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Schäfer C, Moksnes HØ, Rasmussen MS, Hellstrøm T, Brunborg C, Soberg HL, Røise O, Røe C, Andelic N, Anke A. Return to Work One Year after Moderate to Severe Traumatic Injury in a Working Age Population. J Clin Med 2024; 13:5308. [PMID: 39274521 PMCID: PMC11396350 DOI: 10.3390/jcm13175308] [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: 08/15/2024] [Revised: 09/02/2024] [Accepted: 09/05/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: Physical trauma may cause long-term disabilities. The importance of place of residence in the return to work after injuries is little researched. The primary aims of this study were to describe return to work or school (RTW) at 6 and 12 months after moderate to severe traumatic injury and to investigate demographic and injury-related predictors for RTW with an initial focus on geographic centrality of residency. The secondary aim was to investigate the association between RTW and functioning. Methods: A prospective cohort study conducted at two Norwegian trauma centres. Inclusion criteria: age 18 to 70 years, at least a two-day hospital stay and a New Injury Severity Score > 9. Information about centrality, demographics, injuries, and return to work were collected. Associations between possible predictors and RTW were assessed using binary logistic regression. Results: Of the 223 participants, 68% had returned to work after 6 months and 77% after 12 months. Twelve-month RTW was 89% after thorax/abdomen injuries, 78% after extremity/spine injuries and 73% after head injuries. More central residency was a significant predictor for RTW in univariable but only within the extremity/spine injury subgroup in multivariable analysis. Negative factors were age, having a blue-collar job, number of injuries and rehabilitation complexity. Function 12 months post-injury was associated with RTW in the multivariable model. Conclusions: RTW after one year was high in all major trauma groups. Demographic and injury-related factors were more important predictors of RTW than centrality of residency. Blue-collar workers and patients with multiple injuries and high rehabilitation complexity should be given special attention to support RTW.
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Affiliation(s)
- Christoph Schäfer
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Postboks 6050 Langnes, 9037 Tromsø, Norway
- Department of Physical Medicine and Rehabilitation, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
| | - Håkon Øgreid Moksnes
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
| | - Mari Storli Rasmussen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0424 Oslo, Norway
| | - Helene Lundgaard Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Olav Røise
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0130 Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0130 Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
| | - Audny Anke
- Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Postboks 6050 Langnes, 9037 Tromsø, Norway
- Department of Physical Medicine and Rehabilitation, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
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Meakes S, Enninghorst N, Weaver N, Hardy BM, Balogh ZJ. Long-term functional outcomes in polytrauma: a fundamentally new approach is needed in prediction. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02430-6. [PMID: 38358513 DOI: 10.1007/s00068-023-02430-6] [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: 09/14/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE Modern trauma care has reduced mortality but poor long-term outcomes with low follow-up rates are common with limited recommendations for improvements. The aim of this study was to describe the impact of severe injury on the health-related quality of life, specifically characterise the non-responder population and to identify modifiable predictors of poorer outcomes. METHODS Five-year (2012-2016) prospective cohort study was performed at a level 1 trauma centre. Baseline Short-Form Health Survey (SF36) was collected at admission, and at 6 and 12 months postinjury together with demographics, injury mechanism and severity, psychosocial wellbeing, and return to work capacity. RESULTS Of the 306 consecutive patients [age 52 ± 17 years, male 72%, ISS 21 (17, 29), mortality 5%], 195 (64%) completed questionnaires at baseline, and at 12 months. Preinjury physical health scores were above the general population (53.1 vs. 50.3, p < 0.001) and mental health component was consistent with the population norms (51.7 vs. 52.9, p = 0.065). One year following injury, both physical health (13.2, 95% CI 14.8, 11.6) and mental health scores (6.0, 95% CI 8.1, 3.8) were significantly below age- and sex-adjusted preinjury baselines. Non-responders had similar ISS but with a lower admission GCS, and were more likely to be younger, and without comorbidities, employment, or university education. CONCLUSION Contrary to their better than population norm preinjury health status, polytrauma patients remain functionally impaired at least 1 year after injury. The identified high risk for non-responding group needs more focused efforts for follow-up. A fundamentally different approach is required in polytrauma research which identify modifiable predictors of poor long-term outcomes.
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Affiliation(s)
- Simone Meakes
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Natalie Enninghorst
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Natasha Weaver
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Benjamin M Hardy
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia.
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia.
- University of Newcastle, Newcastle, NSW, Australia.
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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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Simmel S, Kus S, Oberhauser C, Coenen M. [Quality of Life and Return to Work Following Rehabilitation - Results of the icfPROreha Study]. DIE REHABILITATION 2023; 62:268-277. [PMID: 37216965 DOI: 10.1055/a-2064-8434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Not only the severity of an injury, but also bio-psycho-social factors affect health-related quality of life and participation in social life after severe musculoskeletal injuries. METHODS Multicentre prospective longitudinal study with follow-up up to 78 weeks after discharge from inpatient trauma rehabilitation. Data were collected using a comprehensive assessment tool. Quality of life was assessed using the EQ-5D-5L, return to work by patients' self-reports and routine data of health insurances. Analyses of the association between quality of life and return to work, change over time in quality of life compared to the general German population and multivariate analyses to predict quality of life were conducted. RESULT Of 612 study participants (444 men (72.5%); M=48.5 years; SD 12.0), 502 (82.0%) returned to work 78 weeks after discharge from inpatient rehabilitation. Quality of life improved during rehabilitation treatment from 50.18 to 64.50 (mean of visual analogue scale of EQ-5D-5L) and slightly to 69.38 78 weeks after discharge from inpatient trauma rehabilitation. EQ-5D index was below the values of the general population. In total, 18 factors were selected to predict quality of life 78 weeks after discharge from inpatient trauma rehabilitation. Among others, pain at rest and suspected anxiety disorder at admission had a very strong effect on quality of life. Contextual factors such as therapies after acute care and self-efficacy also had an effect on quality of life 78 weeks after discharge from inpatient rehabilitation. CONCLUSION Bio-psycho-social factors affect long-term quality of life of patients with musculoskeletal injuries. Already at the time of discharge from acute treatment and even more at the beginning of inpatient rehabilitation, decisions can be made in order to achieve the best possible quality of life for those affected.
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Affiliation(s)
| | - Sandra Kus
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München
- Pettenkofer School of Public Health, München
| | - Cornelia Oberhauser
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München
- Pettenkofer School of Public Health, München
| | - Michaela Coenen
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München
- Pettenkofer School of Public Health, München
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Lotfalla A, Halm J, Schepers T, Giannakópoulos G. Health-related quality of life after severe trauma and available PROMS: an updated review (part I). Eur J Trauma Emerg Surg 2022; 49:747-761. [PMID: 36445397 PMCID: PMC10175342 DOI: 10.1007/s00068-022-02178-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Introduction
Throughout the years, a decreasing trend in mortality rate has been demonstrated in patients suffering severe trauma. This increases the relevance of documentation of other outcomes for this population, including patient-reported outcome measures (PROMs), such as health-related quality of life (HRQoL). The aim of this review was to summarize the results of the studies that have been conducted regarding HRQoL in severely injured patients (as defined by the articles’ authors). Also, we present the instruments that are used most frequently to assess HRQoL in patients suffering severe trauma.
Methods
A literature search was conducted in the Cochrane Library, EMBASE, PubMed, and Web of Science for articles published from inception until the 1st of January 2022. Reference lists of included articles were reviewed as well. Studies were considered eligible when a population of patients with major, multiple or severe injury and/or polytrauma was included, well-defined by means of an ISS-threshold, and the outcome of interest was described in terms of (HR)QoL. A narrative design was chosen for this review.
Results
The search strategy identified 1583 articles, which were reduced to 113 after application of the eligibility criteria. In total, nineteen instruments were used to assess HRQoL. The SF-36 was used most frequently, followed by the EQ-5D and SF-12. HRQoL in patients with severe trauma was often compared to normative population norms or pre-injury status, and was found to be reduced in both cases, regardless of the tool used to assess this outcome. Some studies demonstrated higher scoring of the patients over time, suggesting improved HRQoL after considerable time after severe trauma.
Conclusion
HRQoL in severely injured patients is overall reduced, regardless of the instrument used to assess it. The instruments that were used most frequently to assess HRQoL were the SF-36 and EQ-5D. Future research is needed to shed light on the consequences of the reduced HRQoL in this population. We recommend routine assessment and documentation of HRQoL in severely injured patients.
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David S, Roy N, Lundborg CS, Wärnberg MG, Solomon H. 'Coming home does not mean that the injury has gone'-exploring the lived experience of socioeconomic and quality of life outcomes in post-discharge trauma patients in urban India. Glob Public Health 2022; 17:3022-3042. [PMID: 35129081 DOI: 10.1080/17441692.2022.2036217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Trauma results in long-term socioeconomic outcomes that affect quality of life (QOL) after discharge. However, there is limited research on the lived experience of these outcomes and QOL from low - and middle-income countries. The aim of this study was to explore the different socioeconomic and QOL outcomes that trauma patients have experienced during their recovery. We conducted semi-structured qualitative interviews of 21 adult trauma patients between three to eight months after discharge from two tertiary-care public hospitals in Mumbai, India. We performed thematic analysis to identify emerging themes within the range of different experiences of the participants across gender, age, and mechanism of injury. Three themes emerged in the analysis. Recovery is incomplete-even up to eight months post discharge, participants had needs unmet by the healthcare system. Recovery is expensive-participants struggled with a range of direct and indirect costs and had to adopt coping strategies. Recovery is intersocial-post-discharge socioeconomic and QOL outcomes of the participants were shaped by the nature of social support available and their sociodemographic characteristics. Provisioning affordable and accessible rehabilitation services, and linkages with support groups may improve these outcomes. Future research should look at the effect of age and gender on these outcomes.
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Affiliation(s)
- Siddarth David
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Doctors For You, Mumbai, India
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre for Research in Surgical care delivery in LMICs, BARC Hospital, Mumbai, India
| | | | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Harris Solomon
- Department of Cultural Anthropology and the Duke Global Health Institute, Duke University, Durham, NC, USA
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Return to work after injury in Hong Kong: prospective multi-center cohort study. Eur J Trauma Emerg Surg 2022; 48:3287-3298. [PMID: 35175362 DOI: 10.1007/s00068-022-01899-x] [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: 11/30/2021] [Accepted: 01/30/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Trauma remains a major cause of morbidity and disability worldwide; however, reliable data on the health status of an urban Asian population after injury are scarce. The aim was to evaluate 1-year post-trauma return to work (RTW) status in Hong Kong. METHODS This was a prospective, multi-center cohort study involving four regional trauma centers from 2017 to 2019 in Hong Kong. Participants included adult patients entered into the trauma registry who were working or seeking employment at the time of injury. The primary outcome was the RTW status up to 1 year. The Extended Glasgow Outcome Scale, 12-item Short Form (SF-12) survey and EQ5D were also obtained during 1-, 3-, 6-, 9-, and 12-month follow-ups. Multivariable Cox proportional hazards regression analysis was used for analysis. RESULTS Six hundred and seven of the 1115 (54%) recruited patients had RTW during the first year after injury. Lower physical requirements (p = 0.003, HR 1.51) in pre-injury job nature, higher educational levels (p < 0.001, HR 1.95), non-work-related injuries (p < 0.001, HR 1.85), shorter hospital length of stay (p = 0.007, HR 0.98), no requirement for surgery (p = 0.006, HR 1.34), and patients who could be discharged home (p = 0.006, HR 1.43) were associated with RTW within 12 months post-injury. In addition, 1-month outcomes including extended Glasgow Outcome Scale ≥ 6 (p = 0.001, HR 7.34), higher mean SF-12 physical component summary (p = 0.002, HR 1.02) and mental component summary (p < 0.001, HR 1.03), and higher EQ5D health index (p = 0.018, HR 2.14) were strongly associated with RTW. CONCLUSIONS We have identified factors associated with failure to RTW during the first year following in Hong Kong including socioeconomic factors, injury factors and treatment-related factors and 1-month outcomes. Future studies should focus on the interventions that can impact on RTW outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03219424.
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Duong HP, Garcia A, Hilfiker R, Léger B, Luthi F. Systematic Review of Biopsychosocial Prognostic Factors for Return to Work After Acute Orthopedic Trauma: A 2020 Update. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:791351. [PMID: 36188871 PMCID: PMC9397710 DOI: 10.3389/fresc.2021.791351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/17/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To provide updated evidence on prognostic factors for return to work (RTW) in the early and late phases after acute orthopedic trauma from a biopsychosocial perspective. METHODS A systematic review of articles indexed in the MEDLINE, CINAHL, and Embase databases between 2010 and 2020 was performed. The inclusion criteria were cohort studies of employed populations sustaining acute orthopedic trauma with follow-up data on RTW. Biopsychosocial prognostic factors for RTW must be reported in the multiple regression models and divided into early (≤ 6 months) and late phases (> 6 months) postinjury. Two reviewers performed study selection, assessed the risk of bias and quality using the Quality in Prognosis Studies (QUIPS) tool and the Newcastle-Ottawa Scale (NOS), and extracted data independently. RESULTS Thirty articles were included with a follow-up period of 1-58 months. Based on the QUIPS tool, 7 studies (23%) were considered to have a low risk of bias, and 21 studies (70%) were considered to have a moderate risk of bias. Based on the NOS, the quality was high in 87% of the included studies. The RTW rates ranged from 22% to 74% in the early phase and from 44% to 94% in the late phase. In the early phase, strong evidence was found for injury severity. In the late phase, strong evidence was found for age, injury severity, level of pain, self-efficacy, educational level, blue-collar work, and compensation status; moderate evidence was found for recovery expectations and physical workload. There was limited or inconsistent evidence for the other factors. CONCLUSION Based on the levels of evidence, injury severity should be considered as one of the key barriers to RTW in the early and late phases postinjury. This finding underlines the need for serious injury prevention efforts. Our results also emphasize the multifaceted actions of the biopsychosocial model to facilitate RTW: promoting policies for older injured workers, improving access to medical and rehabilitation facilities, and adapting physical workload. Multiple other factors are likely important but require additional high-quality studies to assess their role in the RTW process.
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Affiliation(s)
- Hong Phuoc Duong
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Anne Garcia
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland
| | - Bertrand Léger
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
| | - François Luthi
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
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9
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Prediction of recovery in trauma patients using Latent Markov models. Eur J Trauma Emerg Surg 2021; 48:2059-2080. [PMID: 34779870 DOI: 10.1007/s00068-021-01798-7] [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: 04/11/2021] [Accepted: 09/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Patients' expectations during recovery after a trauma can affect the recovery. The aim of the present study was to identify different physical recovery trajectories based on Latent Markov Models (LMMs) and predict these recovery states based on individual patient characteristics. METHODS The data of a cohort of adult trauma patients until the age of 75 years with a length of hospital stay of 3 days and more were derived from the Brabant Injury Outcome Surveillance (BIOS) study. The EuroQol-5D 3-level version and the Health Utilities Index were used 1 week, and 1, 3, 6, 12, and 24 months after injury. Four prediction models, for mobility, pain, self-care, and daily activity, were developed using LMMs with ordinal latent states and patient characteristics as predictors for the latent states. RESULTS In total, 1107 patients were included. Four models with three ordinal latent states were developed, with different covariates in each model. The prediction of the (ordinal) latent states in the LMMs yielded pseudo-R2 values between 40 and 53% and between 21 and 41% (depending of the type R2 used) and classification errors between 24 and 40%. Most patients seem to recover fast as only about a quarter of the patients remain with severe problems after 1 month. CONCLUSION The use of LMMs to model the development of physical function post-injury is a promising way to obtain a prediction of the physical recovery. The step-by-step prediction fits well with the outpatient follow-up and it can be used to inform the patients more tailor-made to manage the expectations.
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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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11
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Hung KKC, Kifley A, Brown K, Jagnoor J, Craig A, Gabbe B, Derrett S, Dinh M, Gopinath B, Cameron ID. Impacts of injury severity on long-term outcomes following motor vehicle crashes. BMC Public Health 2021; 21:602. [PMID: 33773593 PMCID: PMC8005247 DOI: 10.1186/s12889-021-10638-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background There is growing evidence that a range of pre-injury, injury related and post-injury factors influence social and health outcomes across the injury severity spectrum. This paper documents health related outcomes for people with mild, moderate and severe injury after motor vehicle crash (MVC) injuries in New South Wales, Australia. Methods This inception cohort study followed 2019 people injured in MVCs, for 6 and 12 months post-injury. We categorised moderate injury as hospital length-of-stay (LOS) of 2–6 days and Injury Severity Score (ISS) of 4–11, while severe injury as LOS ≥7 days or ISS ≥ 12. We examined differences in paid work status, 12-Item Short Form Survey (SF12), EQ-5D and World Health Organisation Disability Assessment Schedule II (WHODAS) outcomes longitudinally from baseline to 12 months between levels of injury severity using linear mixed models for repeated measures. We first considered minimally sufficient adjustment factors (age, sex, crash role, perceived danger in crash, pre-injury health, pre-injury EQ-5D, recruitment source), and then more extensive adjustments including post-injury factors. The presence of mediating pathways for SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) via post-injury factors was evaluated. Results Based on hospital length of stay (LOS), 25 and 10% of participants sustained moderate and severe injuries, respectively, while 43 and 4% had these injuries based on ISS. Twelve months post-injury LOS ≥7 days versus ≤1 day was associated with an estimated 9 units lower mean SF12 PCS using a minimally sufficient adjustment model, and LOS ≥ 7 days was associated with a 3 units lower mean SF12 MCS score. Mediation analyses (LOS ≥ 7 days vs ≤1 day) found for SF12 MCS outcomes, effects of injury severity were small and mostly indirect (direct effect − 0.03, indirect effect − 0.22). Whereas for SF12 PCS outcomes the effect of having a more severe injury rather than mild were both direct and indirect (direct effect − 0.50, indirect effect − 0.38). Conclusions Individuals with severe injuries (those with LOS ≥ 7 days and ISS 12+) had poorer recovery 12 months after the injury. In addition, post-injury mediators have an important role in influencing long-term health outcomes. Trial registration Australia New Zealand Clinical trial registry identification number - ACTRN12613000889752. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10638-7.
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Affiliation(s)
- Kevin K C Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Annette Kifley
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, Level 13, Kolling building, St Leonards, Sydney, NSW, Australia
| | | | - Jagnoor Jagnoor
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, Level 13, Kolling building, St Leonards, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, Level 13, Kolling building, St Leonards, Sydney, NSW, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sarah Derrett
- Injury Prevention Research Unit (IPRU), Preventive & Social Medicine, Dunedin, New Zealand
| | - Michael Dinh
- Royal Prince Alfred Hospital, The University of Sydney, Sydney, Australia
| | - Bamini Gopinath
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, Level 13, Kolling building, St Leonards, Sydney, NSW, Australia.,Macquarie University Hearing, Department of Linguistics, Macquarie University, Sydney, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, Level 13, Kolling building, St Leonards, Sydney, NSW, Australia.
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Mitra B, Bernard S, Gantner D, Burns B, Reade MC, Murray L, Trapani T, Pitt V, McArthur C, Forbes A, Maegele M, Gruen RL. Protocol for a multicentre prehospital randomised controlled trial investigating tranexamic acid in severe trauma: the PATCH-Trauma trial. BMJ Open 2021; 11:e046522. [PMID: 33722875 PMCID: PMC7970250 DOI: 10.1136/bmjopen-2020-046522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Haemorrhage causes most preventable prehospital trauma deaths and about a third of in-hospital trauma deaths. Tranexamic acid (TXA), administered soon after hospital arrival in certain trauma systems, is an effective therapy in preventing or managing acute traumatic coagulopathy. However, delayed administration of TXA appears to be ineffective or harmful. The effectiveness of prehospital TXA, incidence of thrombotic complications, benefit versus risk in advanced trauma systems and the mechanism of benefit remain uncertain. METHODS AND ANALYSIS The Pre-hospital Anti-fibrinolytics for Traumatic Coagulopathy and Haemorrhage (The PATCH-Trauma study) is comparing TXA, initiated prehospital and continued in hospital over 8 hours, with placebo in patients with severe trauma at risk of acute traumatic coagulopathy. We present the trial protocol and an overview of the statistical analysis plan. There will be 1316 patients recruited by prehospital clinicians in Australia, New Zealand and Germany. The primary outcome will be the eight-level Glasgow Outcome Scale Extended (GOSE) at 6 months after injury, dichotomised to favourable (GOSE 5-8) and unfavourable (GOSE 1-4) outcomes, analysed using an intention-to-treat (ITT) approach. Secondary outcomes will include mortality at hospital discharge and at 6 months, blood product usage, quality of life and the incidence of predefined adverse events. ETHICS AND DISSEMINATION The study was approved by The Alfred Hospital Research and Ethics Committee in Victoria and also approved in New South Wales, Queensland, South Australia, Tasmania and the Northern Territory. In New Zealand, Northern A Health and Disability Ethics Committee provided approval. In Germany, Witten/Herdecke University has provided ethics approval. The PATCH-Trauma study aims to provide definitive evidence of the effectiveness of prehospital TXA, when used in conjunction with current advanced trauma care, in improving outcomes after severe injury. TRIAL REGISTRATION NUMBER NCT02187120.
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Affiliation(s)
- Biswadev Mitra
- Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Dashiell Gantner
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Brian Burns
- Greater Sydney Area Helicopter Emergency Medical Service, Sydney, New South Wales, Australia
- Sydney Medical School, Sydney University, Sydney, New South Wales, Australia
| | - Michael C Reade
- Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Joint Health Command, Australian Defence Force, Canberra, Australian Capital Territory, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Lynnette Murray
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Tony Trapani
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Veronica Pitt
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Colin McArthur
- Critical Care Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Marc Maegele
- Cologne Merheim Medical Center, Department of Traumatology, Othopedic Surgery and Sportsmedicine, University of Witten/Herdecke, Cologne, Germany
- Institute for Research in Operative Medicine, University Witten-Herdecke, Cologne, Germany
| | - Russell L Gruen
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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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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Geraerds AJLM, Richardson A, Haagsma J, Derrett S, Polinder S. A systematic review of studies measuring health-related quality of life of general injury populations: update 2010-2018. Health Qual Life Outcomes 2020; 18:160. [PMID: 32471430 PMCID: PMC7260776 DOI: 10.1186/s12955-020-01412-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
Abstract
Background Studies examining the impact of injury on health-related quality of life (HRQL) over time are necessary to understand the short- and long-term consequences of injury for population health. The aim of this systematic review was to provide an evidence update on studies that have measured HRQL over time in general injury populations using a generic (general) health state measure. Methods Studies conducted between 2010 and 2018 that assessed HRQL at more than one time point among general injury populations were eligible for inclusion. Two reviewers independently extracted information from each study on design, HRQL measure used, method of HRQL measure administration, timing of assessment(s), predictive variables, ability to detect change, and findings. Quality appraisals of each study were also completed by two reviewers using items from the RTI Item Bank on Risk of Bias and Precision of Observational Studies and the Guidelines for the Conduction of Follow-up Studies Measuring Injury-Related Disability. Results Twenty-nine studies (44 articles) that met the inclusion criteria were identified. HRQL was measured using 14 different generic measures; the SF-36, SF-12, and EQ-5D were used most frequently. A varying number of follow-up assessments were undertaken, ranging from one to five. Follow-up often occurred 12 months post-injury. Fewer studies (n = 11) examined outcomes two or more years post-injury, and only one to 10 years post-injury. While most studies documented improvements in HRQL over time since the injury event, study populations had not returned to pre-injury status or reached general population norm HRQL values at post-injury follow-ups. Conclusions Since 2010 there has been a substantial increase in the number of studies evaluating the HRQL of general injury populations. However, significant variability in study design continues to impede quantification of the impact of injury on population health over time. Variation between studies is particularly evident with respect to timing and number of follow-up assessments, and selection of instruments to evaluate HRQL.
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Affiliation(s)
- A J L M Geraerds
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.
| | - Amy Richardson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
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15
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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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16
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Devlin A, Beck B, Simpson PM, Ekegren CL, Giummarra MJ, Edwards ER, Cameron PA, Liew S, Oppy A, Richardson M, Page R, Gabbe BJ. The road to recovery for vulnerable road users hospitalised for orthopaedic injury following an on-road crash. ACCIDENT; ANALYSIS AND PREVENTION 2019; 132:105279. [PMID: 31491683 DOI: 10.1016/j.aap.2019.105279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Pedestrians, cyclists and motorcyclists are vulnerable to serious injury due to limited external protective devices. Understanding the level of recovery, and differences between these road user groups, is an important step towards improved understanding of the burden of road trauma, and prioritisation of prevention efforts. This study aimed to characterise and describe patient-reported outcomes of vulnerable road users at 6 and 12 months following orthopaedic trauma. METHODS A registry-based cohort study was conducted using data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and included pedestrians, cyclists and motorcyclists who were hospitalised for an orthopaedic injury following an on-road collision that occurred between January 2009 and December 2016. Outcomes were measured using the 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3 L), Glasgow Outcome Scale - Extended (GOS-E) and return to work questions. Outcomes were collected at 6 and 12 months post-injury. Multivariable generalized estimating equations (GEE), adjusted for confounders, were used to compare outcomes between the road user groups over time. RESULTS 6186 orthopaedic trauma patients met the inclusion criteria during the 8-year period. Most patients were motorcyclists (42.8%) followed by cyclists (32.6%) and pedestrians (24.6%). Problems were most prevalent on the usual activities item of the EQ-5D-3 L at 6-months post-injury, and the pain/discomfort item of the EQ-5D-3 L at 12 months. The adjusted odds of reporting problems on all EQ-5D-3 L items were lower for cyclists when compared to pedestrians. Moreover, an average cyclist had a greater odds of a good recovery on the GOS-E, (AOR 2.75, 95% CI 2.33, 3.25) and a greater odds of returning to work (AOR = 3.13, 95% CI 2.46, 3.99) compared to an average pedestrian. CONCLUSION Pedestrians and motorcyclists involved in on-road collisions experienced poorer patient-reported outcomes at 6 and 12 months post-injury when compared to cyclists. A focus on both primary injury prevention strategies, and investment in ongoing support and treatment to maximise recovery, is necessary to reduce the burden of road trauma for vulnerable road users.
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Affiliation(s)
- Anna Devlin
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Pam M Simpson
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Christina L Ekegren
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Melita J Giummarra
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia; Caulfield Pain Management and Research Centre, Caulfield Hospital, 260 Kooyong Road, Caulfield, VIC, 3162, Australia.
| | - Elton R Edwards
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia; Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Australia.
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.
| | - Susan Liew
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
| | - Andrew Oppy
- Department of Trauma and Orthopaedic Surgery, The Royal Melbourne Hospital, Melbourne, Australia.
| | - Martin Richardson
- Department Surgery, Epworth Clinical school, University of Melbourne, Melbourne, Australia.
| | - Richard Page
- Barwon Centre for Orthopaedic Research and Education, Barwon Health and St John of God Hospital Geelong, 80 Myers St, Geelong 3220, Australia; School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds 3216, Australia.
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park Swansea, United Kingdom.
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Wihlke G, Strömmer L, Troëng T, Brattström O. Long-term follow-up of patients treated for traumatic injury regarding physical and psychological function and health-related quality of life. Eur J Trauma Emerg Surg 2019; 47:129-135. [PMID: 31236642 DOI: 10.1007/s00068-019-01170-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Trauma patients often suffer for long time after their injury with physical and psychological problems. Patient-reported outcome measurements (PROM) help us to understand outcomes beyond mortality. The aim of the study was to describe a sample of Swedish trauma patients, regarding their physical function, psychological morbidity, and quality of life after trauma. METHODS The study population was sourced from the Swedish Trauma Register: taking 1 month of data from five hospitals, over three consecutive years. 218 patients met the inclusion criteria, 147 data sets were used. Inclusion criteria included: age ≥ 18; New Injury Severity Scale (NISS) ≥ 9; and discharged alive. Data were collected at 3, 6, and 12 months after the trauma. EuroQol-5D (EQ-5D), Posttraumatic Symptom Scale-10 (PTSS-10) questionnaires and Glasgow Outcome Score (GOS) instrument were used with additional questions about pain and return to work. RESULTS 12 months after the trauma: full functional recovery (GOS 5) was seen in 68% of the patients; 59% reported difficult or moderate pain or discomfort; and 44.5% of the patients had returned to work. In EQ-5D mobility dimension, no recovery was evident between 6 and 12 months. Twenty percent of the patients had significant symptoms for PTSD after 6 months and 16% after 3 months and 12 months. CONCLUSION Trauma patients had decreased physical function and psychological morbidity up to 1 year after the initial injury. Incorporating PROM in the follow-up after trauma is important to understand the patient's perspective of care and treatment.
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Affiliation(s)
- Gunilla Wihlke
- Trauma and Reparative Medicine, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden. .,Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176, Stockholm, Sweden.
| | - Lovisa Strömmer
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, 141 86, Stockholm, Sweden
| | - Thomas Troëng
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Olof Brattström
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176, Stockholm, Sweden.,Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, 141 86, Stockholm, Sweden
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Baker E, Xyrichis A, Norton C, Hopkins P, Lee G. The long-term outcomes and health-related quality of life of patients following blunt thoracic injury: a narrative literature review. Scand J Trauma Resusc Emerg Med 2018; 26:67. [PMID: 30119640 PMCID: PMC6098638 DOI: 10.1186/s13049-018-0535-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Major Trauma remains a leading cause of mortality and morbidity worldwide. Blunt Thoracic Injury (BTI) accounts for > 15% of United Kingdom (UK) trauma admissions and is consistently associated with respiratory related complications that include pneumonia and respiratory failure. Despite this, it is unclear in current clinical practice how BTI impacts on the recovering trauma patients after discharge from hospital. This study aimed to investigate the state of knowledge on the impact of BTI on the long-term outcomes and health-related quality of life (HRQoL). METHODS Data were sourced from Ovid MEDLINE, Ovid EMBASE, CINAHL and Science Direct using a pre-defined systematic search strategy. A subsequent hand search of key references was used to identify potentially missed studies. Abstracts were screened for eligibility and inclusion. Fifteen studies met the eligibility criteria and were critically appraised. Data were extracted, analysed and synthesised in categories and sub-categories following a narrative approach. RESULTS Three major themes were identified from the 15 studies included in this review: (i) physical impact of BTI, (ii) psychological impact of BTI and (iii) socio-economic impact of BTI. The bulk of the available data focused on the physical impact where further sub-themes included: (i) physical functioning, (ii) ongoing unresolved pain, (iii) reduced respiratory function, (iv) thoracic structural integrity. Although there was a substantial difference in the length and method of follow up, there remains a general trend towards physical symptoms improving over time, particularly over the first six months after injury. Despite this, where sequelae continued at six months it remained likely that these would also be present at two years after injury. CONCLUSION The literature review demonstrated that BTI is associated with substantial sequelae that impacts on all aspects of daily functioning. Despite this there remains a paucity of data relating to long term outcomes in the BTI population, especially relating to psychological and socio-economic impact. There is also little consensus on the measures, tools and time-frames used to measure outcomes and HRQoL in this population. The full impact of BTI on this population needs further exploration.
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Affiliation(s)
- Edward Baker
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK. .,Emergency Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| | - Philip Hopkins
- Department of Intensive Care Medicine, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
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Goldsmith H, McCloughen A, Curtis K. Using the trauma patient experience and evaluation of hospital discharge practices to inform practice change: A mixed methods study. J Clin Nurs 2018; 27:1589-1598. [DOI: 10.1111/jocn.14230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Helen Goldsmith
- Sydney Nursing School; University of Sydney; Sydney NSW Australia
- Trauma Service; St George Hospital; Sydney NSW Australia
| | | | - Kate Curtis
- Sydney Nursing School; University of Sydney; Sydney NSW Australia
- Emergency Service; Illawarra Shoalhaven Local Health District; NSW Australia
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Using emergency trauma team activations to measure trauma activity and injury severity: 10 years of experience using an Australian major trauma centre registry. Eur J Trauma Emerg Surg 2017; 44:555-560. [PMID: 28894892 DOI: 10.1007/s00068-017-0834-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe the outcomes of Emergency Department trauma team activations over a 10-year period with respect to injury severity and hospital length of stay. METHODS This was a retrospective study using trauma registry data at a single Major Trauma Centre in Australia. All trauma team activations and arrivals on pre-hospital major trauma (T1) protocol recorded in the trauma registry between June 2006 and July 2016 were included. The outcome of interest was major trauma, defined as an Injury Severity Score (ISS) >12 or length of stay >3 days or requiring urgent operative intervention or admission to the Intensive Care Unit following trauma. RESULTS A total of 9876 hospital trauma activations were analysed from January 2006 to June 2016. Of these 53.3% were admitted as an in-patient and 16.6% were classified as having an ISS >15. Major trauma occurred in 38% of cases. With respect to hospital utilisation, patients with an ISS <16 accounted for around half of total cumulative in-patient bed-days. CONCLUSIONS Analysis of data from trauma team activations in ED has allowed a description of trauma activity and hospital bed day utilisation as a function of injury severity. The results confirm that those with minor trauma accounted for the vast majority of cases and around half of all hospital in-patient bed-days.
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