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Pelzer D, Beaudart C, Bornheim S, Maertens de Noordhout B, Schwartz C, Kaux JF. Outcomes of Patients with Lower Limb Loss after Using a Training Prosthesis: A Retrospective Case Series Study. Healthcare (Basel) 2024; 12:567. [PMID: 38470678 PMCID: PMC10931137 DOI: 10.3390/healthcare12050567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The aim of this retrospective case series study was to investigate outcomes in patients with lower limb loss based on whether or not they used a training prosthesis (TP) during rehabilitation. The medical records of 171 consecutive patients admitted to rehabilitation hospitalization between January 2014 and December 2018 following a major amputation of the lower limb were reviewed. Patients were categorized into two groups: patients who underwent rehabilitation with a TP and patients who did not use a TP. Outcomes (i.e., discharge destination, length of stay, number of sockets required, and number of the size adaptation of each socket, as well as functional level) were compared between groups. Of the 171 patients, 126 underwent rehabilitation with a TP, and 45 patients underwent rehabilitation without any TP. In conclusion, we found that patients who used a TP had a significantly shorter hospital length of stay when compared to those who did not. This length of stay for patients with TP was not influenced by age but was lowered by a higher body mass index (BMI), tibial instead of femoral amputation, and the male gender. No association was found between the use of TP and discharge destination, functional level, number of socket modifications, and number of sockets required.
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Affiliation(s)
- Doriane Pelzer
- Physical Medicine, Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, 4000 Liège, Belgium; (D.P.); (S.B.); (B.M.d.N.); (C.S.)
| | - Charlotte Beaudart
- Clinical Pharmacology and Toxicology Research Unit, Department of Biomedical Sciences, Namur Research Institute for Life Sciences (NARILIS), Faculty of Medicine, University of Namur, 5000 Namur, Belgium;
| | - Stephen Bornheim
- Physical Medicine, Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, 4000 Liège, Belgium; (D.P.); (S.B.); (B.M.d.N.); (C.S.)
| | - Benoît Maertens de Noordhout
- Physical Medicine, Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, 4000 Liège, Belgium; (D.P.); (S.B.); (B.M.d.N.); (C.S.)
| | - Cédric Schwartz
- Physical Medicine, Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, 4000 Liège, Belgium; (D.P.); (S.B.); (B.M.d.N.); (C.S.)
| | - Jean-François Kaux
- Physical Medicine, Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, 4000 Liège, Belgium; (D.P.); (S.B.); (B.M.d.N.); (C.S.)
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Zhang S, Lin D, Wright ME, Swallow N. Acute inpatient rehabilitation improves function independent of comorbidities in medically complex patients. Arch Rehabil Res Clin Transl 2022; 4:100178. [PMID: 35756989 PMCID: PMC9214302 DOI: 10.1016/j.arrct.2022.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives (1) To evaluate the benefits of acute inpatient rehabilitation for a medically complex patient population and (2) to assess the effect of comorbid conditions on rehabilitation outcomes. Design Retrospective cohort study. Setting Freestanding inpatient rehabilitation facility. Participants A total of 270 medically complex adult patients including those with cardiac, pulmonary, and orthopedic conditions, with mean age of 73.6 years; 52.6% were female and 47.4% were male (N=270). Interventions Not applicable. Main Outcome Measures Functional Independence Measure (FIM) gain, FIM efficiency, rehabilitation length of stay (RLOS), home discharge rate, and readmission to acute care (RTAC). Results Among 270 medically complex patients, mean total FIM gain, mean RLOS, and mean FIM efficiency with SD were 26.0±13.6 points, 12.6±5.9 days, and 2.3±1.6, respectively. A total of 71.9% of patients were discharged to home, 12.2% for RTAC, and 15.9% to a skilled nursing facility (SNF). Hypertension (HTN) was the only comorbidity significantly associated with FIM gain (53.7% [total FIM gain ≥27] vs 67.2% [total FIM gain <27]; P=.024) and FIM efficiency (53.3% [FIM efficiency ≥2.12] vs 67.4% [FIM efficiency <2.12]; P=.025), independent of age, body mass index, sex, race, ethnicity, insurance type, and Charlson Comorbidity Index. The 5 most common reasons for RTAC were cardiac, pulmonary, acute blood loss anemia, infection, and neurologic conditions. Conclusions Among 270 medically complex patients, 71.9% were discharged to home, 15.9% to an SNF, and 12.2% for RTAC with a mean RLOS 12.6 days, mean total FIM gain of 26 points, and mean FIM efficiency of 2.3, which were all better than those of all admissions at our facility in 2018. Furthermore, RLOS, total FIM gain and FIM efficiency in this study were all better than their corresponding eRehabData weighted national benchmarks (RLOS, 15.82 days; FIM gain, 25.57; FIM efficiency, 2.13) for a total of 202,520 discharges in 2018. These findings support acute inpatient rehabilitation for this patient population. With the exception of HTN, no medical comorbidities or demographic variables were associated with rehabilitation outcomes.
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Riandini T, Pang D, Toh MPHS, Tan CS, Choong AMTL, Lo ZJ, Chandrasekar S, Tai ES, Tan KB, Venkataraman K. National Rates of Lower Extremity Amputation in People With and Without Diabetes in a Multi-Ethnic Asian Population: a Ten Year Study in Singapore. Eur J Vasc Endovasc Surg 2021; 63:147-155. [PMID: 34916107 DOI: 10.1016/j.ejvs.2021.09.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/29/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Population level data from Asia on amputation rates in people with and without diabetes are extremely limited. Hence it is unclear how the rising diabetes prevalence in Asia has affected the amputation burden. The present study examined national amputation rates in people with and without diabetes in Singapore from 2008 to 2017 in the context of increasing diabetes prevalence and health system changes. METHODS This was a retrospective observational study using national population data for ages 16 - 100 years obtained from the Ministry of Health Singapore administrative datasets. Age sex standardised major and toe/ray amputation rates per 100 000 people with diabetes and per 100 000 people without diabetes were calculated. Rates were calculated overall and in each ethnic group (Chinese, Malay, Indian, Others), with trends over time calculated using joinpoint trend analysis. In addition, age specific rates, relative risk (RR) of amputation in diabetics compared with non-diabetics and proportion of amputations in the population attributable to diabetes were also calculated. RESULTS Between 2008 and 2017, the database included 3.6 million unique individuals, of whom 75% were Chinese, 8.6% Malay, 7.9% Indian, and 8.4% Others. Of those, 413 486 (11%) had diabetes. Major amputation rates in people with diabetes remained stable (2008: 99.5/100 000; 2017: 95.0/100 000 people with diabetes, p = .91) as did toe/ray amputation rates. Rates in people without diabetes were substantially lower, with major amputation rates decreasing significantly (2008: 3.0/100 000; 2017: 2.1/100 000 people without diabetes, 3% annual reduction, p = .048). Diabetes related amputation rates were highest in Malays and lowest in Chinese. Diabetes related major amputation rates declined significantly among Chinese (3.1% annual reduction, p < .038). While the RR for amputations in diabetes remained stable, the proportion of major amputations attributable to diabetes increased from 63.6% in 2008 to 81.7% in 2017 (3% annual increase, p = .003). CONCLUSION Diabetes related major and toe/ray amputation rates have remained stable but relatively high in Singapore compared with other countries, and the proportion of amputations attributable to diabetes has increased over time. More research is needed to understand the aetiopathological, sociocultural, and health system factors that may underlie the continued high rates of diabetes related amputations in this population.
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Affiliation(s)
- Tessa Riandini
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Deanette Pang
- Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Matthias P H S Toh
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Chuen S Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Andrew M T L Choong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore, Republic of Singapore
| | - Zhiwen J Lo
- Department of Vascular Surgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Sadhana Chandrasekar
- Department of Vascular Surgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore; Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore.
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Conic RRZ, Geis C, Vincent HK. Social Determinants of Health in Physiatry: Challenges and Opportunities for Clinical Decision Making and Improving Treatment Precision. Front Public Health 2021; 9:738253. [PMID: 34858922 PMCID: PMC8632538 DOI: 10.3389/fpubh.2021.738253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/11/2021] [Indexed: 11/15/2022] Open
Abstract
Physiatry is a medical specialty focused on improving functional outcomes in patients with a variety of medical conditions that affect the brain, spinal cord, peripheral nerves, muscles, bones, joints, ligaments, and tendons. Social determinants of health (SDH) play a key role in determining therapeutic process and patient functional outcomes. Big data and precision medicine have been used in other fields and to some extent in physiatry to predict patient outcomes, however many challenges remain. The interplay between SDH and physiatry outcomes is highly variable depending on different phases of care, and more favorable patient profiles in acute care may be less favorable in the outpatient setting. Furthermore, SDH influence which treatments or interventional procedures are accessible to the patient and thus determine outcomes. This opinion paper describes utility of existing datasets in combination with novel data such as movement, gait patterning and patient perceived outcomes could be analyzed with artificial intelligence methods to determine the best treatment plan for individual patients in order to achieve maximal functional capacity.
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Affiliation(s)
- Rosalynn R Z Conic
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States
| | - Carolyn Geis
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
| | - Heather K Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
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Evans CJ, Potts L, Dalrymple U, Pring A, Verne J, Higginson IJ, Gao W. Characteristics and mortality rates among patients requiring intermediate care: a national cohort study using linked databases. BMC Med 2021; 19:48. [PMID: 33579284 PMCID: PMC7880511 DOI: 10.1186/s12916-021-01912-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Adults increasingly live and die with chronic progressive conditions into advanced age. Many live with multimorbidity and an uncertain illness trajectory with points of marked decline, loss of function and increased risk of end of life. Intermediate care units support mainly older adults in transition between hospital and home to regain function and anticipate and plan for end of life. This study examined the patient characteristics and the factors associated with mortality over 1 year post-admission to an intermediate care unit to inform priorities for care. METHODS A national cohort study of adults admitted to intermediate care units in England using linked individual-level Hospital Episode Statistics and death registration data. The main outcome was mortality within 1 year from admission. The cohort was examined as two groups with significant differences in mortality between main diagnosis of a non-cancer condition and cancer. Data analysis used Kaplan-Meier curves to explore mortality differences between the groups and a time-dependant Cox proportional hazards model to determine mortality risk factors. RESULTS The cohort comprised 76,704 adults with median age 81 years (IQR 70-88) admitted to 220 intermediate care units over 1 year in 2016. Overall, 28.0% died within 1 year post-admission. Mortality varied by the main diagnosis of cancer (total n = 3680, 70.8% died) and non-cancer condition (total n = 73,024, 25.8% died). Illness-related factors had the highest adjusted hazard ratios [aHRs]. At 0-28 days post-admission, risks were highest for non-cancer respiratory conditions (pneumonia (aHR 6.17 [95%CI 4.90-7.76]), chronic obstructive pulmonary disease (aHR 5.01 [95% CI 3.78-6.62]), dementia (aHR 5.07 [95% CI 3.80-6.77]) and liver disease (aHR 9.75 [95% CI 6.50-14.6]) compared with musculoskeletal disorders. In cancer, lung cancer showed largest risk (aHR 1.20 [95%CI 1.04-1.39]) compared with cancer 'other'. Risks increased with high multimorbidity for non-cancer (aHR 2.57 [95% CI 2.36-2.79]) and cancer (aHR 2.59 [95% CI 2.13-3.15]) (reference: lowest). CONCLUSIONS One in four patients died within 1 year. Indicators for palliative care assessment are respiratory conditions, dementia, liver disease, cancer and rising multimorbidity. The traditional emphasis on rehabilitation and recovery in intermediate care units has changed with an ageing population and the need for greater integration of palliative care.
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Affiliation(s)
- Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England. .,Sussex Community NHS Foundation Trust HQ, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Laura Potts
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Ursula Dalrymple
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Andrew Pring
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Julia Verne
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England
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van der Laag PJ, Arends SAM, Bosma MS, van den Hoogen A. Factors associated with successful rehabilitation in older adults: A systematic review and best evidence synthesis. Geriatr Nurs 2021; 42:83-93. [PMID: 33387828 DOI: 10.1016/j.gerinurse.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 01/23/2023]
Abstract
Purpose; Returning to community living is an indicator for successful rehabilitation in older adults admitted to geriatric rehabilitation. Predicting successful rehabilitation could contribute to the deployment of early discharge planning, and leads to a more custom-made rehabilitation trajectory. This review aims to present an overview of factors associated with successful rehabilitation following inpatient geriatric rehabilitation. Method; A systematic literature review was conducted in PubMed, CINAHL and Embase. Extracted factors were analysed via Bakker's five levels of evidence. Results; Nine studies with methodological quality of good to moderate were included. For 13 of the 18 extracted factors, limited (n=3), moderate (n=5) and conflicting (n=5) evidence found a significant association. Conclusions; Caregiver, comorbidities, motor-function, nutritional status, time from onset are significantly related to successful rehabilitation. These factors could support healthcare professionals to indicate successful rehabilitation at admission and contributes to deployment of early discharge planning and development of more custom-made rehabilitation trajectories.
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Affiliation(s)
- Patricia J van der Laag
- Zorggroep Florence, Rijswijk, The Netherlands; Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - Susanne A M Arends
- Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, The Netherlands; Stichting Humanitas, Rotterdam, The Netherlands
| | - Martine S Bosma
- Zorggroep Florence, Rijswijk, The Netherlands; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Agnes van den Hoogen
- Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, The Netherlands; Department of Neonatology, Birth Center Wilhelmina's Children Hospital, Division Women and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
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Schneider F, Saulnier PJ, Gand E, Desvergnes M, Lefort N, Thorin E, Thorin-Trescases N, Mohammedi K, Ragot S, Ricco JB, Hadjadj S. Influence of micro- and macro-vascular disease and Tumor Necrosis Factor Receptor 1 on the level of lower-extremity amputation in patients with type 2 diabetes. Cardiovasc Diabetol 2018; 17:81. [PMID: 29879997 PMCID: PMC5992642 DOI: 10.1186/s12933-018-0725-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/26/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes (T2D) face a high amputation rate. We investigated the relationship between the level of amputation and the presence of micro or macro-vascular disease and related circulating biomarkers, Tumor Necrosis Factor Receptor 1 (TNFR1) and Angiopoietin like-2 protein (ANGPTL2). METHODS We have analyzed data from 1468 T2D participants in a single center prospective cohort (the SURDIAGENE cohort). Our outcome was the occurrence of lower limb amputation categorized in minor (below-ankle) or major (above ankle) amputation. Microvascular disease was defined as a history of albuminuria [microalbuminuria: uACR (urinary albumine-to-creatinine ratio) 30-299 mg/g or macroalbuminuria: uACR ≥ 300 mg/g] and/or severe diabetic retinopathy or macular edema. Macrovascular disease at baseline was divided into peripheral arterial disease (PAD): peripheral artery revascularization and/or major amputation and in non-peripheral macrovascular disease: coronary artery revascularization, myocardial infarction, carotid artery revascularization, stroke. We used a proportional hazard model considering survival without minor or major amputation. RESULTS During a median follow-up period of 7 (0.5) years, 79 patients (5.5%) underwent amputation including 29 minor and 50 major amputations. History of PAD (HR 4.37 95% CI [2.11-9.07]; p < 0.001), severe diabetic retinopathy (2.69 [1.31-5.57]; p = 0.0073), male gender (10.12 [2.41-42.56]; p = 0.0016) and serum ANGPTL2 concentrations (1.25 [1.08-1.45]; p = 0.0025) were associated with minor amputation outcome. History of PAD (6.91 [3.75-12.72]; p < 0.0001), systolic blood pressure (1.02 [1.00-1.03]; p = 0.004), male gender (3.81 [1.67-8.71]; p = 0.002), and serum TNFR1 concentrations (HR 13.68 [5.57-33.59]; p < 0.0001) were associated with major amputation outcome. Urinary albumin excretion was not significantly associated with the risk of minor and major amputation. CONCLUSIONS This study suggests that the risk factors associated with the minor vs. major amputation including biomarkers such as TNFR1 should be considered differently in patients with T2D.
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Affiliation(s)
- Fabrice Schneider
- Service de Chirurgie Vasculaire, CHU de Poitiers, Rue de la Milétrie, BP577, 86021, Poitiers, France. .,UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France.
| | - Pierre-Jean Saulnier
- Centre d'Investigation Clinique CIC1402, INSERM, Université de Poitiers, CHU de Poitiers, Poitiers, France
| | - Elise Gand
- CHU de Poitiers, Pôle Dune, Poitiers, France
| | - Mathieu Desvergnes
- Service de Chirurgie Vasculaire, CHU de Poitiers, Rue de la Milétrie, BP577, 86021, Poitiers, France
| | - Nicolas Lefort
- Service de Chirurgie Vasculaire, CHU de Poitiers, Rue de la Milétrie, BP577, 86021, Poitiers, France
| | - Eric Thorin
- Department of Surgery, Faculty of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Nathalie Thorin-Trescases
- Department of Surgery, Faculty of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | | | - Stéphanie Ragot
- Centre d'Investigation Clinique CIC1402, INSERM, Université de Poitiers, CHU de Poitiers, Poitiers, France
| | - Jean-Baptiste Ricco
- Service de Chirurgie Vasculaire, CHU de Poitiers, Rue de la Milétrie, BP577, 86021, Poitiers, France.,UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
| | - Samy Hadjadj
- Centre d'Investigation Clinique CIC1402, INSERM, Université de Poitiers, CHU de Poitiers, Poitiers, France.,Service d'Endocrinologie, CHU de Poitiers, Poitiers, France
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Wong TH, Nadkarni NV, Nguyen HV, Lim GH, Matchar DB, Seow DCC, King NKK, Ong MEH. One-year and three-year mortality prediction in adult major blunt trauma survivors: a National Retrospective Cohort Analysis. Scand J Trauma Resusc Emerg Med 2018; 26:28. [PMID: 29669572 PMCID: PMC5907285 DOI: 10.1186/s13049-018-0497-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Survivors of trauma are at increased risk of dying after discharge. Studies have found that age, head injury, injury severity, falls and co-morbidities predict long-term mortality. The objective of our study was to build a nomogram predictor of 1-year and 3-year mortality for major blunt trauma adult survivors of the index hospitalization. Methods Using data from the Singapore National Trauma Registry, 2011–2013, we analyzed adults aged 18 and over, admitted after blunt injury, with an injury severity score (ISS) of 12 or more, who survived the index hospitalization, linked to death registry data. The study population was randomly divided 60/40 into separate construction and validation datasets, with the model built in the construction dataset, then tested in the validation dataset. Multivariable logistic regression was used to analyze 1-year and 3-year mortality. Results Of the 3414 blunt trauma survivors, 247 (7.2%) died within 1 year, and 551 (16.1%) died within 3 years of injury. Age (OR 1.06, 95% CI 1.05–1.07, p < 0.001), male gender (OR 1.53, 95% CI 1.12–2.10, p < 0.01), low fall from 0.5 m or less (OR 3.48, 95% CI 2.06–5.87, p < 0.001), Charlson comorbidity index of 2 or more (OR 2.26, 95% CI 1.38–3.70, p < 0.01), diabetes (OR 1.31, 95% CI 1.68–2.52, p = 0.04), cancer (OR 1.76, 95% CI 0.94–3.32, p = 0.08), head and neck AIS 3 or more (OR 1.79, 95% CI 1.13–2.84, p = 0.01), length of hospitalization of 30 days or more (OR 1.99, 95% CI 1.02–3.86, p = 0.04) were predictors of 1-year mortality. This model had a c-statistic of 0.85. Similar factors were found significant for the model predictor of 3-year mortality, which had a c-statistic of 0.83. Both models were validated on the second dataset, with an overall accuracy of 0.94 and 0.84 for 1-year and 3-year mortality respectively. Conclusions Adult survivors of major blunt trauma can be risk-stratified at discharge for long-term support.
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Affiliation(s)
- Ting Hway Wong
- Department of General Surgery, Singapore General Hospital / Duke-National University of Singapore Medical School, Outram Road, Singapore, 169608, Republic of Singapore.
| | | | - Hai V Nguyen
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada
| | - Gek Hsiang Lim
- National Registry of Diseases Office, Health Promotion Board, Singapore, Singapore
| | | | - Dennis Chuen Chai Seow
- Department of Geriatric Medicine, Singapore General Hospital / Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Nicolas K K King
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital / Duke-National University of Singapore Medical School, Singapore, Singapore
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