care. Injury 2023; 54:871-879. [PMID: 36642567 DOI: 10.1016/j.injury.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Mortality due to trauma has reduced the past decades. Trauma network implementations have been an important contributor to this achievement. Besides mortality, patient reported outcome parameters should be included in evaluation of trauma care. While concentrating major trauma care, hospitals are designated with a certain level of trauma care following specific criteria. OBJECTIVE Comparing health status of major trauma patients after two years across different levels of trauma care in trauma networks. METHODS Multicentre observational study comprising a secondary longitudinal multilevel analysis on prospective cohorts from two neighbouring trauma regions in the Netherlands. INCLUSION CRITERIA patient aged ≥ 18 with an ISS > 15 surviving their injuries at least one year after trauma. Health status was measured one and two years after trauma by EQ-5D-5 L, added with a sixth health dimension on cognition. Level I trauma centres were considered as reference in uni- and multivariate analysis. RESULTS Respondents admitted to a level I trauma centre scored less favourable EQ-US and EQ-VAS in both years (0.81-0.81, 71-75) than respondents admitted to a level II (0.88-0.87, 78-85) or level III (0.89-0.88, 75-80) facility. Level II facilities scored significantly higher EQ-US and EQ-VAS in time for univariate analysis (β 0.095, 95% CI 0.038-0.153, p = 0.001, and β 7.887, 95% CI 3.035-12.740, p = 0.002), not in multivariate analysis (β 0.052, 95% CI -0.010-0.115, p = 0.102, and β 3.714, 95% CI -1.893-9.321, p = 0.193). Fewer limitations in mobility (OR 0.344, 95% CI 0.156-0.760), self-care (OR 0.219, 95% CI 0.077-0.618), and pain and discomfort (OR 0.421, 95% CI 0.214-0.831) remained significant for level II facilities in multivariate analysis, whereas significant differences with level III facilities disappeared. CONCLUSION Major trauma patients admitted to level I trauma centres reported a less favourable general health status and more limitations compared to level II and III facilities scoring populations norms one to two years after trauma. Differences on general health status and limitations in specific health domains disappeared in adjusted analysis. Well-coordinated trauma networks offer homogeneous results for all major trauma patients when they are distributed in different centres according to their need of care.
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Driessen MLS, van Zwet EW, Sturms LM, de Jongh MAC, Leenen LPH. Funnel plots a graphical instrument for the evaluation of population performance and quality of trauma care: a blueprint of implementation. Eur J Trauma Emerg Surg 2023; 49:513-522. [PMID: 36083495 DOI: 10.1007/s00068-022-02100-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Using patient outcomes to monitor medical centre performance has become an essential part of modern health care. However, classic league tables generally inflict stigmatization on centres rated as "poor performers", which has a negative effect on public trust and professional morale. In the present study, we aim to illustrate that funnel plots, including trends over time, can be used as a method to control the quality of data and to monitor and assure the quality of trauma care. Moreover, we aimed to present a set of regulations on how to interpret and act on underperformance or overperformance trends presented in funnel plots. METHODS A retrospective observational cohort study was performed using the Dutch National Trauma Registry (DNTR). Two separate datasets were created to assess the effects of healthy and multiple imputations to cope with missing values. Funnel plots displaying the performance of all trauma-receiving hospitals in 2020 were generated, and in-hospital mortality was used as the main indicator of centre performance. Indirect standardization was used to correct for differences in the types of cases. Comet plots were generated displaying the performance trends of two level-I trauma centres since 2017 and 2018. RESULTS Funnel plots based on data using healthy imputation for missing values can highlight centres lacking good data quality. A comet plot illustrates the performance trend over multiple years, which is more indicative of a centre's performance compared to a single measurement. Trends analysis offers the opportunity to closely monitor an individual centres' performance and direct evaluation of initiated improvement strategies. CONCLUSION This study describes the use of funnel and comet plots as a method to monitor and assure high-quality data and to evaluate trauma centre performance over multiple years. Moreover, this is the first study to provide a regulatory blueprint on how to interpret and act on the under- or overperformance of trauma centres. Further evaluations are needed to assess its functionality. LEVEL OF EVIDENCE Retrospective study, level III.
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Affiliation(s)
- M L S Driessen
- Dutch Network for Emergency Care (LNAZ), Newtonlaan 115, 3584 BH, Utrecht, The Netherlands.
| | - E W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - L M Sturms
- Dutch Network for Emergency Care (LNAZ), Newtonlaan 115, 3584 BH, Utrecht, The Netherlands
| | - M A C de Jongh
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
| | - L P H Leenen
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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Zhou Q, Huang H, Zheng L, Chen H, Zeng Y. Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study. BMC Emerg Med 2023; 23:5. [PMID: 36653746 PMCID: PMC9850752 DOI: 10.1186/s12873-023-00776-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Little evidence suggests that trauma centres are associated with a lower risk of mortality in severely injured patients (Injury Severity Score (ISS) ≥16) with multiple injuries in China. The objective of this study was to determine the association between the establishment of trauma centres and mortality among severely injured patients with multiple injuries and to identify some risk factors associated with mortality. METHODS A retrospective single-centre study was performed including trauma patients admitted to the First Affiliated Hospital of Nanchang University (FAHNU) between January 2016 and December 2021. To determine whether the establishment of a trauma centre was an independent predictor of mortality, logistic regression analysis and propensity score matching (PSM) were performed. RESULTS Among 431 trauma patients, 172 were enrolled before the trauma centre was built, while 259 were included after the trauma centre was built. A higher frequency of older age and traffic accident injury was found in patients diagnosed after the trauma centre was built. The times for the completion of CT examinations, emergency operations and blood transfusions in the "after trauma centre" group were shorter than those in the "before trauma centre" group. However, the total expenditure of patients was increased. In the overall group, univariate and multivariate logistic regression analyses showed that a higher ISS was an independent predictor for worse mortality (OR = 17.859, 95% CI, 8.207-38.86, P < 0.001), while the establishment of a trauma centre was favourable for patient survival (OR = 0.492), which was also demonstrated by PSM. After determining the cut-off value of time for the completion of CT examination, emergency operation and blood transfusion, we found that the values were within the "golden one hour", and it was better for patients when the time was less than the cut-off value. CONCLUSION Our study showed that for severely injured patients, the establishment of a trauma centre was favourable for a lower mortality rate. Furthermore, the completion of a CT examination, emergency surgery and blood transfusion in a timely manner and a lower ISS were associated with a decreased mortality rate.
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Affiliation(s)
- Qiangping Zhou
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
| | - Haijin Huang
- grid.412604.50000 0004 1758 4073Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Linhui Zheng
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
| | - Haiming Chen
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
| | - Yuanlin Zeng
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
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10
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Stoitsas K, Bahulikar S, de Munter L, de Jongh MAC, Jansen MAC, Jung MM, van Wingerden M, Van Deun K. Clustering of trauma patients based on longitudinal data and the application of machine learning to predict recovery. Sci Rep 2022; 12:16990. [PMID: 36216874 PMCID: PMC9550811 DOI: 10.1038/s41598-022-21390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/27/2022] [Indexed: 12/29/2022] Open
Abstract
Predicting recovery after trauma is important to provide patients a perspective on their estimated future health, to engage in shared decision making and target interventions to relevant patient groups. In the present study, several unsupervised techniques are employed to cluster patients based on longitudinal recovery profiles. Subsequently, these data-driven clusters were assessed on clinical validity by experts and used as targets in supervised machine learning models. We present a formalised analysis of the obtained clusters that incorporates evaluation of (i) statistical and machine learning metrics, (ii) clusters clinical validity with descriptive statistics and medical expertise. Clusters quality assessment revealed that clusters obtained through a Bayesian method (High Dimensional Supervised Classification and Clustering) and a Deep Gaussian Mixture model, in combination with oversampling and a Random Forest for supervised learning of the cluster assignments provided among the most clinically sensible partitioning of patients. Other methods that obtained higher classification accuracy suffered from cluster solutions with large majority classes or clinically less sensible classes. Models that used just physical or a mix of physical and psychological outcomes proved to be among the most sensible, suggesting that clustering on psychological outcomes alone yields recovery profiles that do not conform to known risk factors.
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Affiliation(s)
- Kostas Stoitsas
- Department of Methodology and Statistics, Tilburg University, Tilburg, 5000 LE, The Netherlands.
| | - Saurabh Bahulikar
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, 5000 LE, The Netherlands
| | - Leonie de Munter
- Department Traumatology, ETZ Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Mariska A C de Jongh
- Network Emergency Care Brabant, Brabant Trauma Registry, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Maria A C Jansen
- Network Emergency Care Brabant, Brabant Trauma Registry, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Merel M Jung
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, 5000 LE, The Netherlands
| | - Marijn van Wingerden
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, 5000 LE, The Netherlands
| | - Katrijn Van Deun
- Department of Methodology and Statistics, Tilburg University, Tilburg, 5000 LE, The Netherlands
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11
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Effects of light stroking massage with olive oil on acute pain severity and number of taken non-steroidal anti-inflammatory drugs among outpatients with extremities trauma: A double-blind, placebo-controlled superiority trial. Int J Orthop Trauma Nurs 2022; 46:100953. [DOI: 10.1016/j.ijotn.2022.100953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/28/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
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12
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Ratter J, Pellekooren S, Wiertsema S, van Dongen JM, Geleijn E, de Groot V, Bloemers FW, Jansma E, Ostelo RWJG. Content validity and measurement properties of the Lower Extremity Functional Scale in patients with fractures of the lower extremities: a systematic review. J Patient Rep Outcomes 2022; 6:11. [PMID: 35092528 PMCID: PMC8800956 DOI: 10.1186/s41687-022-00417-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background Fractures of lower extremities are common trauma-related injuries, and have major impact on patients' functional status. A frequently used Patient-Reported Outcome Measure (PROM) to evaluate patients’ functional status with lower extremity fractures is the Lower Extremity Functional Scale (LEFS). However, there is no systematic review regarding content validity and other measurement properties of the LEFS in patients with lower extremity fractures. Methods A search was performed in PubMed, Embase, Scopus, and Cochrane Library from inception until November 2020. Studies on development of the LEFS and/or the evaluation of one or more measurement properties of the LEFS in patients with lower extremity fractures were included, and independently assessed by two reviewers using COSMIN guidelines. Results Seven studies were included. Content validity of the LEFS was rated 'inconsistent', supported by very low quality of evidence. Structural validity was rated ‘insufficient’ supported by doubtful methodological quality. Internal consistency, measurement error, and responsiveness were rated 'indeterminate' supported by inadequate to adequate methodological quality. The methodological quality of the construct validity (hypotheses testing) assessment was rated as 'inadequate'. Conclusion The LEFS has several shortcomings, the lack of sufficient content validity being the most important one as content validity is considered the most crucial measurement property of a PROM according to the COSMIN guidelines. In interpreting the outcomes, one should therefore be aware that not all relevant aspects of physical functioning may be accounted for in the LEFS. Further validation in a well-designed content validity study is needed, including a clearly defined construct and patient involvement during the assessment of different aspects of content validity. Plain English summary Bone fractures of the lower extremities are a common injury. During rehabilitation it is essential to evaluate how patients experience their physical functioning, in order to monitor the progress and to optimize treatment. To measure physical functioning often questionnaires (also known as Patient Reported Outcome Measures) are used, such as the Lower Extremity Functional Scale (LEFS). However, it is not clear if the LEFS actually measures physical function, and if its other measurement properties are sufficient for using this questionnaire among patients with fractures in the lower extremities. Therefore, we systematically searched and assessed scientific papers on the development of the LEFS (i.e., its ability to measure physical functioning), and papers on the performance of the LEFS with regard to several measurement properties to identify possible factors that may cause measurement errors. Hereby we have assessed the quality of the studies included. Our main finding was that the LEFS may not measure all aspects of physical function. Given the low quality of the papers included in our study, these findings come with considerable uncertainty. As the LEFS was developed more than 20 years ago, it may not represent physical functioning as we currently conceptualize this. Therefore, we recommend to perform a study in which the content of the LEFS will be evaluated by experts in the field as well as patients, and modify the questionnaire as needed.
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Affiliation(s)
- Julia Ratter
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands.
| | - Sylvia Pellekooren
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Suzanne Wiertsema
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Elise Jansma
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Location VUmc, Amsterdam Movement Sciences, Amsterdam UMC, De Boelelaan 1117, Amsterdam, The Netherlands
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13
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Gross T, Amsler F. Main factors predicting somatic, psychological, and cognitive patient outcomes after significant injury: a pilot study of a simple prognostic tool. BJS Open 2021; 5:6448573. [PMID: 34864883 PMCID: PMC8643586 DOI: 10.1093/bjsopen/zrab109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background There are still insufficient data on the complexity and predictability of patient-related outcomes following trauma. The aim of this study was to assess longer-term outcomes in patients with significant injury and to develop a simple scoring method to identify patients at high risk of subsequent deficits 1–2 years after injury. Methods We conducted a prospective cohort study of survivors of significant injury (New Injury Severity Score, NISS greater than or equal to 8), with analysis of patients’ 1- to 2-year health-related quality of life (HRQoL) and their functional outcomes based on Short Form-36 (SF-36), Trauma Outcome Profile (TOP), and Quality Of Life after Brain Injury (QOLIBRI). Documented variables suspected or known from the literature to be possible factors associated with outcome were first analysed by univariate analysis, and significant variables were entered into a stepwise logistic regression analysis. Scores predicting longer-term impaired outcome were constructed from risk factors resulting from multivariate analysis. Results Depending on the patient-reported outcome measure (PROM) used, up to 30 per cent of 1052 study patients (mean NISS 18.6) indicated somatic, 27 per cent psychological, and 54 per cent cognitive deficits. The investigated sociodemographic, injury-related, treatment, and early hospital outcome variables demonstrated only low associations with longer-term outcome in univariate analysis that were highest for preinjury pain or function (R = 0.4) and outcome at hospital discharge (R = 0.3). After logistic regression, the study variables explained a maximum variance of 23 per cent for somatic, 11 per cent for psychological, and 14 per cent for cognitive longer-term outcomes. The resulting Aarau trauma prognostic longer-term outcome scoring (ATPLOS) system, developed by checking eight risk factors, had a specificity of up to 80 per cent, and importantly may facilitate early detection of patients at risk of a poorer longer-term outcome. Conclusion Despite the high rate of deficits recorded for survivors of significant injury, particularly in loss of cognitive function, the multiple variables analysed only led to a limited characterization of patient-related longer-term outcomes. Until more is known about additional individual influencing factors, the proposed scoring system may serve well for clinical evaluation. Registration number NCT 02165137 (http://www.clinicaltrials.gov)
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Affiliation(s)
- Thomas Gross
- Trauma Unit, Cantonal Hospital Aarau, Aarau and University of Basel, Basel, Switzerland
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14
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van Ditshuizen JC, van Lieshout EMM, van Beeck EF, Verhofstad MHJ, den Hartog D. Health-related quality of life and return to work 1 year after major trauma from a network perspective. Eur J Trauma Emerg Surg 2021; 48:2421-2431. [PMID: 34514511 PMCID: PMC9192406 DOI: 10.1007/s00068-021-01781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/01/2021] [Indexed: 12/04/2022]
Abstract
Introduction Major trauma often results in long-term disabilities. The aim of this study was to assess health-related quality of life, cognition, and return to work 1 year after major trauma from a trauma network perspective. Methods All major trauma patients in 2016 (Injury Severity Score > 15, n = 536) were selected from trauma region Southwest Netherlands. Eligible patients (n = 365) were sent questionnaires with the EQ-5D-5L and questions on cognition, level of education, comorbidities, and resumption of paid work 1 year after trauma. Results A 50% (n = 182) response rate was obtained. EQ-US and EQ-VAS scored a median (IQR) of 0.81 (0.62–0.89) and 70 (60–80), respectively. Limitations were prevalent in all health dimensions of the EQ-5D-5L; 90 (50%) responders reported problems with mobility, 36 (20%) responders reported problems with self-care, 108 (61%) responders reported problems during daily activities, 129 (73%) responders reported pain or discomfort, 70 (39%) responders reported problems with anxiety or depression, and 102 (61%) of the patients reported problems with cognition. Return to work rate was 68% (37% full, 31% partial). A median (IQR) EQ-US of 0.89 (0.82–1.00) and EQ-VAS of 80 (70–90) were scored for fully working responders; 0.77 (0.66–0.85, p < 0.001) and 70 (62–80, p = 0.001) for partial working respondents; and 0.49 (0.23–0.69, p < 0.001) and 55 (40–72, p < 0.001) for unemployed respondents. Conclusion The majority experience problems in all health domains of the EQ-5D-5L and cognition. Return to work status was associated with all health domains of the EQ-5D-5L and cognition.
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Affiliation(s)
- Jan C. van Ditshuizen
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - 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
| | - Ed F. van Beeck
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Michiel H. J. Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Dennis den Hartog
- 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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15
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Abstract
BACKGROUND Following hospital discharge after traumatic injuries, many patients' rehabilitation is inhibited by poor health-related quality of life (HRQoL). OBJECTIVE The purpose of this review is to identify factors that influence the HRQoL of polytrauma patients after hospital discharge. METHODS A systematic literature search was performed in CINAHL and PubMed databases for English-language articles published between January 2015 and January 2020. Articles that dealt with pediatric or narrow adult populations, exclusively considered brain and spinal cord injuries, burn injuries, or isolated fractures were excluded. In total, 22 nonexperimental cohort studies were eligible for inclusion. RESULTS Based on these studies, with minor disagreements explainable by deficient sampling, variables that impacted HRQoL fell into 11 categories: demographics, preinjury HRQoL, preexisting conditions, mental health status, injury type and location, injury severity, course of hospitalization, time after injury, financial and employment status, functional capacity, and pain. CONCLUSION The finding with the greatest implications was that mental health, positive coping, self-efficacy, and perception of physical state significantly influence HRQoL after injury and, along with other modifiable variables, can be optimized by directed treatment. Additionally, targeted assessments and interventions can be utilized to improve quality of life for patients with nonmodifiable risk factors.
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16
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Ratter J, Wiertsema S, van Dongen JM, Geleijn E, Ostelo RWJG, de Groot V, Bloemers FW. Effectiveness and cost-effectiveness of the Transmural Trauma Care Model investigated in a multicenter trial with a controlled before-and-after design: A study protocol. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1894. [PMID: 33480123 PMCID: PMC8047890 DOI: 10.1002/pri.1894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/07/2020] [Accepted: 12/25/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The rehabilitation of trauma patients in primary care is challenging, and there are no guidelines for optimal treatment. Also, the organization of care is not well-structured. The Transmural Trauma Care Model (TTCM) has been developed in the Netherlands, aiming to improve patient outcomes by optimizing the organization and the quality of the rehabilitation process in primary care. A recent feasibility study showed that implementation of the TTCM at a Dutch Level 1 trauma center was feasible, patient outcomes were improved, and costs were reduced. This study aims to assess the effectiveness and cost-effectiveness of the TTCM compared to the usual care in a multicenter trial. METHODS A multicenter trial with a controlled before-and-after design will be performed at 10 hospitals in the Netherlands. First, participating hospitals will include 322 patients in the control group, receiving usual care as provided in these specific hospitals. Subsequently, the TTCM will be implemented in all participating hospitals, and hospitals will include an additional 322 patients in the intervention group. The TTCM consists of a multidisciplinary team at the outpatient clinic (trauma surgeon and hospital-based physical therapist), an educated and trained network of primary care trauma physical therapists, and structural communication between them. Co-primary outcomes will investigate generic and disease-specific, health-related quality of life. Secondary outcomes will include pain, patient satisfaction, perceived recovery, and patient-reported physical functioning. For the economic evaluation, societal and healthcare costs will be measured. Measurements will take place at baseline and after 6 weeks, 3, 6, and 9 months. Analyses will be based on the intention-to-treat principle. Missing data will be handled using longitudinal data analyses in the effect analyses and by multivariate imputation in the economic evaluation. CONCLUSION This trial with a controlled before-and-after design will give insight into the effectiveness and cost-effectiveness of the TTCM in a multicenter trial.
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Affiliation(s)
- Julia Ratter
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Suzanne Wiertsema
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Johanna M. van Dongen
- Department of Health Sciences, Faculty of ScienceVrije Universiteit AmsterdamVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Raymond W. J. G. Ostelo
- Department of Health Sciences, Faculty of ScienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam UMClocatie VUmcAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Vincent de Groot
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Frank W. Bloemers
- Department of Trauma SurgeryAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
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17
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Visser E, Oudsten BLD, Gosens T, Lodder P, De Vries J. Psychological risk factors that characterize the trajectories of quality of life after a physical trauma: a longitudinal study using latent class analysis. Qual Life Res 2021; 30:1317-1335. [PMID: 33447963 PMCID: PMC8068651 DOI: 10.1007/s11136-020-02740-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The course and corresponding characteristics of quality of life (QOL) domains in trauma population are unclear. Our aim was to identify longitudinal QOL trajectories and determine and predict the sociodemographic, clinical, and psychological characteristics of trajectory membership in physical trauma patients using a biopsychosocial approach. METHODS Patients completed a questionnaire set after inclusion, and at 3, 6, 9, and 12 months follow-up. Trajectories were identified using repeated-measures latent class analysis. The trajectory characteristics were ranked using Cohen's d effect size or phi coefficient. RESULTS Altogether, 267 patients were included. The mean age was 54.1 (SD = 16.1), 62% were male, and the median injury severity score was 5.0 [2.0-9.0]. Four latent trajectories were found for psychological health and environment, five for physical health and social relationships, and seven trajectories were found for overall QOL and general health. The trajectories seemed to remain stable over time. For each QOL domain, the identified trajectories differed significantly in terms of anxiety, depressive symptoms, acute stress disorder, post-traumatic stress disorder, Neuroticism, trait anxiety, Extraversion, and Conscientiousness. DISCUSSION Psychological factors characterized the trajectories during 12 months after trauma. Health care providers can use these findings to identify patients at risk for impaired QOL and offer patient-centered care to improve QOL.
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Affiliation(s)
- Eva Visser
- Department Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Brenda Leontine Den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopaedics, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Jolanda De Vries
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.
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18
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van de Ree CLP, de Munter L, Biesbroeck BHH, Kruithof N, Gosens T, de Jongh MAC. The prevalence and prognostic factors of psychological distress in older patients with a hip fracture: A longitudinal cohort study. Injury 2020; 51:2668-2675. [PMID: 32741607 DOI: 10.1016/j.injury.2020.07.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/01/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION A hip fracture can be experienced as a traumatic event that can induce psychological distress. The aim of this study is to give more insight into the prevalence of symptoms of psychological distress in older patients following the first year after a hip fracture. In addition, prognostic factors were determined for psychological distress after hip fracture. MATERIALS AND METHODS This hip fracture cohort data was derived from the Brabant Injury Outcome Surveillance, a multicenter longitudinal prospective cohort study. Hip fracture patients (≥65years) admitted to a hospital between August 2015 and November 2016 were asked to complete a questionnaire at 1 week, and 1, 3, 6 and 12 months. The Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety and depression and the Impact of Event Scale (IES) was used to assess symptoms of posttraumatic stress (PTS). Prognostic factors were assessed with multivariable logistic mixed models. RESULTS In total 570 patients (inclusion rate: 69.7%) were included. The prevalence of psychological distress ranged from 36% at 1 week to 31% at 1 year after hip fracture. Frailty at onset of hip fracture was the most important prognostic factor of symptoms of depression (Odds ratio (OR), 2.74; 95% Confidence interval (CI) 1.41 to 5.34) and anxiety (OR, 2.60; 95% CI 1.15 to 5.85) on average in the year following hip fracture. Frailty was not a prognostic factor of symptoms of PTS (OR, 1.97; 95% CI 0.42 to 9.23). CONCLUSIONS The prevalence of psychological distress is high in the first year after a hip fracture. Frailty at onset of a hip fracture is the most important prognostic factor of symptoms of depression and anxiety. These findings have important implications for strategies with early identification of frail patients with a hip fracture at high risk of psychological distress.
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Affiliation(s)
- C L P van de Ree
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands.
| | - L de Munter
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
| | - B H H Biesbroeck
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
| | - N Kruithof
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
| | - T Gosens
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands; Department of Orthopaedic Surgery, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - M A C de Jongh
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands; Brabant Trauma Registry, Network Emergency Care Brabant, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
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19
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Simon HL, Paula T, Luz MM, Nemeth SK, Moug SJ, Keller DS. Frailty in older patients undergoing emergency colorectal surgery: USA National Surgical Quality Improvement Program analysis. Br J Surg 2020; 107:1363-1371. [DOI: 10.1002/bjs.11770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/24/2020] [Accepted: 05/14/2020] [Indexed: 12/21/2022]
Abstract
Abstract
Background
Frailty is associated with advancing age and may result in adverse postoperative outcomes. A suspected growing elderly population needing emergency colorectal surgery stimulated this study of the prevalence and impact of frailty.
Methods
Elderly patients (defined as aged at least 65 years by Medicare and the United States Census Bureau) who underwent emergency colorectal resection between 2012 and 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program population database. The five-item modified frailty index (mFI-5) score was calculated, and patients stratified into groups 0, 1 or 2 +. Main outcome measures were the prevalence of frailty, and its impact on 30-day postoperative morbidity, mortality, reoperation, duration of hospital stay (LOS), discharge destination and readmission.
Results
A total of 10 025 patients were identified with a median age 75 years, of whom 41·8 per cent were men. The majority (87·7 per cent) had an ASA fitness grade of III or greater and 3129 (31·2 per cent) were frail (mFI-5 group 2+). Major morbidity occurred in one-third of patients and the postoperative mortality rate was 15·9 per cent. Some 52·0 per cent of patients had a prolonged hospital stay and 11·0 per cent were readmitted. Although most patients (88·0 per cent) lived independently before surgery, only 45·4 per cent were discharged home directly. Frailty (mFI-5 2+) predicted mortality, overall and major morbidity, reoperation, prolonged LOS, discharge to an institution and readmission, but frailty was independent of sex.
Conclusion
Frailty is associated with morbidity, mortality and loss of independence in elderly patients needing emergency colorectal surgery.
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Affiliation(s)
| | - T Paula
- Division of Colorectal Surgery, USA
| | - M M Luz
- Division of Colorectal Surgery, USA
| | - S K Nemeth
- Columbia HeartSource, Center for Innovation and Outcomes Research, USA
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - D S Keller
- Division of Colorectal Surgery, USA
- Herbert Irving Comprehensive Cancer Center, Department of Surgery, Columbia University Medical Center, New York, USA
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20
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Havermans RJM, de Jongh MAC, de Munter L, Lansink KWW. Longitudinal analysis of health status the first year after trauma in severely injured patients. Scand J Trauma Resusc Emerg Med 2020; 28:29. [PMID: 32312282 PMCID: PMC7169038 DOI: 10.1186/s13049-020-00719-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/19/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE While survival rates after a trauma are increasing a considerable part of the trauma population are still at risk for both short and long term disabilities. Little is known about prognostic factors over time after a severe trauma. The aim of the present prospective cohort study was to examine trauma and patient related prognostic factors for a lower health status over time after a severe trauma. METHODS A multicentre prospective observational cohort study was conducted. Adult trauma patients with severe injuries (ISS ≥ 16) were included from August 2015 until November 2016 if admitted to one of the hospitals in Noord-Brabant (the Netherlands). Outcome measure was health status, measured by the EuroQol-5D (EQ-5D utility and EQ-Visual analogue scale) and the Health Utilities Index (HUI2 and HUI3) one week and one, three, six, and twelve months after injury. Patient and trauma characteristics were analysed as prognostic factors with linear mixed models. The effect of each prognostic factor over time was analysed by adding the interaction term between the prognostic factor and time point in a multivariable linear mixed model, adjusted for confounders. Additionally, the risk factors for problems in the EQ-5 dimensions of HS and cognition were analysed. RESULTS In total 239 severely injured patients participated. Pre-injury health status, hospital length of stay, ISS and comorbidities were significant prognostic factors for a lower health status. A younger age and extremity injury were prognostic factors for a lower health status until one month after trauma and unemployment before trauma and comorbidities six until twelve months after trauma. In the EQ-5 dimensions 44.1% remained problems in mobility, 15.3% in self-care, 46.4% in activity, 53.3% in pain, 32.5% in anxiety and 35.7% in cognition. CONCLUSIONS Lower pre-injury health status, longer hospital length of stay, higher ISS, and comorbidities were significant prognostic factors for a lower health status during one year after a severe injury. A younger age and an extremity injury were short-term prognostic factors and unemployment before trauma and comorbidities were long-term prognostic factors. Even after twelve months patients in our population reported more problems in all EQ-5D dimensions when compared to the Dutch reference population.
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Affiliation(s)
- Roos Johanna Maria Havermans
- Brabant Trauma Registry, Network Emergency Care Brabant, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
| | | | - Leonie de Munter
- Department Trauma TopCare, ETZ hospital, Tilburg, The Netherlands
| | - Koen Willem Wouter Lansink
- Brabant Trauma Registry, Network Emergency Care Brabant, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.,Department of Surgery, ETZ hospital, Tilburg, The Netherlands
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