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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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Jeanmougin T, Cole E, Duceau B, Raux M, James A. Heterogeneity in defining multiple trauma: a systematic review of randomized controlled trials. Crit Care 2023; 27:363. [PMID: 37736733 PMCID: PMC10515068 DOI: 10.1186/s13054-023-04637-w] [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: 08/08/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION While numerous randomized controlled trials (RCTs) have been conducted in the field of trauma, a substantial portion of them are yielding negative results. One potential contributing factor to this trend could be the lack of agreement regarding the chosen definitions across different trials. The primary objective was to identify the terminology and definitions utilized for the characterization of multiple trauma patients within randomized controlled trials (RCTs). METHODS A systematic review of the literature was performed in MEDLINE, EMBASE and clinicaltrials.gov between January 1, 2002, and July 31, 2022. RCTs or RTCs protocols were eligible if they included multiple trauma patients. The terms employed to characterize patient populations were identified, and the corresponding definitions for these terms were extracted. The subsequent impact on the population recruited was then documented to expose clinical heterogeneity. RESULTS Fifty RCTs were included, and 12 different terms identified. Among these terms, the most frequently used were "multiple trauma" (n = 21, 42%), "severe trauma" (n = 8, 16%), "major trauma" (n = 4, 8%), and trauma with hemorrhagic shock" (n = 4, 8%). Only 62% of RCTs (n = 31) provided a definition for the terms used, resulting a total of 21 different definitions. These definitions primarily relied on the injury severity score (ISS) (n = 15, 30%), displaying an important underlying heterogeneity. The choice of the terms had an impact on the study population, affecting both the ISS and in-hospital mortality. Eleven protocols were included, featuring five different terms, with "severe trauma" being the most frequent, occurring six times (55%). CONCLUSION This systematic review uncovers an important heterogeneity both in the terms and in the definitions employed to recruit trauma patients within RCTs. These findings underscore the imperative of promoting the use of a unique and consistent definition.
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Affiliation(s)
- Thomas Jeanmougin
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and critical care, Pitié-Salpêtrière Hospital, Paris, France
| | - Elaine Cole
- Centre of Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Baptiste Duceau
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and critical care, Pitié-Salpêtrière Hospital, Paris, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013, Paris, France
| | - Arthur James
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and critical care, Pitié-Salpêtrière Hospital, Paris, France.
- Centre of Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK.
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Lucas VJ, Burke S, Selby A, Johnson NA. The effectiveness of cognitive behavioural therapy for patients with concurrent hand and psychological disorders. J Hand Surg Eur Vol 2023; 48:27-32. [PMID: 36204989 DOI: 10.1177/17531934221128867] [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] [Indexed: 02/03/2023]
Abstract
We investigated the effectiveness of cognitive behavioural therapy (CBT) for patients with psychological disorders thought to be influencing recovery from elective and traumatic hand conditions. Demographic data and psychological assessment scores (Primary Health Questionnaire 9 (PHQ9), General Anxiety Disorder Assessment (GAD7), Impact of Event Scale (IES)) were prospectively collected before and after CBT treatment. One hundred and fourteen patients underwent CBT with 81 completing treatment. Full data was available for 78 (68%) patients. Mean age was 43 (range 13-84) and 63% were women. Sixty-one per cent had sustained a traumatic hand injury. PHQ9, GAD7 and IES scores decreased significantly following treatment. Many patients with hand conditions have associated psychological problems that may influence outcome. CBT in a hand unit setting appears to be an effective treatment. Further research with a control group should investigate whether CBT improves psychological health or if this may occur as patients recover from their physical hand disorder regardless of CBT.Level of evidence: IV.
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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: 3] [Impact Index Per Article: 1.5] [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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Hegy JK, Abegglen S, Schade V, Hoffmann-Richter U, Znoj H. Effects of a tailored multidisciplinary counselling intervention to support the adjustment process after a traumatic injury: a randomized controlled trial. Disabil Rehabil 2021; 44:6055-6064. [PMID: 34343051 DOI: 10.1080/09638288.2021.1960442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the efficacy of a tailored counselling intervention for injured workers regarding different aspects of subjective well-being. MATERIALS AND METHODS Prospective randomized controlled trial with 192 mildly-to-moderately injured workers who were on sick leave for at least 18 weeks and showed a high-risk profile for a complicated rehabilitation process in a screening. Patients were assessed at baseline, 12 and 18 months post-injury. The outcome variables concerned five aspects of subjective well-being (negative feelings, life and job satisfaction, satisfaction related to family and health). Both the control and the experimental group received conventional case management. Participants in the intervention group additionally received tailored workplace interventions and/or mental health counselling sessions. RESULTS Participants in the intervention group received an average of 2.23 (SD = 6.94) counselling sessions. Both groups showed a significant reduction (mean (95% CI) of negative feelings control group 2.6 (2.3-3.4), intervention group 2.4 (1.6-3.4)), with a significant difference in negative feelings between the groups (p = 0.01). CONCLUSIONS Our results suggest that a tailored counselling intervention has a modest long-term effect (d = 0.74) on negative feelings for mildly-to-moderately injured workers. However, future studies should evaluate the feasibility of this study's treatment approach.Implications for rehabilitationAccidents and the resulting injuries often cause a wide range of burdens including psychosocial and emotional distress as well as long-time sick leaves.Tailored counselling led to significant reductions of negative feelings in mildly-to-moderately injured workers over time.By showing that even conventional case management can have a beneficial effect on subjective wellbeing, the results of this study reaffirm the holistic biopsychosocial nature of injury rehabilitation.
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Affiliation(s)
| | - Sandra Abegglen
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Volker Schade
- Center for Human Resource Management and Organizational Engineering (CPMO), Bern, Switzerland
| | | | - Hansjörg Znoj
- Department of Psychology, University of Bern, Bern, Switzerland
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The role of psychological support interventions in trauma patients on mental health outcomes: A systematic review and meta-analysis. J Trauma Acute Care Surg 2019; 87:463-482. [DOI: 10.1097/ta.0000000000002371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE We aimed to produce comprehensive guidelines and recommendations that can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury. METHODS A panel of 15 members with expertise in orthopaedic trauma, pain management, or both was convened to review the literature and develop recommendations on acute musculoskeletal pain management. The methods described by the Grading of Recommendations Assessment, Development, and Evaluation Working Group were applied to each recommendation. The guideline was submitted to the Orthopaedic Trauma Association (OTA) for review and was approved on October 16, 2018. RESULTS We present evidence-based best practice recommendations and pain medication recommendations with the hope that they can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury. Recommendations are presented regarding pain management, cognitive strategies, physical strategies, strategies for patients on long term opioids at presentation, and system implementation strategies. We recommend the use of multimodal analgesia, prescribing the lowest effective immediate-release opioid for the shortest period possible, and considering regional anesthesia. We also recommend connecting patients to psychosocial interventions as indicated and considering anxiety reduction strategies such as aromatherapy. Finally, we also recommend physical strategies including ice, elevation, and transcutaneous electrical stimulation. Prescribing for patients on long term opioids at presentation should be limited to one prescriber. Both pain and sedation should be assessed regularly for inpatients with short, validated tools. Finally, the group supports querying the relevant regional and state prescription drug monitoring program, development of clinical decision support, opioid education efforts for prescribers and patients, and implementing a department or organization pain medication prescribing strategy or policy. CONCLUSIONS Balancing comfort and patient safety following acute musculoskeletal injury is possible when utilizing a true multimodal approach including cognitive, physical, and pharmaceutical strategies. In this guideline, we attempt to provide practical, evidence-based guidance for clinicians in both the operative and non-operative settings to address acute pain from musculoskeletal injury. We also organized and graded the evidence to both support recommendations and identify gap areas for future research.
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Early psychological interventions for posttraumatic stress, depression and anxiety after traumatic injury: A systematic review and meta-analysis. Clin Psychol Rev 2018; 62:11-36. [DOI: 10.1016/j.cpr.2018.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/27/2018] [Accepted: 05/03/2018] [Indexed: 12/22/2022]
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Hoffman K, Cole E, Playford ED, Grill E, Soberg HL, Brohi K. Health outcome after major trauma: what are we measuring? PLoS One 2014; 9:e103082. [PMID: 25051353 PMCID: PMC4106876 DOI: 10.1371/journal.pone.0103082] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/25/2014] [Indexed: 11/19/2022] Open
Abstract
Importance Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients. Objective To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma. Data Sources MEDLINE, EMBASE, and CINAHL (from 2006–2012) were searched for studies evaluating health outcome after traumatic injuries. Study selection and data extraction Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts. Results 34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%). Conclusion Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.
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Affiliation(s)
- Karen Hoffman
- Centre for Trauma Sciences, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- * E-mail: (KH); (KB)
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - E. Diane Playford
- University College London (UCL) institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Eva Grill
- Ludwig-Maximilians-Universität Munich, Institute for Medical Informatics, Biometry and Epidemiology (IBE), Munich, Germany
| | - Helene L. Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- * E-mail: (KH); (KB)
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Steinhausen S, Ommen O, Antoine SL, Koehler T, Pfaff H, Neugebauer E. Short- and long-term subjective medical treatment outcome of trauma surgery patients: the importance of physician empathy. Patient Prefer Adherence 2014; 8:1239-53. [PMID: 25258518 PMCID: PMC4173813 DOI: 10.2147/ppa.s62925] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To investigate accident casualties' long-term subjective evaluation of treatment outcome 6 weeks and 12 months after discharge and its relation to the experienced surgeon's empathy during hospital treatment after trauma in consideration of patient-, injury-, and health-related factors. The long-term results are compared to the 6-week follow-up outcomes. PATIENTS AND METHODS Two hundred and seventeen surgery patients were surveyed at 6 weeks, and 206 patients at 12 months after discharge from the trauma surgical general ward. The subjective evaluation of medical treatment outcome was measured 6 weeks and 12 months after discharge with the respective scale from the Cologne Patient Questionnaire. Physician Empathy was assessed with the Consultation and Relational Empathy Measure. The correlation between physician empathy and control variables with the subjective evaluation of medical treatment outcome 12 months after discharge was identified by means of logistic regression analysis under control of sociodemographic and injury-related factors. RESULTS One hundred and thirty-six patients were included within the logistic regression analysis at the 12-month follow-up. Compared to the 6-week follow-up, the level of subjective evaluation of medical treatment outcome was slightly lower and the association with physician empathy was weaker. Compared to patients who rated the empathy of their surgeon lower than 31 points, patients with ratings of 41 points or higher had a 4.2-fold higher probability to be in the group with a better medical treatment outcome (3.5 and above) on the Cologne Patient Questionnaire scale 12 months after discharge from hospital (P=0.009, R (2)=33.5, 95% confidence interval: 1.440-12.629). CONCLUSION Physician empathy is the strongest predictor for a higher level of trauma patients' subjective evaluation of treatment outcome 6 weeks and 12 months after discharge from the hospital. Interpersonal factors between surgeons and their patients are possible key levers for improving patient outcomes in an advanced health system. Communication trainings for surgeons might prepare them to react appropriately to their patients' needs and lead to satisfactory outcomes for both parties.
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Affiliation(s)
- Simone Steinhausen
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Germany
- Correspondence: Simone Steinhausen, Institute for Research in Operative Medicine Chair of Surgical Research, Faculty of Health – School of Medicine Witten/Herdecke University Ostmerheimer Str 200, Building 38 51109 Cologne, Germany, Tel +49 221 989 5713, Fax +49 221 989 5730, Email
| | - Oliver Ommen
- Federal Centre for Health Education (BZgA), Cologne, Germany
| | - Sunya-Lee Antoine
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Germany
| | | | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Science and Faculty of Medicine, University of Cologne, Germany
| | - Edmund Neugebauer
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Germany
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Zetterlund P, Plos K, Bergbom I, Ringdal M. Memories from intensive care unit persist for several years--a longitudinal prospective multi-centre study. Intensive Crit Care Nurs 2012; 28:159-67. [PMID: 22579396 DOI: 10.1016/j.iccn.2011.11.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 11/23/2011] [Accepted: 11/28/2011] [Indexed: 01/22/2023]
Abstract
INTRODUCTION In connection with the care received in the intensive care unit (ICU), the patient can experience discomfort and frustration. Earlier studies have shown mechanical ventilation (MV) to be a factor that increases patients' delusional memories in the ICU. The patients who need MV after a physical trauma constitute a vulnerable group who so far has attracted little attention from a long-term perspective. AIM The aim for this study is to describe mechanically ventilated trauma patients over time regarding their memories, psychological recovery and health related quality of life (HRQoL). METHODS In a multicentre study, 41 patients who had received MV, answered a questionnaire with the SF-36, HAD and ICUM tool on two occasions about one and five years after the injury and care in the ICU. RESULTS The patients' memories were stable over time and significantly more patients remembered panic and anxiety. 37% remembered pain one year after the trauma and 46% five years thereafter. The majority of the patients remembered the family's presence from their ICU stay. Half of the patients had thoughts regarding why they had so few recollections. One fourth of the patients experienced clear symptoms of anxiety and the same amount had symptoms of depression one year after the injury. In seven of the patients the symptoms of probable anxiety persisted after five years. In six of the patients the symptoms of probable depression persisted after five years. Two of eight dimensions in HRQoL, the physical and emotional role functions, had improved significantly five years after the injury. CONCLUSIONS Five years after the trauma, the memories from the ICU were still the same and the HRQoL improved in only two out of eight dimensions. A smaller group of patients had remaining symptoms of psychological ill-health. MV in connection with trauma may result in continued reduced health in the long term.
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Affiliation(s)
- Per Zetterlund
- Operation Norr, AN/OP/IVA, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
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Attenberger C, Amsler F, Gross T. Clinical evaluation of the Trauma Outcome Profile (TOP) in the longer-term follow-up of polytrauma patients. Injury 2012; 43:1566-74. [PMID: 21255778 DOI: 10.1016/j.injury.2011.01.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 01/01/2011] [Accepted: 01/04/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND No sufficiently validated disease-specific instrument is available to assess patient outcome after polytrauma. The aim of this investigation was to test the recently published Trauma Outcome Profile (TOP) in the longer-term outcome of multiply injured patients. METHODS Single centre validation study on the TOP in comparison with objective and subjective measures of patient, injury or treatment characteristics and longer-term outcome (e.g. medical outcomes study Short Form-36, SF-36; Nottingham Health Profile, NHP; working capacity), at least 2 years following trauma in 117 survivors of polytrauma (injury severity score, ISS>16), using comparative analysis and correlation testing of prospectively collected data. RESULTS Patients' mean weighted self-rating with regard to the 10 single TOP dimensions of Health Related Quality of Life (HRQoL, 0-100) ranged from lowest values for mental functioning (52.6+33.5) to highest values for daily activities (79.0+27.5). The rate of persons who indicated an abnormal level of function or pain increased significantly from pre-injury status (2% and 5%, resp.) to 46% for both values at longer-term follow-up (p<0.001). Observed associations between single dimensions or TOP component summary scores with the corresponding values from general HRQol instruments, such as the SF-36, resulted in R (Pearson) up to 0.85. Survivors of polytrauma who presented with a reduced working capacity (RWC) at longer-term follow-up in all TOP dimensions included a significantly higher rate of patients conspicuous for a relevantly reduced outcome compared with those with a non reduced working capacity (NRWC) (posttraumatic stress disease, PTSD: p<0.05; all other dimensions: p<0.001). Patients with a RWC were characterised by an almost fivefold probability of reduced outcome with regard to the TOP dimensions 'social interaction' or 'satisfaction' (odds ratio, OR 12.4 (95% CI 5.1-30.1) and 12.5 (4.0-39.0), resp.). CONCLUSIONS This first clinical and methodological evaluation in a well defined cohort of polytrauma patients found the TOP to be a reliable and well discriminating score covering both relevant general and trauma-specific aspects of longer-term outcome. Despite these promising primary results, until further validation, the TOP should be used together with already accepted HRQoL measures to allow adequate international comparison of data in the future.
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Affiliation(s)
- Corinna Attenberger
- Computer Assisted Radiology & Surgery Switzerland, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
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Aukema TS, Beenen LF, Hietbrink F, Leenen LP. Validation of the Thorax Trauma Severity Score for mortality and its value for the development of acute respiratory distress syndrome. Open Access Emerg Med 2011; 3:49-53. [PMID: 27147852 PMCID: PMC4753967 DOI: 10.2147/oaem.s22802] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of the present study was to evaluate and to validate the Thorax Trauma Severity Score (TTSS) for mortality. METHODS By database analysis 712 patients with an injury to the chest admitted to the Universal Medical Center Utrecht between 2000 and 2004 were studied. All patients with a score of ≥1 on the AISthorax were included in the study. The patients' file was evaluated for: TTSS, intensive care unit stay, days on ventilation, thorax trauma-related complications (eg, acute respiratory distress syndrome [ARDS]), total hospital stay, and mortality. RESULTS Of the 516 patients included in the study, 140 (27%) developed thorax-related complications. The overall in-hospital mortality rate was 10%. The receiver operating characteristic curve for predicting mortality demonstrated an adequate discrimination by a value of 0.844. The TTSS was statistically significant higher in patients who died of thorax-related complications than in patients who died because of nonthorax-related complications and survivors (P < 0.001, confidence interval [CI] 95%). In patients who developed ARDS the TTSS was significant higher (P = 0.005, CI 95%). CONCLUSION This study supports the use of the TTSS for predicting mortality in thoracic injury patients. Furthermore, the TTSS appears capable of predicting ARDS.
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Affiliation(s)
- Tjeerd S Aukema
- Department of Surgery, University Medical Center Utrecht, Utrecht
| | - Ludo Fm Beenen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Utrecht
| | - Luke Ph Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht
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Early short-term inpatient psychotherapeutic treatment versus continued outpatient psychotherapy on psychosocial outcome: a randomized controlled trial in trauma patients. ACTA ACUST UNITED AC 2011; 70:433-41. [PMID: 21057336 DOI: 10.1097/ta.0b013e3181f024fe] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inpatient psychotherapeutic support has been shown to reduce mental health problems in severely injured patients. However, this effect mostly disappears after discharge. The aim of this study was to compare short-term inpatient versus continued long-term outpatient psychotherapeutic support. METHODS Patients with at least two injuries of a combined Abbreviated Injury Scale Severity Score Index≥5 were included in the study. Of 862 screened patients, 113 met all inclusion criteria. They were randomly assigned to a short-term group (n=59), where only inpatient support was given, and a long-term group (n=54), with additional outpatient sessions. The cognitive behavioral treatment was standardized by a manual. Psychological assessment for depression, anxiety, and posttraumatic stress disorder (PTSD) was performed in written form at the time of inclusion, discharge, and 6 months, 12 months, and 18 months after trauma. RESULTS Forty-one percent (n=46) of all patients completed follow-up visits. The results show that symptoms of depression, anxiety, and PTSD disappeared more often in the long-term group than in the short-term group 1 year after trauma. Differences nearly reach significance for anxiety (p=0.051) and PTSD (p=0.059). Twenty-one percent of the short-term group patients showed at least one mental health disorder compared with no patients in the long-term group 1 year after trauma (p=0.035). CONCLUSION Psychotherapeutic support of severely injured patients seems to be more effective in reducing depression, anxiety, and PTSD if extended further into outpatient care. This conclusion should be considered preliminary because of the small number of study patients.
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Functional outcome and quality of life in victims of terrorist explosions as compared to conventional trauma. Eur J Trauma Emerg Surg 2011; 37:31-6. [PMID: 26814747 DOI: 10.1007/s00068-010-0020-2] [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: 09/07/2009] [Accepted: 01/30/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Following trauma, the number of preventable deaths is low. Outcome should also be measured in terms of quality of life (QoL). Studies analyzing QoL in trauma patients have been published, but little is known about the long term QoL of victims of terrorist attacks. METHODS This is a case-control study of casualties of the March 11, 2004 attacks in Madrid. Patients treated for other trauma with similar age and Injury Severity Score (ISS), served as controls. Patients were assessed using the POLO-Chart (VAS, SF-36 and TOP). RESULTS Fifty-eight patients were included, 32 casualties admitted following the March 11, 2004 attacks and 26 controls. Both groups were comparable in age (average = 37), ISS (average = 23) and time from trauma (average = 1,770 days). Subjects demonstrated lower scores for the VAS, and the SF-36 clusters social functioning, role emotional and mental health. There was a tendency towards higher prevalence of symptoms associated to posttraumatic stress disorder (PTSD) in subjects (p = 0.056). Subjects suffered from higher residual pain in the head region (p = 0.032). Strong association was found between the presence of symptoms associated to depression, anxiety and PTSD and worse QoL (p < 0.001). CONCLUSION Subjects present more emotional distortions, residual pain in the head region and a tendency towards a worsened perception of their own health and wellness. They also present symptoms associated to PTSD more frequently. The presence of symptoms associated to PTSD, depression or anxiety was an independent variable related to lower QoL in both groups.
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Gross T, Attenberger C, Huegli RW, Amsler F. Factors associated with reduced longer-term capacity to work in patients after polytrauma: a Swiss trauma center experience. J Am Coll Surg 2010; 211:81-91. [PMID: 20610253 DOI: 10.1016/j.jamcollsurg.2010.02.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 02/10/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Knowledge of the factors associated with longer-term reduced capacity to work (RCW) is lacking in patients after polytrauma. STUDY DESIGN We studied a prospectively collected cohort of polytrauma survivors (n = 115; age 39.5 +/- 20.6 years [mean +/- SD]; 98% blunt trauma; Injury Severity Score [ISS] 27.5 +/- 8.2) at a university trauma center. Uni- and multivariable analyses of patient, trauma, and treatment characteristics as well as parameters of self-reported functional outcomes were studied to determine their association with a reduced capacity to work (RCW) at least 2 years after injury. RESULTS Postinjury quality of life was worse compared with preinjury status in univariate analysis (eg, Euro Quality of Life Group Visual Analogue Scale [EQ VAS] 66.2 +/- 24.4 vs 89.7 +/- 14.7; p = <0.001). In 53% of patients (n = 61), an RCW was found and functional outcomes were significantly lower than those in non-RCW patients (p < 0.001). Lower educational status (odds ratio [OR] 0.25; 95% CI 0.07 to 0.92; p = 0.036), higher ISS (OR 1.12; 95% CI 1.02 to 1.22; p = 0.017), less time in the emergency room (OR 0.92; 95% CI 0.86 to 0.97; p = 0.005), higher mean nurse labor per day and patient (OR 1.01; 95% CI 1.000 to 1.004; p = 0.033), and a reduced Nottingham Health Profile value (OR 1.10; 95% CI 1.06 to 1.15; p < 0.001) were associated with an RCW in the multiple logistic regression model (proportion of variance explained: 0.74). CONCLUSIONS In this cohort of patients surviving polytrauma, approximately 50% of patients sustained longer-term RCW. Several characteristics, such as level of education or trauma severity, showed an independent association with patients' capacity to work, which was significantly associated with patients' self-rated scorings of well-being.
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Affiliation(s)
- Thomas Gross
- Computer Assisted Radiology & Surgery Switzerland (CARCAS), University Hospital Basel, Basel, Switzerland.
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Simmel S, Bühren V. [Surviving multiple trauma--what comes next? The rehabilitation of seriously injured patients]. Unfallchirurg 2010; 112:965-74. [PMID: 19816668 DOI: 10.1007/s00113-009-1686-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The survival chances of multiple trauma patients have improved continuously over the last decades. Therefore, not only the question of whether the patient survives a serious accident arises, but rather how the patient survives it. The after effects of trauma are seen not only physically, but also psychologically and socially. These affect quality of life and are evident years after the accident. The International Classification of Functioning, Disability and Health (ICF) provides a system to classify the after effects of trauma, which can be measured with the help of assessment instruments. Knowing which parameters can influence trauma after effects is essential for the planning, organization, and implementation of a rehabilitation programme following severe injury. The requirements of an optimal rehabilitation process place high demands on the rehabilitation facility and on the rehabilitation team, which ultimately can only be fulfilled by specialized facilities.
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Affiliation(s)
- S Simmel
- Abteilung für BG-Rehabilitation, BG-Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418 Murnau.
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De Silva M, MacLachlan M, Devane D, Desmond D, Gallagher P, Schnyder U, Brennan M, Patel V. Psychosocial interventions for the prevention of disability following traumatic physical injury. Cochrane Database Syst Rev 2009; 2009:CD006422. [PMID: 19821365 PMCID: PMC3428876 DOI: 10.1002/14651858.cd006422.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Traumatic physical injury can result in many disabling sequelae including physical and mental health problems and impaired social functioning. OBJECTIVES To assess the effectiveness of psychosocial interventions in the prevention of physical, mental and social disability following traumatic physical injury. SEARCH STRATEGY The search was not restricted by date, language or publication status. We searched the following electronic databases; Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Controlled Trials metaRegister (www.controlled-trials.com), AMED (Allied & Complementary Medicine), ISI Web of Science: Social Sciences Citation Index (SSCI), PubMed. We also screened the reference lists of all selected papers and contacted authors of relevant studies. The latest search for trials was in February 2008. SELECTION CRITERIA Randomised controlled trials that consider one or more defined psychosocial interventions for the prevention of physical disability, mental health problems or reduced social functioning as a result of traumatic physical injury. We excluded studies that included patients with traumatic brain injury (TBI). DATA COLLECTION AND ANALYSIS Two authors independently screened the titles and abstracts of search results, reviewed the full text of potentially relevant studies, independently assessed the risk of bias and extracted data. MAIN RESULTS We included five studies, involving 756 participants. Three studies assessed the effect of brief psychological therapies, one assessed the impact of a self-help booklet, and one the effect of collaborative care. The disparate nature of the trials covering different patient populations, interventions and outcomes meant that it was not possible to pool data meaningfully across studies. There was no evidence of a protective effect of brief psychological therapy or educational booklets on preventing disability. There was evidence from one trial of a reduction in both post-traumatic stress disorder (PTSD) and depressive symptoms one month after injury in those who received a collaborative care intervention combined with a brief psycho-educational intervention, however this was not retained at follow up. Overall mental health status was the only disability outcome affected by any intervention. In three trials the psychosocial intervention had a detrimental effect on the mental health status of patients. AUTHORS' CONCLUSIONS This review provides no convincing evidence of the effectiveness of psychosocial interventions for the prevention of disability following traumatic physical injury. Taken together, our findings cannot be considered as supporting the provision of psychosocial interventions to prevent aspects of disability arising from physical injury. However, these conclusions are based on a small number of disparate trials with small to moderate sample sizes and are therefore necessarily cautious. More research, using larger sample sizes, and similar interventions and patient populations to enable pooling of results, is needed before these findings can be confirmed.
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Affiliation(s)
- Mary De Silva
- London School of Hygiene & Tropical MedicineNutrition & Public Health Intervention Research UnitKeppel StreetLondonUKWC1E 7HT
| | - Malcolm MacLachlan
- Trinity College, University of DublinCentre for Global Health and School of PsychologyDublinIreland
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyÁras MoyolaUniversity RoadGalwayIreland
| | - Deirdre Desmond
- National University of IrelandDepartment of PsychologyJohn Hume BuildingMaynoothCo. KildareIreland
| | | | - Ulrich Schnyder
- University HospitalDepartment of PsychiatryCulmannstrasse 8ZurichSwitzerlandCH‐9091
| | - Muireann Brennan
- Centers for Disease Control and PreventionInternational Emergency & Refugee Health Branch1600 Clifton Road NE MS E‐97AtlantaGAUSA30333
| | - Vikram Patel
- London School of Hygiene & Tropical MedicineNutrition & Public Health Intervention Research UnitKeppel StreetLondonUKWC1E 7HT
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A fate worse than death? Long-term outcome of trauma patients admitted to the surgical intensive care unit. ACTA ACUST UNITED AC 2009; 67:341-8; discussion 348-9. [PMID: 19667888 DOI: 10.1097/ta.0b013e3181a5cc34] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Trauma centers successfully save lives of severely injured patients who would have formerly died. However, survivors often have multiple complications and morbidities associated with prolonged intensive care unit (ICU) stays. Because the reintegration of patients into the society to lead an active and a productive life is the ultimate goal of trauma center care, we questioned whether our "success" may condemn these patients to a fate worse than death? METHODS Charts on all patients > or =18 years with ICU stay > or =10 days, discharged alive between June 1, 2002, and May 31, 2005, were reviewed. Patients with complete spinal cord injuries were excluded. Demographics, Injury Severity Score (ISS), presence of severe traumatic brain injury (TBI; Head Abbreviated Injury Scale [AIS] score = 4 or 5), presence of extremity fractures, need for operative procedures, ventilator days, complications, and discharge disposition were collected. Glasgow Outcome Scale score was calculated on discharge. Patients were contacted by phone to determine general health, work status, and using this data, Glasgow Outcome Scale score and a modified Functional Independence Measure (FIM) score were calculated. RESULTS Two hundred and forty-one patients met inclusion criteria. Thirty-three patients died postdischarge from the hospital and 39 were known to be alive from the electronic medical records but were unable to be contacted. Sixty-nine patients could not be tracked down and were ultimately considered as lost to follow-up. The remaining 100 patients who were successfully contacted participated in the study. Eighty-one percent were men with a mean age of 42 years, mean and median ISS of 28. Severe TBI was present in 50 (50%) patients. Mean and median follow-up was 3.3 years from discharge. At the time of follow-up, 92 (92%) patients were living at home, 5 in nursing homes, and 3 in assisted living, a shelter, or halfway house. FIM scores ranged from 6 to 12 with 55% reached a maximal FIM score of 12. One quarter of patients had FIM scores < or =10 and 10% had locomotion scores of < or =2 (very dependent). Seventy percent considered themselves to be less active. Seventy-six patients were either working or in full-time school before their trauma. Of the 24 patients not working preinjury, 12 were > or =55 years of age. At the time of follow-up, 37 patients (49%) were back to work or school. Severe TBI patients (57%, 21 of 37) were less likely to return to work when compared with 38% (12 of 38; p = 0.03) without severe TBI. There was no relationship with age, ISS, presence of any TBI, head AIS, presence of any extremity fracture, extremity AIS, or ventilator days in patients who did or did not return to work. CONCLUSIONS These data demonstrate that ICU survivors >3 years after severe injury have significant impairments including inability to return to work or regain previous levels of activity and that the goal of reintegrating patients back into the society is not being met. Further studies better defining the limitations and barriers to improved quality of life are necessary. Survival, although important, is no longer a sufficient outcome to measure trauma center success.
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Pre-traumatic, trauma- and treatment-related determinants of self-rated health after a severe trauma. Langenbecks Arch Surg 2009; 394:539-46. [PMID: 19214559 DOI: 10.1007/s00423-008-0458-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND This analysis examines the relationship between different pre-traumatic, trauma and treatment related factors and self-rated health of heavily injured patients after a severe trauma. MATERIALS & METHODS A written questionnaire was sent to 121 seriously injured patients who were predominantly hurt by traffic or work related accidents and were treated between june 1996 and july 2000 in two hospitals in North Rhine-Westphalia. Information regarding age, gender, education, occupation, income, injury severity, injury of extremities, state anxiety, date of discharge and taking part in a cognitive behavioural intervention were gathered during the inpatient stage, information about self-rated health, patients subjective evaluation of medical treatment outcome and shared decision making with physicians were gathered about four years after trauma. RESULTS Results of a multivariate stepwise linear regression show that poor self-rated health is significantly associated with a negative subjective evaluation of medical treatment outcome, less shared decision making behaviour of physician, low socio-economic status and older age. CONCLUSIONS Treatment but not trauma related factors and socio-economic and demographic characteristics of patients are significantly associated with self-rated health of severely injured patients. It seems to be important for long-term health to take into account: 1.) patient reported outcomes e.g. subjective evaluation of medical treatment outcome, 2.) shared decision making behaviour of physicians and 3.) to be aware of patients with low socio-economic status or 4.) older age as a high risk population.
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