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Ackermann A, Pappinen J, Nurmi J, Nordquist H, Saviluoto A, Mannila S, Mäkelä S, Torkki P. A scenario based approach to optimizing cost-effectiveness of physician-staffed Helicopter Emergency Medical Services compared to ground-based Emergency Medical Services in Finland. Scand J Trauma Resusc Emerg Med 2024; 32:60. [PMID: 38956713 PMCID: PMC11221128 DOI: 10.1186/s13049-024-01231-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES Since Helicopter Emergency Medical Services (HEMS) is an expensive resource in terms of unit price compared to ground-based Emergency Medical Service (EMS), it is important to further investigate which methods would allow for the optimization of these services. The aim of this study was to evaluate the cost-effectiveness of physician-staffed HEMS compared to ground-based EMS in developed scenarios with improvements in triage, aviation performance, and the inclusion of ischemic stroke patients. METHODS Incremental cost-effectiveness ratio (ICER) was assessed by comparing health outcomes and costs of HEMS versus ground-based EMS across six different scenarios. Estimated 30-day mortality and quality-adjusted life years (QALYs) were used to measure health benefits. Quality-of-Life (QoL) was assessed with EuroQoL instrument, and a one-way sensitivity analysis was carried out across different patient groups. Survival estimates were evaluated from the national FinnHEMS database, with cost analysis based on the most recent financial reports. RESULTS The best outcome was achieved in Scenario 3.1 which included a reduction in over-alerts, aviation performance enhancement, and assessment of ischemic stroke patients. This scenario yielded 1077.07-1436.09 additional QALYs with an ICER of 33,703-44,937 €/QALY. This represented a 27.72% increase in the additional QALYs and a 21.05% reduction in the ICER compared to the current practice. CONCLUSIONS The cost-effectiveness of HEMS can be highly improved by adding stroke patients into the dispatch criteria, as the overall costs are fixed, and the cost-effectiveness is determined based on the utilization rate of capacity.
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Affiliation(s)
- Axel Ackermann
- Department of Public Health, Faculty of Medicine, University of Helsinki, P.O. BOX 00020, Helsingin Yliopisto, Helsinki, 00014, Finland.
| | - Jukka Pappinen
- Department of Public Health, Faculty of Medicine, University of Helsinki, P.O. BOX 00020, Helsingin Yliopisto, Helsinki, 00014, Finland
| | - Jouni Nurmi
- Helsinki University Hospital and University of Helsinki, Acute, Medical Helicopter FinnHEMS 10, Vesikuja 9, Vantaa, 01530, Finland
- FinnHEMS Oy, c/o Avia Pilot, Lentäjäntie 3, Vantaa, 01530, Finland
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Department of Healthcare and Emergency care, Pääskysentie 1, Kotka, 48220, Finland
| | - Anssi Saviluoto
- Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Santtu Mannila
- Copterpoint Oy, Vähäniityntie 18B, Helsinki, 00570, Finland
| | - Simo Mäkelä
- Data Science, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, P.O. BOX 00020, Helsingin Yliopisto, Helsinki, 00014, Finland
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Ackermann A, Pappinen J, Nurmi J, Nordquist H, Torkki P. The Estimated Cost-Effectiveness of Physician-Staffed Helicopter Emergency Medical Services Compared to Ground-Based Emergency Medical Services in Finland. Air Med J 2024; 43:229-235. [PMID: 38821704 DOI: 10.1016/j.amj.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 06/02/2024]
Abstract
OBJECTIVE Because the unit cost of helicopter emergency medical services (HEMS) is higher than traditional ground-based emergency medical services (EMS), it is important to further investigate the impact of HEMS. The aim of this study was to evaluate the cost-effectiveness of physician-staffed HEMS compared with ground-based EMS in Finland under current practices. METHODS The incremental cost-effectiveness ratio was evaluated using the differences in outcomes and costs between HEMS and ground-based EMS. The estimated mortality within 30 days and quality-adjusted life years (QALYs) were used to measure health benefits. Quality of life was estimated according to the EuroQoL scale, and a 1-way sensitivity analysis was conducted on the QALY indexes ranging from 0.6 to 0.8. Survival rates were calculated according to the national HEMS database, and the cost structure was estimated at 48 million euros based on financial statements. RESULTS HEMS prevented the 30-day mortality of 68.1 patients annually, with an incremental cost-effectiveness ratio of €43,688 to €56,918/QALY. Fixed costs accounted for 93% of HEMS expenses because of 24/7 operations, making the capacity utilization rate a major determinant of total costs. CONCLUSION HEMS intervention is cost-effective compared with ground-based EMS and is acceptable from a societal willingness-to-pay perspective. These findings contribute valuable insights for health care management decision making and highlight the need for future research for service optimization.
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Affiliation(s)
- Axel Ackermann
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland.
| | - Jukka Pappinen
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jouni Nurmi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vantaa, Finland
| | - Hilla Nordquist
- Department of Healthcare and Emergency Care, South-Eastern Finland University of Applied Sciences, Kotka, Finland
| | - Paulus Torkki
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland
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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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Finstad J, Røise O, Clausen T, Rosseland LA, Havnes IA. A qualitative longitudinal study of traumatic orthopaedic injury survivors' experiences with pain and the long-term recovery trajectory. BMJ Open 2024; 14:e079161. [PMID: 38191252 PMCID: PMC10806614 DOI: 10.1136/bmjopen-2023-079161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES To explore trauma patients' experiences of the long-term recovery pathway during 18 months following hospital discharge. DESIGN Longitudinal qualitative study. SETTING AND PARTICIPANTS Thirteen trauma patients with injuries associated with pain that had been interviewed 6 weeks after discharge from Oslo University Hospital in Norway, were followed up with an interview 18 months postdischarge. METHOD The illness trajectory framework informed the data collection, with semistructured, in-depth interviews that were analysed thematically. RESULTS Compared with the subacute phase 6 weeks postdischarge, several participants reported exacerbated mental and physical health, including increased pain during 18 months following discharge. This, andalternating periods of deteriorated health status during recovery, made the pathway unpredictable. At 18 months post-discharge, participants were coping with experiences of reduced mental and physical health and socioeconomic losses. Three main themes were identified: (1) coping with persistent pain and reduced physical function, (2) experiencing mental distress without access to mental healthcare and (3) unmet needs for follow-up care. Moreover, at 18 months postdischarge, prescribed opioids were found to be easily accessible from GPs. In addition to relieving chronic pain, motivations to use opioids were to induce sleep, reduce withdrawal symptoms and relieve mental distress. CONCLUSIONS AND IMPLICATIONS The patients' experiences from this study establish knowledge of several challenges in the trauma population's recovery trajectories, which may imply that subacute health status is a poor predictor of long-term outcomes. Throughout recovery, the participants struggled with physical and mental health needs without being met by the healthcare system. Therefore, it is necessary to provide long-term follow-up of trauma patients' health status in the specialist health service based on individual needs. Additionally, to prevent long-term opioid use beyond the subacute phase, there is a need to systematically follow-up and reassess motivations and indications for continued use throughout the recovery pathway.
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Affiliation(s)
- Jeanette Finstad
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav Røise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Trauma Registry, Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Amalia Havnes
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Cole E, Crouch R, Baxter M, Wang C, Sivapathasuntharam D, Peck G, Jennings C, Jarman H. Investigating the effects of frailty on six-month outcomes in older trauma patients admitted to UK major trauma centres: a multi-centre follow up study. Scand J Trauma Resusc Emerg Med 2024; 32:1. [PMID: 38178162 PMCID: PMC10768225 DOI: 10.1186/s13049-023-01169-8] [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: 10/05/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Pre-injury frailty is associated with adverse in-hospital outcomes in older trauma patients, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older frail patients at six months after Major Trauma Centre (MTC) admission. METHODS This was a multi-centre study of patients aged ≥ 65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5 L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5 L VAS at follow up. RESULTS Fifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p = 0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p = 0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤ 50) for frail patients (Frail: 65% vs. Not-frail: 30% p < 0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p = 0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p = 0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p = 0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p = 0.01). CONCLUSIONS Frailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. Pre-injury frailty is a predictor of poor longer-term HRQoL after trauma and recognition should enable early specialist pathways and discharge planning.
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Affiliation(s)
- Elaine Cole
- Centre for Trauma Sciences, Queen Mary University, London, England.
| | - Robert Crouch
- University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Mark Baxter
- University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Chao Wang
- Kingston University, Kingston, England
| | | | - George Peck
- Imperial College Healthcare NHS Trust, London, England
| | - Cara Jennings
- King's College Hospital NHS Foundation, Kingston, England
| | - Heather Jarman
- St George's University Hospital NHS Foundation Trust, London, England
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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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James A, Tran VT, Gauss T, Hamada S, Roquet F, Bitot V, Boutonnet M, Raux M, Ravaud P. Important Issues to Severe Trauma Survivors: A Qualitative Study. Ann Surg 2022; 275:189-195. [PMID: 32209913 DOI: 10.1097/sla.0000000000003879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Identify issues that are important to severe trauma survivors up to 3 years after the trauma. BACKGROUND Severe trauma is the first cause of disability-adjusted life years worldwide, yet most attention has focused on acute care and the impact on long-term health is poorly evaluated. METHOD We conducted a large-scale qualitative study based on semi-structured phone interviews. Qualitative research methods involve the systematic collection, organization, and interpretation of conversations or textual data with patients to explore the meaning of a phenomenon experienced by individuals themselves. We randomly selected severe trauma survivors (abbreviated injury score ≥3 in at least 1 body region) who were receiving care in 6 urban academic level-I trauma centers in France between March 2015 and March 2018. We conducted double independent thematic analysis. Issues reported by patients were grouped into overarching domains by a panel of 5 experts in trauma care. Point of data saturation was estimated with a mathematical model. RESULTS We included 340 participants from 3 months to 3 years after the trauma [median age: 41 years (Q1-Q3 24-54), median injury severity score: 17 (Q1-Q3 11-22)]. We identified 97 common issues that we grouped into 5 overarching domains: body and neurological issues (29 issues elicited by 277 participants), biographical disruption (23 issues, 210 participants), psychological and personality issues (21 issues, 147 participants), burden of treatment (14 issues, 145 participants), and altered relationships (10 issues, 87 participants). Time elapsed because the trauma, injury location, or in-hospital trauma severity did not affect the distribution of these domains across participants' answers. CONCLUSIONS This qualitative study explored trauma survivors' experiences of the long-term effect of their injury and allowed for identifying a set of issues that they consider important, including dimensions that seem overlooked in trauma research. Our findings confirm that trauma is a chronic medical condition that demands new approaches to post-discharge and long-term care.
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Affiliation(s)
- Arthur James
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- Center d'épidémiologie clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France AP-HP
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
- Sorbonne Université, Paris, France
| | - Viet-Thi Tran
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- Center d'épidémiologie clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France AP-HP
| | - Tobias Gauss
- Department of Anaesthesia and Critical Care, Hôpital Beaujon, HUPNVS, AP-HP, Clichy, France
| | - Sophie Hamada
- Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
- CESP, INSERM, Université paris Sud, UVSQ, Université Paris-Saclay, Paris
| | - Florian Roquet
- Service d'Anesthésie-réanimation, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Service de Biostatistique et Informatique Médicale, Unité INSERM UMR 1153, Université Paris Diderot, Paris, France
| | - Valérie Bitot
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service d'anesthésie et des réanimations chirurgicales, Créteil Cedex, France
| | - Mathieu Boutonnet
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart Cedex, France
| | - Mathieu Raux
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Philippe Ravaud
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
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Abstract
BACKGROUND The reintegration into the social and professional environment and the achievement of the best possible quality of life after multiple injuries can often only be achieved after a lengthy rehabilitation process and belongs in the hands of experienced doctors, therapists, and rehabilitation managers. REHABILITATION PHASES Rehabilitation after serious accidents must be differentiated from "normal" orthopedic rehabilitation after elective surgery. The challenges of trauma rehabilitation require coordinated rehabilitation phases. This is the only way to avoid the so-called "rehab hole" between discharge from the acute clinic and the start of post-acute rehabilitation. A 6-phase model is described. After acute treatment (phase A) and any necessary early rehabilitation (phase B), phase C of post-acute rehabilitation places special demands on the rehabilitation facility. Phase D of the follow-up rehabilitation is established. The further rehabilitation (phase E) provides measures specifically tailored to the consequences of the accident, such as pain rehabilitation or activity-oriented procedures. Long-term follow-up care for previously severely injured patients is necessary (phase F). PROSPECTS An integration of trauma rehabilitation centers into the existing trauma network remains the goal to improve the outcome after polytrauma.
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Affiliation(s)
- Stefan Simmel
- Abteilung für BG-Rehabilitation, BG-Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland.
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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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Collins J, Lizarondo L, Porritt K. Adult patient and/or carer experiences of planning for hospital discharge after major trauma: a qualitative systematic review protocol. JBI Evid Synth 2021; 18:341-347. [PMID: 31764434 DOI: 10.11124/jbisrir-d-19-00218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To investigate patient and/or carer experiences of planning for discharge from an acute setting after a major trauma event. INTRODUCTION The experience of injury through major trauma is a worldwide issue that affects people of any age. These patients often experience long-lasting disability. During discharge from the acute setting, patients are at a high risk of experiencing an adverse event due to the complex nature of the process. This review aims to explore patient/carer opinion of their encounter with the discharge planning process following major trauma. INCLUSION CRITERIA This review will consider studies that include patients aged between 18 and 65 who had major traumatic central nervous system injury or were allocated an Injury Severity Score >12, with demonstrated possibility of having an ongoing disability at least one year post-injury. Qualitative studies exploring patient and/or carer experiences of their participation in discharge planning from a trauma unit, acute ward or inpatient rehabilitation to a community setting will be included. METHODS A three-stage search will be conducted and will include unpublished and gray literature. Databases to be searched include PubMed, Embase, PyscInfo, Scopus and CINAHL. Only studies published in English will be considered. Identified studies will be screened for inclusion in the review by two independent reviewers. Data will be extracted using a standardized tool and reviewers will discuss any disagreement. Data synthesis will adhere to the meta-aggregative approach to categorize findings. The categories will be synthesized into a set of findings that can be applied as evidence-based practice. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019138431.
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Affiliation(s)
- Jeanette Collins
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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Calthorpe S, Kimmel LA, Webb MJ, Gabbe BJ, Holland AE. Measurement of mobility and physical function in hospitalised trauma patients: A systematic review of instruments and their measurement properties. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619879326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
IntroductionIt is well recognised that organised trauma systems reduce trauma patient mortality. As established systems mature, there is an increasing need to better understand the patient recovery trajectory. Mobility and physical function are key aspects of recovery, but the optimal instruments for measurement in the acute hospital setting remain unclear.MethodsA systematic review was undertaken to identify and describe mobility and physical function instruments scored by direct patient assessment, in adult trauma patients in an acute hospital setting. Databases were searched with no date restrictions. Instruments that were specific to subgroups or related to individual conditions, diseases or joints were excluded. The consensus-based standards for the selection of health measurement instruments checklist was used to assess risk of bias where relevant. Clinimetric properties were reported where possible, including reliability, validity and responsiveness.ResultsFourteen thousand one hundred and fourteen articles were identified with 37 eligible for final review, including six instruments. None had been specifically designed for use in a heterogeneous range of trauma patients. The Functional Independence Measure was the most commonly cited (n = 10 studies), with evidence of construct validity, responsiveness and minimal floor/ceiling effects (<3%). The Acute Care Index of Function (n = 1 study) was found to be valid and responsive whilst the modified Iowa Level of Assistance (n = 2 studies) was reliable and responsive, but ceiling effects ranged from 26% to 37%. Little clinimetric data were available for other measures.ConclusionEvidence from a few studies show promise for the use of the Functional Independence Measure, Acute Care Index of Function and modified Iowa Level of Assistance to measure mobility and physical function in trauma patients, however comprehensive clinimetric data are lacking. Future research should test these scores in specifically designed clinimetric property studies in defined trauma patient populations. This would enable the identification of a gold standard measure for evaluating treatment effectiveness, enabling benchmarking between centres, allow prediction of recovery pathways and optimise trauma patient outcomes.
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Affiliation(s)
- Sara Calthorpe
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melissa J Webb
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, UK
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
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