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Druery M, Das A, Warren J, Newcombe PA, Lipman J, Cameron CM. Early predictors of health-related quality of life outcomes at 12 months post-burn: ABLE study. Injury 2024; 55:111545. [PMID: 38584078 DOI: 10.1016/j.injury.2024.111545] [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: 01/18/2024] [Revised: 03/21/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
There remains a paucity of evidence on the early predictors of long-term Health-Related Quality of Life (HRQoL) outcomes post-burn in hospitalised adults. The overall aim of this study was to identify the factors (personal, environmental, burn injury and burn treatment factors) that may predict long-term HRQoL outcomes among adult survivors of hospitalised burn injuries at 12 months post-burn. A total of 274 participants, aged 18 years or over, admitted to a single state-wide burn centre with a burn injury were recruited. Injury and burn treatment information were collected from medical records or the hospital database and surveys collected demographic and social data. HRQoL outcome data were collected at 3-, 6- and 12-months using the 12-Item Short Form Survey (SF-12 v1) and Burns Specific Health Scale-Brief (BSHS-B). Personal, environmental, burn injury and burn treatment factors were also recorded at baseline. Analyses were performed using linear and logistic regression. Among 274 participants, 71.5 % (N=196) remained enrolled in the study at 12 months post-burn. The majority of participants reported HRQoL outcomes comparable with population norms and statistically significant improvements in generic (SF-12 v1) and condition-specific (BSHS-B) outcomes over time. However, for participants with poor HRQoL outcomes at 12-months post-burn, Univariable predictors included longer hospital length of stay, unemployment at the time of injury, a diagnosed pre-injury mental health condition, inadequate pre-burn social support, intentional injury, recreational drug use pre-injury and female gender. The early multivariable predictors of insufficient HRQoL outcomes were female gender, a previously diagnosed mental health condition, unemployment, inadequate social support, intentional injury, and prolonged hospital length of stay. These results suggest potential factors that could be used to screen and burns patients for psychosocial intervention and long-term follow up.
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Affiliation(s)
| | - Arpita Das
- Jamieson Trauma Institute, Australia; Queensland University of Technology, Australia.
| | - Jacelle Warren
- Jamieson Trauma Institute, Australia; Queensland University of Technology, Australia
| | | | - Jeffrey Lipman
- The University of Queensland, Australia; Jamieson Trauma Institute, Australia
| | - Cate M Cameron
- Jamieson Trauma Institute, Australia; Queensland University of Technology, Australia
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Maclennan B, Wyeth E, Derrett S. Health-related quality of life following trauma: Prevalence of problems and factors associated with six-month outcomes in a New Zealand cohort. Injury 2024; 55:111468. [PMID: 38452699 DOI: 10.1016/j.injury.2024.111468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/01/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
Injury is a leading cause of health loss in Aotearoa me Te Waipounamu (New Zealand; NZ). The NZ Trauma Registry was established in 2015 to monitor outcomes in those experiencing severe injury and to identify ways of improving the quality of care for these patients. Few NZ studies have assessed outcomes in trauma patients using patient-reported outcome measures (PROMs) despite increasing recognition that the impacts of injury are better understood through PROMs. Our aim was to estimate the prevalence of self-reported problems with health-related quality of life (HRQoL) outcomes six months post-injury, and identify factors associated with these, in a cohort of Māori (the Indigenous population of NZ) and non-Māori individuals who had experienced major trauma. HRQoL outcomes were measured according to the five dimensions of the EQ-5D-5L. This information, along with sociodemographic data, was collected via structured telephone interviews. Participants (n = 870), aged 16 years or more, were recruited following admission to a trauma hospital in one of three (of NZ's four) trauma regions. Multivariable models were developed using modified Poisson Regression to identify factors associated with outcomes for both Māori and non-Māori patients. The prevalence and severity of problems across each of the five EQ-5D-5L dimensions was similar for Māori and non-Māori except for Anxiety/Depression. The prevalence and severity of problems with Anxiety/Depression was greater for Māori. Factors associated with HRQoL problems at six-months were also largely similar for each cohort. Those commonly associated with outcomes were age, hospital length of stay, adequacy of household income, and participants' expectations regarding recovery from injury. Further research examining recovery expectations in trauma patients to determine which factors contribute to formulating recovery expectations, and the potential impact of recovery expectations on treatment and rehabilitation, would be of value. Should expectations, at least in part, influence HRQoL outcomes, then routinely collecting data on patients' recovery expectations, adequacy of household income and potential barriers to treatment and rehabilitation, could help inform post-hospital treatment plans, and identify those who may require additional support following discharge from hospital.
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Affiliation(s)
- Brett Maclennan
- Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Division of Health Sciences, University of Otago, New Zealand
| | - Emma Wyeth
- Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Division of Health Sciences, University of Otago, New Zealand.
| | - Sarah Derrett
- Te Roopū Rakahau Hauora Māori a Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Division of Health Sciences, University of Otago, New Zealand
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McDonald JR, Wagoner M, Shaikh F, Sercy E, Stewart L, Knapp ER, Kiley JL, Campbell WR, Tribble DR. Mental and Physical Health-Related Quality of Life Following Military Polytrauma. Mil Med 2024:usae055. [PMID: 38421743 DOI: 10.1093/milmed/usae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The long-term impact of deployment-related trauma on mental and physical health-related quality of life (HRQoL) among military personnel is not well understood. We describe the mental and physical HRQoL among military personnel following deployment-related polytrauma after their discharge from the hospital and examine factors associated with HRQoL and longitudinal trends. MATERIALS AND METHODS The U.S. military personnel with battlefield-related trauma enrolled in the Trauma Infectious Diseases Outcomes Study were surveyed using SF-8 Health Surveys at 1 month post-discharge (baseline) and at follow-up intervals over 2 years. Inclusion in the longitudinal analysis required baseline SF-8 plus responses during early (3 and/or 6 months) and later follow-up periods (12, 18, and/or 24 months). Associations of demographics, injury characteristics, and hospitalization with baseline SF-8 scores and longitudinal changes in SF-8 scores during follow-up were examined. Survey responses were used to calculate the Mental Component Summary score (MCS) and the Physical Component Summary score (PCS). The MCS focuses on vitality, mental health, social functioning, and daily activity limitations, whereas PCS is related to general health, bodily pain, physical functioning, and physical activity limitations. Longitudinal trends in SF-8 scores were assessed using chi-square tests by comparing the median score at each timepoint to the median 1-month (baseline) score, as well as comparing follow-up scores to the immediately prior timepoint (e.g., 6 months vs. 3 months). Associations with the 1-month baseline SF-8 scores were assessed using generalized linear regression modeling and associations with longitudinal changes in SF-8 were examined using generalized linear regression modeling with repeated measures. RESULTS Among 781 enrollees, lower baseline SF-8 total scores and PCS were associated with spinal and lower extremity injuries (P < .001) in the multivariate analyses, whereas lower baseline MCS was associated with head/face/neck injuries (P < .001). Higher baseline SF-8 total was associated with having an amputation (P = .009), and lower baseline SF-8 total was also associated with sustaining a traumatic brain injury (TBI; P = .042). Among 524 enrollees with longitudinal follow-up, SF-8 scores increased, driven by increased PCS and offset by small MCS decreases. Upward SF-8 total score and PCS trends were associated with time post-hospital discharge and limb amputation (any) in the multivariate analyses (P < .05), whereas downward trends were independently associated with spinal injury and developing any post-discharge infection (P ≤ .001). Patients with lower extremity injuries had lower-magnitude improvements in PCS over time compared to those without lower extremity injuries (P < .001). Upward MCS trend was associated with higher injury severity (P = .003) in the multivariate analyses, whereas downward trends were independently associated with having a TBI (P < .001), time post-hospital discharge (P < .001), and occurrence of post-discharge infections (P = .002). CONCLUSIONS Overall, HRQoL increased during the 2-year follow-up period, driven by PCS improvement. Increasing HRQoL was associated with time since hospital discharge and limb amputation, whereas a downward trend in HRQoL was associated with spinal injury and post-discharge infection. The longitudinal decline in MCS, driven by TBI occurrence, time since hospital discharge, and developing post-discharge infections, emphasizes the importance of longitudinal mental health care in this population.
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Affiliation(s)
- Jay R McDonald
- Infectious Disease Section, VA St. Louis Health Care System, John Cochran Division, St. Louis, MO 63106, USA
- Infectious Disease Division, Washington University School of Medicine, St. Louis,, MO 63110, USA
| | - Matthew Wagoner
- St. Louis University School of Medicine, St. Louis, MO 63014, USA
| | - Faraz Shaikh
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Erica Sercy
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Laveta Stewart
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Emma R Knapp
- Infectious Disease Section, VA St. Louis Health Care System, John Cochran Division, St. Louis, MO 63106, USA
| | - John L Kiley
- Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX 78234, USA
| | - Wesley R Campbell
- Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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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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Ingram-Walpole S, Shah S, Almerie Q, Campana LG, Griffiths B. Thoracic spine stab injury with a retained knife. BMJ Case Rep 2024; 17:e256312. [PMID: 38199662 PMCID: PMC10806944 DOI: 10.1136/bcr-2023-256312] [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] [Indexed: 01/12/2024] Open
Abstract
A female was admitted to a Major Trauma Centre with an isolated thoracic spine stab injury involving a retained knife. The patient was haemodynamically stable with an unremarkable peripheral neurological examination. A CT scan with three-dimensional image reconstruction showed the knife blade lodged in the T11 vertebra with its tip close to the spinal cord, aorta and inferior vena cava. A multidisciplinary trauma team, including anaesthetists, vascular, neurosurgeons and general surgeons, agreed on the treatment strategy. The lodged knife was safely withdrawn in the operating theatre with the patient in a prone position under sedation and local anaesthesia. Following the procedure, neurological examination remained normal, and an MRI scan revealed no spinal cord injury. We discuss the management of penetrating spinal injuries, the importance of detailed preoperative imaging, timely multidisciplinary input and how to safely remove a knife when a prone position prevents standard airway management.
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Affiliation(s)
| | - Shaneel Shah
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Qutayba Almerie
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Ben Griffiths
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK
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Zwemer C, Kartiko S, Forssten MP, Zebley JA, Hughes JD, Sarani B, Mohseni S. Firearms-related injury and sex: a comparative National Trauma Database (NTDB) Study. Trauma Surg Acute Care Open 2023; 8:e001181. [PMID: 38156275 PMCID: PMC10753733 DOI: 10.1136/tsaco-2023-001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/22/2023] [Indexed: 12/30/2023] Open
Abstract
Background Existing study findings on firearms-related injury patterns are largely skewed towards males, who comprise the majority of this injury population. Given the paucity of existing data for females with these injuries, we aimed to elucidate the demographics, injury patterns, and outcomes of firearms-related injury in females compared with males in the USA. Materials and methods A 7-year (2013-2019) retrospective review of the National Trauma Database was conducted to identify all adult patients who suffered firearms-related injuries. Patients who were males were matched (1:1, caliper 0.2) to patients who were females by demographics, comorbidities, injury patterns and severity, and payment method, to compare differences in mortality and several other post-injury outcomes. Results There were 196 696 patients admitted after firearms-related injury during the study period. Of these patients, 23 379 (11.9%) were females, 23 378 of whom were successfully matched to a male counterpart. After matching, females had a lower rate of in-hospital mortality (18.6% vs. 20.0%, p<0.001), deep vein thrombosis (1.2% vs. 1.5%, p=0.014), and had a lower incidence of drug or alcohol withdrawal syndrome (0.2% vs. 0.5%, p<0.001) compared with males. Conclusion Female victims of firearms-related injuries experience lower rates of mortality and complications compared with males. Further studies are needed to elucidate the cause of these differences. Level of evidence Level III.
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Affiliation(s)
- Catherine Zwemer
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Susan Kartiko
- Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Maximilian Peter Forssten
- Örebro University School of Medical Sciences, Orebro, Sweden
- Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden
| | - James A Zebley
- Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Joy Dowden Hughes
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Babak Sarani
- Center for Trauma and Critical Care, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Shahin Mohseni
- Örebro University School of Medical Sciences, Orebro, Sweden
- Division of Trauma and Emergency Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
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Nayak SS, Gadicherla S, Roy S, Chichra M, Dhaundiyal S, Nayak VS, Kamath V. Assessment of quality of life in patients with surgically treated maxillofacial fractures. F1000Res 2023; 12:483. [PMID: 38571567 PMCID: PMC10988203 DOI: 10.12688/f1000research.129579.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 04/05/2024] Open
Abstract
Background: The complex nature of maxillofacial injuries can affect the surgical treatment outcomes and general well-being of the patient. To evaluate the efficiency of the surgical treatment, assessment of the quality of life (QOL) of the patients is of vital importance. Due to the absence of an exclusive QOL assessment tool for maxillofacial fractures, we introduce the 'Twenty-point quality of life assessment in facial trauma patients in Indian population'. The aim of this study was to assess and evaluate the QOL following surgical management of maxillofacial trauma patients based on the severity of the injury. Methods: The study consisted of 182 subjects divided into two groups of 91 each (Group A: severe facial injury and Group B: mild to moderate facial injury). The Facial Injury Severity Scale (FISS) was used to determine the severity of facial fractures and injuries. The twenty-point quality of life assessment tool includes Zone 1 (Psychosocial impact) and Zone 2 (Functional and aesthetic impact), with ten domains each to assess QOL. Results: In Zone 1, the mean scores for Group A and Group B were 38.6 and 39.26, respectively. In Zone 2, Group B (44.56) had higher mean scores compared to Group A (32.92) (p< 0.001). Group B (83.8) had higher mean scores compared to Group A (71.58) when the total of both Zone 1 and Zone 2 were taken into consideration (p<0,001). In Group A, 9 out of 91 patients had a total score of 81- 100 compared to 68 in the same range in Group B. Conclusions: Proper surgical management with adequate care to the hard and soft tissues can improve the QOL by reducing postoperative psychosocial and functional complications. Aesthetic outcomes play an important role in determining the QOL. Mild/ Moderate injuries show better QOL compared to severe maxillofacial injuries.
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Affiliation(s)
- Sunil S Nayak
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education,, Manipal, Karnataka, 576104, India
| | - Srikant Gadicherla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education,, Manipal, Karnataka, 576104, India
| | - Sreea Roy
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education,, Manipal, Karnataka, 576104, India
| | - Muskaan Chichra
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education,, Manipal, Karnataka, 576104, India
| | - Shriya Dhaundiyal
- Graduate Research Apprentice, Post grad, Northeastern university, Boston, USA
| | - Vanishri S Nayak
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Vinayak Kamath
- Department of Public Health Dentistry,, Goa Dental College and Hospital,, Bambolim, Goa, India
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Kotyśko M, Frankowiak J. Psychometric characteristics of the Center for Epidemiologic Studies Depression Scale-Revised in a population of Polish university students. PLoS One 2023; 18:e0290536. [PMID: 37751443 PMCID: PMC10521978 DOI: 10.1371/journal.pone.0290536] [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: 05/05/2023] [Accepted: 08/10/2023] [Indexed: 09/28/2023] Open
Abstract
The Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) has already been validated on the Polish population. However, the structure of the scale obtained at that time was not confirmed by confirmatory factor analysis (CFA) in subsequent studies on the Polish sample and measurement invariance for gender was not performed. The purpose of this article is to present the results of psychometric analyses to verify the structure of the CESD-R in a university student sample. An online cross-sectional study was conducted with 1519 university students (March/April 2021). The dataset was randomly divided into three subsets to perform principal component analysis (PCA, Subset 1) and CFA for CESD-R versions with different numbers of factors and items (Subsets 2 and 3). Measurement invariance for gender was verified for the whole sample. PCA pointed to a three-factor solution that was analyzed in the subsequent CFA. Due to high correlation coefficients between factors, further steps were taken using only one factor. For CFA, 20-, 18- and 9-item versions of the CESD-R were used, but the 9-item version obtained the best model fit parameters and was used to evaluate the measurement invariance for gender, which was confirmed. The 9-item CESD-R has the best model fit compared to other versions of this scale and is gender invariant. Further research is needed to verify the criterion validity of this shortened scale.
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Affiliation(s)
- Martyna Kotyśko
- Department of Clinical Psychology, Development and Education, Faculty of Social Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Joanna Frankowiak
- Department of Clinical Psychology, Development and Education, Faculty of Social Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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da Silva FA, Silva Martins MT, Gutiérrez-Peredo GB, Kraychete AC, Penalva CC, Lopes MB, Matos CM, Lopes AA. Mortality, health-related quality of life, and depression symptoms in younger and older men and women undergoing hemodialysis. Int J Artif Organs 2023; 46:492-497. [PMID: 37424237 DOI: 10.1177/03913988231183724] [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] [Indexed: 07/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Some studies on maintenance hemodialysis (MHD) patients report a longer survival, albeit with poorer health-related quality of life (HRQoL), and more depression symptoms in women than in men. Whether these gender differences vary with age is uncertain. We tested the associations of gender with mortality, depression symptoms, and HRQoL in MHD patients of different age groups. METHODS We used data from 1504 adult MHD patients enrolled in the PROHEMO, a prospective cohort in Salvador, Brazil. The KDQOL-SF was used for the component summaries of the mental (MCS) and physical (PCS) HRQoL scales. Depression symptoms were assessed by the complete version of the Center for Epidemiological Studies Depression Screening Index (CES-D). To test for gender differences, extensively adjusted linear models were used for depression and HRQoL scores, and Cox models for death hazard ratio (HR). RESULTS Women reported worse HRQoL than men, particularly for ages ⩾60 years. In the age group ⩾60 years, the adjusted difference (AD) in score was -3.45; 95% CI: -6.81, -0.70 for MCS -3.16; -5.72, -0.60 for PCS. Older (⩾60 years) women also had more depression symptoms (AD 4.98; 2.33, 7.64). Mortality was slightly lower in women than in men with an adjusted HR of 0.89 (0.71, 1.11) and consistent across age categories. CONCLUSIONS In a sample of Brazilian MHD patients, women had a slightly lower mortality, albeit with more depression symptoms and poorer HRQoL than men, particularly among older patients. This study highlights the need to investigate gender inequalities for MHD patients across different cultures and populations.
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Affiliation(s)
- Fernanda Albuquerque da Silva
- NEPHRON Clinic, Salvador, BA, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia (UFBA), Salvador, BA, Brazil
| | - Marcia Tereza Silva Martins
- Postgraduate Program in Medicine and Health, Federal University of Bahia (UFBA), Salvador, BA, Brazil
- Clinic of Renal Disease and Hypertension (CLINIRIM), Salvador, BA, Brazil
| | | | - Angiolina Campos Kraychete
- Postgraduate Program in Medicine and Health, Federal University of Bahia (UFBA), Salvador, BA, Brazil
- Institute of Nephrology and Dialysis (INED), Salvador, BA, Brazil
| | | | - Marcelo Barreto Lopes
- Postgraduate Program in Medicine and Health, Federal University of Bahia (UFBA), Salvador, BA, Brazil
- Nephrology Department at Hospital São Rafael, D'Or Institute for Research and Education (IDOR), Salvador, Bahia, Brazil
| | - Cacia Mendes Matos
- Postgraduate Program in Medicine and Health, Federal University of Bahia (UFBA), Salvador, BA, Brazil
- Institute of Nephrology and Dialysis (INED), Salvador, BA, Brazil
| | - Antonio Alberto Lopes
- Unit of Clinical Epidemiology and Evidence Based Medicine, Professor Edgard Santos University Hospital, UFBA, Salvador, BA, Brazil
- Department of Internal Medicine, Federal University of Bahia, Salvador, BA, Brazil
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Neufeld MY, Plaitano E, Janeway MG, Munzert T, Scantling D, Allee L, Sanchez SE. History repeats itself: Impact of mental illness on violent reinjury and hospital reencounters among female victims of interpersonal violence. J Trauma Acute Care Surg 2023; 95:143-150. [PMID: 37068014 PMCID: PMC10407825 DOI: 10.1097/ta.0000000000003984] [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] [Indexed: 04/18/2023]
Abstract
BACKGROUND Violence-related reinjury impacts both patients and health care systems. Mental illness (MI) is prevalent among violently injured individuals. The relationship between preexisting MI and violent reinjury among women has not been fully characterized. Our objective was to determine if risk of hospital reencounter-violent reinjury and all-cause-was associated with preexisting MI at time of index injury among female victims of violence. METHODS All females (15-100 + years) presenting to a level I trauma center with violent injury (2002-2019) surviving to discharge were included (N = 1,056). Exposure was presence of preexisting MI. The primary outcome was hospital reencounters for violent reinjury and all-cause within one year (through 2020). The secondary outcome was the development of a new MI within one year of index injury. Odds of reencounter and development of new MI for those with and without preexisting MI were compared with multivariable logistic regression, stratified for interaction when appropriate. RESULTS There were 404 women (38%) with preexisting MI at time of index injury. Approximately 11% of patients with preexisting MI experienced violent reinjury compared to 5% of those without within 1 year ( p < 0.001). Specifically, those with MI in the absence of concomitant substance use had more than three times the odds of violent reinjury (adjusted Odds Ratio, 3.52 (1.57, 7.93); p = 0.002). Of those with preexisting MI, 64% had at least one reencounter for any reason compared to 46% of those without ( p < 0.001 ) . Odds of all-cause reencounter for those with preexisting MI were nearly twice of those without (adjusted Odds Ratio, 1.81 [1.36, 2.42]; p < 0.0001). CONCLUSION Among female victims of violence, preexisting MI is associated with a significantly increased risk of hospital reencounter and violent reinjury within the first year after index injury. Recognition of this vulnerable population and improved efforts at addressing MI in trauma patients is critical to ongoing prevention efforts to reduce violent reinjury. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Miriam Y Neufeld
- From the Department of Surgery (M.Y.N., T.M., D.S., L.A., S.E.S.), Boston Medical Center; Department of Surgery (M.Y.N., D.S., L.A., S.E.S.), Boston University School of Medicine; Undergraduate Program in Neuroscience (E.P.), Boston University College of Arts and Sciences, Boston, Massachusetts; and Department of Surgery (M.G.J.), University of Michigan, Ann Arbor, Michigan
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11
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Orlas CP, Rentas C, Hau K, Ortega G, Sanchez SE, Kaafarani HM, Salim A, Herrera-Escobar JP. Intersection of Race, Ethnicity, and Sex in New Functional Limitations after Injury: Black and Hispanic Female Survivors at Greater Risk. J Am Coll Surg 2023; 236:47-56. [PMID: 36129186 DOI: 10.1097/xcs.0000000000000428] [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
BACKGROUND The impact of disparities at the intersection of multiple marginalized social identities is poorly understood in trauma. We sought to evaluate the joint effect of race, ethnicity, and sex on new functional limitations 6 to 12 months postinjury. STUDY DESIGN Moderately to severely injured patients admitted to one of three Level I trauma centers were asked to complete a phone-based survey assessing functional outcomes 6 to 12 months postinjury. Multivariate adjusted regression analyses were used to compare functional limitations by race and ethnicity alone, sex alone, and the interaction between both race and ethnicity and sex. The joint disparity and its composition were calculated across race and sex strata. RESULTS Included were 4,020 patients: 1,621 (40.3%) non-Hispanic White male patients, 1,566 (39%) non-Hispanic White female patients, 570 (14.2%) Black or Hispanic/Latinx male patients, and 263 (6.5%) Black or Hispanic/Latinx female patients (BHF). The risk-adjusted incidence of functional limitations was highest among BHF (50.6%) vs non-Hispanic White female patients (39.2%), non-Hispanic White male patients (35.8%), and Black or Hispanic male patients (34.6%; p < 0.001). In adjusted analysis, women (odds ratio 1.35 [95% CI 1.16 to 1.57]; p < 0.001) and Blacks or Hispanic patients (odds ratio 1.28 [95% CI 1.03 to 1.58]; p = 0.02) were more likely to have new functional limitations 6 to 12 months postinjury. When sex and race were analyzed together, BHF were more likely to have new functional limitations compared with non-Hispanic White male patients (odds ratio 2.12 [1.55 to 2.90]; p < 0.001), with 63.5% of this joint disparity being explained by the intersection of race and ethnicity and sex. CONCLUSION More than half of the race and sex disparity in functional limitations experienced by BHF is explained by the unique experience of being both minority and a woman. Intermediate modifiable factors contributing to this intersectional disparity must be identified.
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Affiliation(s)
- Claudia P Orlas
- From the Center for Surgery and Public Health (Orlas, Rentas, Hau, Ortega, Herrera-Escobar), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Courtney Rentas
- From the Center for Surgery and Public Health (Orlas, Rentas, Hau, Ortega, Herrera-Escobar), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kaman Hau
- From the Center for Surgery and Public Health (Orlas, Rentas, Hau, Ortega, Herrera-Escobar), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gezzer Ortega
- From the Center for Surgery and Public Health (Orlas, Rentas, Hau, Ortega, Herrera-Escobar), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sabrina E Sanchez
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA (Sanchez)
| | - Haytham Ma Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Kaafarani)
| | - Ali Salim
- Division of Trauma, Burn, and Surgical Critical Care (Salim, Herrera-Escobar), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Juan P Herrera-Escobar
- From the Center for Surgery and Public Health (Orlas, Rentas, Hau, Ortega, Herrera-Escobar), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Trauma, Burn, and Surgical Critical Care (Salim, Herrera-Escobar), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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12
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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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Elreichouni A, Al-Hajj S, Maciejewski KR, Ariss AB, Mowafi H. Factors impacting trauma-specific quality of life following injury: A multi-center assessment in Lebanon. Injury 2022; 53:3255-3262. [PMID: 35970634 DOI: 10.1016/j.injury.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/07/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Injuries account for a large portion of the global burden of disease, representing over 10% of all disability adjusted life years (DALYs). This study analyzes the economic impact of injury for those experiencing moderate-to-severe injury in Beirut, Lebanon. It further examines the impact of different demographic and socioeconomic factors on trauma-specific quality of life 1-2 years following injury. METHODS This was a prospective cohort study following patients 1-2 years after being treated for injury at one of three hospitals in Beirut, Lebanon. Patients interviewed by phone. In addition to questions on financial impact, access to healthcare, and socioeconomic status, the Trauma-specific Quality of Life (TQoL) Questionnaire was used to assess quality of life following injury. Multivariable linear models were constructed to examine TQoL and demographics among institutes. RESULTS 116 patients completed interviews. The average out-of-pocket cost of injury was 2975.42 USD, 65% of which was borrowed. 21% of people lost employment due to injury. Patients at Geitawi Hospital and the Rafic Hariri Governmental Hospital borrowed more on average and had higher reductions in employment than patients at the American University of Beirut Medical Center (AUBMC). There was a loss of income for those employed at the time of injury, with a mean monthly loss of 261.6 USD. The economic impact of injury was 10,329.00 USD. 25% of patients reported difficulty with accessing follow-up care, predominantly due to cost. Mean-adjusted Trauma-specific Quality of life (TQoL) was highest at AUBMC. Education was associated with functional recovery in the TQoL questionnaire; for every additional year of education there was an increase in the functional recovery domain of 0.03. CONCLUSION Individuals that experienced moderate-to-severe injury in Beirut, Lebanon, suffered financial repercussions, including reductions in income, less employment, or unemployment. Across all patients surveyed, higher level of education was associated with better functional quality of life. More study into the intricacies of accessing healthcare care in Lebanon, especially given the current economic and political climate, are crucial to maintain the health of those experiencing injury and can help inform targeted interventions.
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Affiliation(s)
- Ali Elreichouni
- Yale School of Medicine, Yale University, New Haven, CT, United States.
| | - Samar Al-Hajj
- Faculty of Health Sciences, American University in Beirut, Beirut, Lebanon.
| | | | - Abdel Badih Ariss
- Department of Emergency Medicine, American University in Beirut Medical Center, Beirut, Lebanon.
| | - Hani Mowafi
- Department of Emergency Medicine, Yale University, New Haven, CT, United States.
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14
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Finstad J, Clausen T, Rosseland LA, Røise O, Havnes IA. Patient Experiences after Physical Trauma: The Negative Effect of the COVID-19 Pandemic on Recovery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12258. [PMID: 36231553 PMCID: PMC9566588 DOI: 10.3390/ijerph191912258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic generated a crisis within the healthcare system, during which acute, COVID-19-related health needs were prioritized over less urgent needs, including vulnerable subgroups. This study explored experiences of recovery among survivors of physical injuries associated with severe pain during the COVID-19 pandemic in Norway. In-depth interviews were conducted among 13 participants. Findings generated by a thematic analysis revealed that the pandemic, including the contagion control measures and interrupted healthcare, were of negative consequence for the participants' recovery experiences and mental and physical health. Despite experiencing severe pain and perceived needs for support, the participants experienced being deprioritized by the healthcare system. They experienced a reduced capacity to cope with pandemic-related stress and to perform everyday tasks, which they perceived as generating an additional burden for their loved ones. Alcohol was reported to be used in an effort to relieve the associated mental distress. As suggested by this study, injury survivors constitute a vulnerable subgroup for whom the continuity of rehabilitation services during a national crisis, as well as the integration of mental health support, can be essential for mitigating the negative impact of the crisis on recovery and for promoting optimal long-term health outcomes.
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Affiliation(s)
- Jeanette Finstad
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, P.O. Box 4956, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. Box 1039, 0315 Oslo, Norway
| | - Leiv Arne Rosseland
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, P.O. Box 4956, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Oslo, Norway
| | - Olav Røise
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Oslo, Norway
- Norwegian Trauma Registry, Division of Orthopedic Surgery, Oslo University Hospital, P.O. Box 4956, 0424 Oslo, Norway
| | - Ingrid A. Havnes
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Oslo, Norway
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Ingram MCE, Nagalla M, Shan Y, Nasca BJ, Thomas AC, Reddy S, Bilimoria KY, Stey A. Sex-Based Disparities in Timeliness of Trauma Care and Discharge Disposition. JAMA Surg 2022; 157:609-616. [PMID: 35583876 PMCID: PMC9118066 DOI: 10.1001/jamasurg.2022.1550] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 02/25/2022] [Indexed: 11/14/2022]
Abstract
Importance Differences in time to diagnostic and therapeutic measures can contribute to disparities in outcomes. However, whether there is an association of timeliness by sex for trauma patients is unknown. Objective To investigate whether sex-based differences in time to definitive interventions exist for trauma patients in the US and whether these differences are associated with outcomes. Design, Setting, and Participants This was a retrospective cohort study conducted from July 2020 to July 2021, using the 2013 to 2016 Trauma Quality Improvement Program (TQIP) databases from level I to III trauma centers in the US. Patients 18 years or older with an Injury Severity Score (ISS) greater than 15 and who carried diagnoses of traumatic brain injury, intra-abdominal injury, pelvic fracture, femur fracture, and spinal injury as a result of their trauma were included in the study. Data were analyzed from July 2020 to July 2021. Main Outcomes and Measures Primary outcomes assessed timeliness to interventions, using Wilcoxon signed rank and χ2 tests. Secondary outcomes included location of discharge after injury, using propensity score-matched generalized estimating equations modeling. Results Of the 28 332 patients included, 20 002 (70.6%) were male patients (mean [SD] age, 43.3 [18.2] years) and 8330 (29.4%) were female patients (mean [SD] age, 48.5 [21.1] years), with significantly different distributions of ISS scores (ISS score 16-24: male patient, 10 622 [53.1%]; female patient, 4684 [56.2%]; ISS score 41-74: male patient, 2052 [10.3%]; female patient, 852 [10.2%]). Male patients more frequently had abdominal (4257 [21.3%] vs 1268 [15.2%]) and spinal cord (3989 [20.0%] vs 1274 [15.3%]) injuries, whereas female patients experienced greater proportions of femur (3670 [44.0%] vs 8422 [42.1%]) and pelvic (3970 [47.6%] vs 6963 [34.8%]) fractures. Female patients experienced significantly longer emergency department length of stay (median [IQR], 184 [92-314] minutes vs 172 [86-289] minutes; P < .001), longer time in pretriage (median [IQR], 52 [36-80] minutes vs 49 [34-77] minutes; P < .001), and increased likelihood of discharge to nursing or long-term care facilities instead of home after matching by age, ISS, mechanism, and injury type (male patient:female patient, odds ratio, 0.72; 95% CI, 0.67-0.78). Conclusions and Relevance Results of this cohort study suggest that female trauma patients experienced slightly longer delays in trauma care and had a higher likelihood of discharge to long-term care facilities than their male counterparts.
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Affiliation(s)
- Martha-Conley E. Ingram
- Surgical Outcomes Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Monica Nagalla
- Surgical Outcomes Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ying Shan
- Surgical Outcomes Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brian J. Nasca
- Surgical Outcomes Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Arielle C. Thomas
- Committee on Trauma, American College of Surgeons, Chicago, Illinois
| | - Susheel Reddy
- Surgical Outcomes Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karl Y. Bilimoria
- Surgical Outcomes Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anne Stey
- Surgical Outcomes Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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16
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Kalbas Y, Halvachizadeh S, Kumabe Y, Luidl AT, Steel JL, Zelle BA, Cinelli P, Pape HC, Pfeifer R. Post-traumatic growth in polytraumatized patients after 20+ years: a long-term follow-up study of 337 patients treated at a level 1 trauma center. Eur J Trauma Emerg Surg 2022; 49:1279-1286. [PMID: 35763055 DOI: 10.1007/s00068-022-02022-w] [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: 03/25/2022] [Accepted: 05/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE There is limited research on the long-term psychiatric outcomes of polytraumatized patients. Existing studies focus mainly on the negative sequelae. Post-traumatic growth (PTG) describes positive personal development after severe physical or mental distress. In this study, we investigated post-traumatic growth in polytraumatized patients at least 20 years after trauma. METHODS Patients treated for polytrauma at a German level 1 trauma center between 1971 and 1990, were contacted 20+ years later. A questionnaire with 37 questions from the stress-related growth scale (SRGS) and the post-traumatic growth inventory (PGI) was administered. PTG was quantified in five specific areas. PTG and patient demographics were then analyzed using logistic regression. RESULTS Eligible questionnaires were returned by 337 patients. 96.5% of patients reported improvements regarding at least one of the 37 questions. Approximately, a third of patients noticed distinct improvements regarding their relationship to others (29.2%), appreciation of life (36.2%) and attitudes towards new possibilities (32.5%). Patient demographics were significant predictors for the development of PTG: Older (p < 0.001), female (p = 0.042) and married patients (p = 0.047) showed a greater expression of PTG. We also saw significantly more PTG in patients with higher injury severity (p = 0.033). CONCLUSION 20 years after polytrauma, patients report improvements in their relationship with others, appreciation of life and attitude towards new possibilities. Women and married patients show higher expression of PTG. Furthermore, there is higher expression of PTG with higher age and injury severity. Post-traumatic growth should be identified and fostered in clinical practice. LEVEL OF EVIDENCE III-prospective long-term follow-up study.
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Affiliation(s)
- Yannik Kalbas
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland.
| | - Sascha Halvachizadeh
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Yohei Kumabe
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | | | - Jennifer Lynne Steel
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Boris A Zelle
- Department of Orthopaedics, UT Health San Antonio, Joe R. & Teresa Lozano Long School of Medicine, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Paolo Cinelli
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
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17
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Martin-Herz SP, McMahon RJ, Malzyner S, Chiang N, Zatzick DF. Impact of posttraumatic stress disorder and depressive symptoms on quality of life in adolescents after general traumatic injury. J Trauma Stress 2022; 35:386-397. [PMID: 34861072 DOI: 10.1002/jts.22750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 11/06/2022]
Abstract
Posttraumatic stress disorder (PTSD) and depressive symptoms have been associated with poorer health-related quality of life in adolescents after general traumatic injuries; few studies have examined the broader construct of postinjury quality of life (QOL). We evaluated the impact of traumatic injury on adolescent QOL and examined factors that potentially contribute to poorer outcomes, using the Youth Quality of Life Instrument-Research Version as the outcome measure. Data were collected within 30 days postinjury and 2, 5, and 12 months postinjury. Mixed-model regression (MMR) was used for the main analyses. Participants (N = 204) were drawn from a prospective cohort study of 12-18-year-olds admitted to a Level 1 trauma center (n = 108) and healthy participants from a local cross-sectional study (n = 116); study group participants were significantly older. The initial MMR indicated that female adolescents had significantly lower QOL, B = -2.69, 95% CI [-4.68, -0.70], and were more likely to score above the cutoffs for PTSD (19.1% vs. 2.0%), χ2 (1, N = 381) = 34.6, p < .001, or depression (32.8% vs. 14.0%), χ2 (1, N = 381) = 18.7, p < .001, on post hoc analyses. Adolescents with mental health conditions in the year postinjury had significant QOL deficits without predicted improvements toward baseline, PTSD: B = -10.05, 95% CI [-15.29, -4.81]; depression: B = -18.00, 95% CI [-21.69, -14.31]. These findings highlight the importance of ongoing mental health monitoring and care for adolescents, particularly female adolescents, following traumatic injury even when physical recovery appears complete.
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Affiliation(s)
- Susanne P Martin-Herz
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Robert J McMahon
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.,B.C. Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | | | - Nikki Chiang
- University of California, Berkeley, Berkeley, California, USA
| | - Douglas F Zatzick
- Department of Psychiatry, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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18
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Banierink H, Ten Duis K, Meesters AML, Trouwborst NM, Heineman E, Wendt KW, Ploegmakers JJW, Reininga IHF, IJpma FFA. The effects of pelvic ring injuries on quality of life, physical, and mental health: results of a 2-year prospective cohort study. Eur J Trauma Emerg Surg 2022; 48:2849-2857. [PMID: 35254459 PMCID: PMC9360067 DOI: 10.1007/s00068-022-01893-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
Purpose Pelvic ring injuries are known to affect the patients’ daily life in terms of physical functioning and quality of life (QoL). Still, prospective studies on the patient’s perception over the first 2 years of rehabilitation are lacking. Therefore, patients cannot be properly informed about whether or when they will return to their pre-existing level of physical functioning and QoL. Methods A prospective longitudinal cohort study was performed over a 4-year period including all consecutive patients above 18 years who sustained a pelvic ring injury in a level 1 trauma center. Validated patient-reported outcome measures (PROMs) were used to assess physical functioning (SMFA) and QoL (EQ-5D) at baseline (recalled pre-injury score), 6 weeks, 3 months, 6 months, 1 year and 2 years after the injury. It was assessed whether patients had fully recovered by comparing follow-up scores to baseline PROMs. Binary logistic regression analysis was used to identify independent predictors for patients who did not fully recover. Most experienced difficulties at 3 months and 1 year were identified by analyzing the highest reported scores on individual items of the SMFA. Results A total of 297 patients with a pelvic ring injury were identified of which 189 were eligible for follow-up and 154 (82%) responded. Median SMFA function score at 3 months, 1 and 2 years was 70, 78 and 88, respectively, compared to 96 out of 100 before the injury. Median SMFA bother score was 67, 79 and 88, respectively. Median EQ-5D score at 3 months, 1 and 2 years was 0.61, 0.81 and 0.85, respectively, compared to 1 (maximum achievable) before the injury. After 1 and 2 years of follow-up, 61% and 75% of the patients fully “recovered” in physical functioning and 52% and 71% fully recovered in terms of QoL. Female gender and high-energy trauma were independent predictors for not fully recovering after 1 year. After 3 months of follow-up, 54% of patients reported severe difficulties with recreational activities, whereas after 1 year, most experienced difficulties (31% of patients) concerned heavy house or yard work. Moreover, after 3 months and 1 year, 44% and 27% of patients reported feeling physically disabled. Conclusion Pelvic ring injuries have a large impact on the patients’ daily life in the first 2 years of rehabilitation. Directly after the injury, physical functioning and QoL decrease strongly but then gradually improve over a 2-year period with about 75% of patients fully recovering. Female gender and high-energy trauma are shown to be independent predictors for not fully recovering. After 3 months, patients experience difficulties with both the physical and mental effects of the injury which continue to be present after 1 year. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01893-3.
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Affiliation(s)
- Hester Banierink
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Kaj Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne M L Meesters
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nymke M Trouwborst
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Heineman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaus W Wendt
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joris J W Ploegmakers
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge H F Reininga
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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19
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Functional outcomes more than 5 years following acetabulum fracture. OTA Int 2022; 5:e173. [PMID: 35252780 PMCID: PMC8887944 DOI: 10.1097/oi9.0000000000000173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
Objectives: The purposes of this project were to evaluate functional outcomes more than 5 years after acetabulum fracture and to determine factors related to function. Methods: This retrospective study consisted of 205 adult patients treated for acetabulum fracture who completed the Musculoskeletal Function Assessment (MFA) a minimum of 5 years following injury. The MFA includes survey of daily activities, gross and fine mobility, social and work function, sleeping, and mood. Higher scores indicate worse function. Results: Two hundred five patients with 210 fractures, 69.3% of whom were male, with mean age of 45.7 and mean body mass index 30.1 were included after mean 128 months follow-up. Fracture patterns included OTA/AO 62A (37.1%), 62B (40.5%), or 62C (22.4%), and 80.0% were treated surgically. Late complications were noted in 35.2%, including posttraumatic arthrosis (PTA: 19.5%), osteonecrosis and/or heterotopic ossification. Mean MFA of all patients was 31.4, indicating substantial residual dysfunction. Worse MFA scores were associated with morbid obesity (body mass index >40: 42.3, P>.09), and current tobacco smoking history vs former smoker vs nonsmoker (45.2 vs 36.1 vs 23.0, P < .002). Patients with late complications had worse mean MFA scores (38.7 vs 27.7, P = .001); PTA was the most common late complication, occurring in 19.5%. Conclusions: More than 5 years following acetabulum fracture, substantial residual dysfunction was noted, as demonstrated by mean MFA. Worse outcomes were associated with late complications and tobacco smoking. While fracture pattern was not associated with outcome, those patients who had late complications, mostly PTA, had worse outcomes.
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Somoye MS, Adetayo AM, Adeyemo WL, Ladeinde AL, Gbotolorun MO. A comparative study of quality of life of patients with maxillofacial fracture and healthy controls at two tertiary healthcare institutions. J Korean Assoc Oral Maxillofac Surg 2021; 47:351-359. [PMID: 34713809 PMCID: PMC8564083 DOI: 10.5125/jkaoms.2021.47.5.351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/07/2022] Open
Abstract
Objectives Despite treatment, the pre-traumatic facial appearance of patients with maxillofacial fractures might not be able to be restored, and this difference can affect the person's quality of life (QoL). This study was designed to evaluate changes in QoL of people with maxillofacial fractures. Materials and Methods The study population was comprised of participants with maxillofacial fracture and age- and sex-matched healthy controls without history of such fracture. QoL was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF) questionnaire, which was administered to the patients before treatment (Time 1), at 6 weeks post-treatment (Time 2), and at 12 weeks postoperatively (Time 3). The values were compared with those of healthy controls. The QoL was compared between closed reduction group and open reduction and internal fixation group. Results The QoL scores of people with maxillofacial fracture before treatment were significantly lower (P=0.001) than those of healthy controls in all domains of the WHOQOL-BREF. The QoL scores in the psychological and social domains of patients with maxillofacial fracture at Time 3 were still lower than those of healthy controls (P=0.001). Conclusion The QoL of patients with maxillofacial fracture was significantly reduced before treatment in all domains and remained reduced in both psychological and social domains weeks after treatment. Therefore, clinicians must be aware of and manage the residual psychosocial issues that can accompany the post-treatment period of maxillofacial injury.
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Affiliation(s)
- Mayowa Solomon Somoye
- Department of Oral & Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Adekunle Moses Adetayo
- Department of Surgery, Benjamin Carson Snr School of Medicine, Babcock University, Ilisan-Remo, Nigeria
| | - Wasiu Lanre Adeyemo
- Department of Oral & Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Akinola Ladipo Ladeinde
- Department of Oral & Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
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Idzik(199) A, Leńczuk-Gruba A, Kobos E, Pietrzak M, Dziedzic B. Loneliness and Depression among Women in Poland during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010698. [PMID: 34682443 PMCID: PMC8535819 DOI: 10.3390/ijerph182010698] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/23/2022]
Abstract
Background: The COVID-19 pandemic has forced many changes in the functioning of people all over the world in a short period of time. According to a WHO report (2020), it is women who are at a particular risk of the negative effects of the pandemic, especially in terms of mental health. Aim of study: The aim of the study was to assess the prevalence of anxiety, depression, irritability, and loneliness among adult women during the COVID-19 pandemic. Materials and methods: The study was conducted on a representative sample of women in Poland (n = 452). The data were collected using the HADS-M scale and the R-UCLA scale. Results: A low level of loneliness was found in 37.3% of the women, moderate in 38.9%, moderately high in 22.3% and very high in 1.3% of women. Self-rating of physical and mental health was significantly positively correlated with anxiety, depression, and irritability in HADS-M, and loneliness in R-UCLA. As the severity of loneliness increased, so did Hospital Anxiety and Depression Scale scores on all subscales (p < 0.001). Conclusions: The study group presented with mental well-being disorders in the form of anxiety and depression. Two in three women experienced loneliness.
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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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Hewitt J, Bains N, Wallis K, Gething S, Pennington A, Carter B. The Use of Patient Reported Outcome Measures (PROMs) 6 Months Post-Stroke and Their Association with the National Institute of Health Stroke Scale (NIHSS) on Admission to Hospital. Geriatrics (Basel) 2021; 6:geriatrics6030088. [PMID: 34562989 PMCID: PMC8482088 DOI: 10.3390/geriatrics6030088] [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: 06/24/2021] [Revised: 08/26/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022] Open
Abstract
Patient Reported Outcome Measures (PROMs) assess clinical outcomes from the perspective of the patient. The stroke community recommended fifteen questions for use in stroke survivors, based on the established PROMIS10 with five additional stroke-specific questions. This study aimed to determine its association with the National Institute of Health Stroke Scale (NIHSS) on admission. PROM responses were taken from an existing randomised control trial and, using secondary analysis, the total score was calculated out of 100. The association between PROMs and NIHSS was estimated. Using a multivariable regression, an adjusted mean difference (aMD) in PROM total score for the baseline clinical characteristics was calculated. 343 participants (16.3%) completed the PROM; mean age 71.7 (30–94) years; 133 women (38.8%). There was a strong association between increasing NIHSS Scores on admission to hospital and worsening PROM scores at 6 months (p = 0.002). There was consistency between the NIHSS and modified Rankin score with the stroke-specific domain and total PROM scores. When adjusted, women had lower (worse) total PROM scores, with aMD = −3.85 (95% CI −6.30–−1.41; p = 0.002) and so did haemorrhagic strokes, with a reduction of 3.88 (95% CI −0.61–7.37; p = 0.097). This study contributes to the evaluation process of this stroke-specific PROM and emphasises that stroke severity on admission correlates with poorer patient outcomes 6 months following a stroke, especially in women and those suffering haemorrhagic stroke.
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Affiliation(s)
- Jonathan Hewitt
- Division of Population Medicine, Cardiff University, Cardiff CF10 3AT, UK; (N.B.); (K.W.); (S.G.); (A.P.)
- Correspondence: ; Tel.:+44-2920-716982
| | - Natalie Bains
- Division of Population Medicine, Cardiff University, Cardiff CF10 3AT, UK; (N.B.); (K.W.); (S.G.); (A.P.)
| | - Katherine Wallis
- Division of Population Medicine, Cardiff University, Cardiff CF10 3AT, UK; (N.B.); (K.W.); (S.G.); (A.P.)
| | - Stephanie Gething
- Division of Population Medicine, Cardiff University, Cardiff CF10 3AT, UK; (N.B.); (K.W.); (S.G.); (A.P.)
| | - Anna Pennington
- Division of Population Medicine, Cardiff University, Cardiff CF10 3AT, UK; (N.B.); (K.W.); (S.G.); (A.P.)
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK;
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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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25
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van der Vlegel M, Haagsma JA, Havermans RJM, de Munter L, de Jongh MAC, Polinder S. Long-term medical and productivity costs of severe trauma: Results from a prospective cohort study. PLoS One 2021; 16:e0252673. [PMID: 34086788 PMCID: PMC8177462 DOI: 10.1371/journal.pone.0252673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background Through improvements in trauma care there has been a decline in injury mortality, as more people survive severe trauma. Patients who survive severe trauma are at risk of long-term disabilities which may place a high economic burden on society. The purpose of this study was to estimate the health care and productivity costs of severe trauma patients up to 24 months after sustaining the injury. Furthermore, we investigated the impact of injury severity level on health care utilization and costs and determined predictors for health care and productivity costs. Methods This prospective cohort study included adult trauma patients with severe injury (ISS≥16). Data on in-hospital health care use, 24-month post-hospital health care use and productivity loss were obtained from hospital registry data and collected with the iMTA Medical Consumption and Productivity Cost Questionnaire. The questionnaires were completed 1 week and 1, 3, 6, 12 and 24 months after injury. Log-linked gamma generalized linear models were used to investigate the drivers of health care and productivity costs. Results In total, 174 severe injury patients were included in this study. The median age of participants was 55 years and the majority were male (66.1%). The mean hospital stay was 14.2 (SD = 13.5) days. Patients with paid employment returned to work 21 weeks after injury. In total, the mean costs per patient were €24,760 with in-hospital costs of €11,930, post-hospital costs of €7,770 and productivity costs of €8,800. Having an ISS ≥25 and lower health status were predictors of high health care costs and male sex was associated with higher productivity costs. Conclusions Both health care and productivity costs increased with injury severity, although large differences were observed between patients. It is important for decision-makers to consider not only in-hospital health care utilization but also the long-term consequences and associated costs related to rehabilitation and productivity loss.
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Affiliation(s)
- Marjolein van der Vlegel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roos J. M. Havermans
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
| | - Leonie de Munter
- Department Trauma TopCare, ETZ Hospital, Tilburg, The Netherlands
| | | | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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26
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Gross T, Morell S, Amsler F. Medically graded reduced capacity to work (RCW) following significant injury as explained by patient related outcome measures (PROMs) - A prospective trauma center evaluation. Disabil Health J 2021; 14:101114. [PMID: 34059469 DOI: 10.1016/j.dhjo.2021.101114] [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: 05/12/2020] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Data is limited how well patient-reported longer-term outcome measures (PROMs) explain medically graded reduced capacity for work (RCW). OBJECTIVE This prospective study investigates the association of RCW with several PROMs in addition to demographic and injury-related variables in significantly injured of working age. METHODS Patients (New Injury Severity Score, NISS ≥ 8) were recruited consecutively. RCW, as registered by the largest Swiss accident insurer, was tested against demographic, trauma and treatment characteristics, and patients' contemporaneous two year rating of functional outcome and quality of life following trauma with measures such as the Short-Form (SF)-36 or Trauma Outcome Profile (TOP), using uni- and multivariable analysis. RESULTS 140 patients (mean 42 years, 2-year RCW rate 21%) participated in the longer-term follow-up of self-rated outcome. In multivariable analysis, all investigated baseline factors together accounted for 48% of the variance explaining 2-year postinjury RCW with 31% contributed by demographic, injury or treatment related variables, and 17% by patients' condition at hospital discharge. Patients' self-rated longer-term outcome provided 61% of the information on concurrent RCW, whereby 53% identified worsening of physical function (SF-36) and additional 8% constraints in daily activities (TOP). Four variables (Glasgow Outcome Scale at the time of hospital discharge and SF-36 physical functioning, TOP daily activities, SF-36 role physical at two years) explained 71% of RCW, corresponding to an area under the curve (AUC) of 0.95. CONCLUSIONS Objectively graded RCW 2 years after injury was found to be well explained by the combined information of patients' subjective longer-term outcome together with basic patient, trauma and treatment characteristics.
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Affiliation(s)
- Thomas Gross
- Department of Traumatology, Cantonal Hospital, Tellstr.1, CH-5001, Aarau, Switzerland.
| | - Sabrina Morell
- Department of Traumatology, Cantonal Hospital, Tellstr.1, CH-5001, Aarau, Switzerland
| | - Felix Amsler
- Amsler Consulting, Gundeldingerrain 111, CH-4059, Basel, Switzerland
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27
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Moore EE, Moore HB, Kornblith LZ, Neal MD, Hoffman M, Mutch NJ, Schöchl H, Hunt BJ, Sauaia A. Trauma-induced coagulopathy. Nat Rev Dis Primers 2021; 7:30. [PMID: 33927200 PMCID: PMC9107773 DOI: 10.1038/s41572-021-00264-3] [Citation(s) in RCA: 278] [Impact Index Per Article: 92.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 12/12/2022]
Abstract
Uncontrolled haemorrhage is a major preventable cause of death in patients with traumatic injury. Trauma-induced coagulopathy (TIC) describes abnormal coagulation processes that are attributable to trauma. In the early hours of TIC development, hypocoagulability is typically present, resulting in bleeding, whereas later TIC is characterized by a hypercoagulable state associated with venous thromboembolism and multiple organ failure. Several pathophysiological mechanisms underlie TIC; tissue injury and shock synergistically provoke endothelial, immune system, platelet and clotting activation, which are accentuated by the 'lethal triad' (coagulopathy, hypothermia and acidosis). Traumatic brain injury also has a distinct role in TIC. Haemostatic abnormalities include fibrinogen depletion, inadequate thrombin generation, impaired platelet function and dysregulated fibrinolysis. Laboratory diagnosis is based on coagulation abnormalities detected by conventional or viscoelastic haemostatic assays; however, it does not always match the clinical condition. Management priorities are stopping blood loss and reversing shock by restoring circulating blood volume, to prevent or reduce the risk of worsening TIC. Various blood products can be used in resuscitation; however, there is no international agreement on the optimal composition of transfusion components. Tranexamic acid is used in pre-hospital settings selectively in the USA and more widely in Europe and other locations. Survivors of TIC experience high rates of morbidity, which affects short-term and long-term quality of life and functional outcome.
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Affiliation(s)
- Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA.
- Department of Surgery, University of Colorado Denver, Aurora, CO, USA.
| | - Hunter B Moore
- Department of Surgery, University of Colorado Denver, Aurora, CO, USA
| | - Lucy Z Kornblith
- Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Matthew D Neal
- Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Maureane Hoffman
- Duke University School of Medicine, Transfusion Service, Durham VA Medical Center, Durham, NC, USA
| | - Nicola J Mutch
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Herbert Schöchl
- Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg and Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria
| | | | - Angela Sauaia
- Department of Surgery, University of Colorado Denver, Aurora, CO, USA
- Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
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Herrera-Escobar JP, El Moheb M, Ranjit A, Weed C, Brasel K, Kasotakis G, Kaafarani HMA, Velmahos G, Nehra D, Haider AH, Jarman M, Salim A. Sex differences in long-term outcomes after traumatic injury: A mediation analysis. Am J Surg 2021; 222:842-848. [PMID: 33541687 DOI: 10.1016/j.amjsurg.2021.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND We sought to examine the association and potential mediators between sex and long-term trauma outcomes. METHODS Moderately-to-severely injured patients admitted to 3 level-1 trauma centers were contacted between 6 and 12-months post-injury to assess for functional limitations, use of pain medications, and posttraumatic stress disorder (PTSD). Multivariable adjusted regression analyses were used to compare long-term outcomes by sex. Potential mediators of the relationship between sex and outcomes was explored using mediation analysis. RESULTS 2607 patients were followed, of which 45% were female. Compared to male, female patients were more likely to have functional limitations (OR: 1.45; 95% CI: 1.31-1.60), take pain medications (OR: 1.17; 95% CI: 1.02-1.38), and screen positive for PTSD (OR: 1.60; 95% CI: 1.46-1.76) post-injury. Age, extremity injury, previous psychiatric illness, and pre-injury unemployment, partially mediated the effect of female sex on long-term outcomes. CONCLUSIONS There are significant sex differences in long-term trauma outcomes, which are partially driven by patient and injury-related factors.
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Affiliation(s)
- Juan P Herrera-Escobar
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Mohamad El Moheb
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anju Ranjit
- Department of Obstetrics and Gynecology, Howard University Hospital, Washington, D.C, USA
| | - Christina Weed
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Karen Brasel
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - George Kasotakis
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Haytham M A Kaafarani
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George Velmahos
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Adil H Haider
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Aga Khan University School of Medicine, Karachi, Pakistan
| | - Molly Jarman
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Visser E, Oudsten BLD, Gosens T, Lodder P, De Vries J. Psychological risk factors that characterize the trajectories of quality of life after a physical trauma: a longitudinal study using latent class analysis. Qual Life Res 2021; 30:1317-1335. [PMID: 33447963 PMCID: PMC8068651 DOI: 10.1007/s11136-020-02740-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The course and corresponding characteristics of quality of life (QOL) domains in trauma population are unclear. Our aim was to identify longitudinal QOL trajectories and determine and predict the sociodemographic, clinical, and psychological characteristics of trajectory membership in physical trauma patients using a biopsychosocial approach. METHODS Patients completed a questionnaire set after inclusion, and at 3, 6, 9, and 12 months follow-up. Trajectories were identified using repeated-measures latent class analysis. The trajectory characteristics were ranked using Cohen's d effect size or phi coefficient. RESULTS Altogether, 267 patients were included. The mean age was 54.1 (SD = 16.1), 62% were male, and the median injury severity score was 5.0 [2.0-9.0]. Four latent trajectories were found for psychological health and environment, five for physical health and social relationships, and seven trajectories were found for overall QOL and general health. The trajectories seemed to remain stable over time. For each QOL domain, the identified trajectories differed significantly in terms of anxiety, depressive symptoms, acute stress disorder, post-traumatic stress disorder, Neuroticism, trait anxiety, Extraversion, and Conscientiousness. DISCUSSION Psychological factors characterized the trajectories during 12 months after trauma. Health care providers can use these findings to identify patients at risk for impaired QOL and offer patient-centered care to improve QOL.
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Affiliation(s)
- Eva Visser
- Department Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Brenda Leontine Den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopaedics, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Jolanda De Vries
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.
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30
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Visser E, Den Oudsten BL, Traa MJ, Gosens T, De Vries J. Patients' experiences and wellbeing after injury: A focus group study. PLoS One 2021; 16:e0245198. [PMID: 33411828 PMCID: PMC7790403 DOI: 10.1371/journal.pone.0245198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 12/27/2020] [Indexed: 01/07/2023] Open
Abstract
Background Injury can have physical, psychological and social consequences. It is unclear which factors have an impact on patients’ wellbeing after injury. This study aimed to explore, using focus groups, patients’ experiences and wellbeing after injury and which factors, impede or facilitate patients’ wellbeing. Methods Trauma patients, treated in the shock room of the Elisabeth-TweeSteden Hospital, the Netherlands, participated in focus groups. Purposive sampling was used. Exclusion criteria were younger than 18 years old, severe traumatic brain injury, dementia, and insufficient knowledge of the Dutch language. The interviews were recorded, transcribed verbatim, and analyzed using coding technique open, axial, and selective coding, based on phenomenological approach. Results Six focus groups (3 to 7 participants) were held before data saturation was reached. In total, 134 patients were invited, 28 (21%) agreed to participate (Median age: 59.5; min. 18 –max. 84). Main reasons to decline were fear that the discussion would be too confronting or patients experienced no problems regarding the trauma or treatment. Participants experienced difficulties on physical (no recovery to pre-trauma level), psychological (fear of dying or for permanent limitations, symptoms of posttraumatic stress disorder, cognitive dysfunction), social (impact on relatives and social support) wellbeing. These are impeding factors for recovery. However, good communication, especially clarity about the injury and expectations concerning recovery and future perspectives could help patients in surrendering to care. Patients felt less helpless when they knew what to expect. Conclusions This is the first study that explored patients’ experiences and wellbeing after injury. Patients reported that their injury had an impact on their physical, psychological, and social wellbeing up to 12 months after injury. Professionals with the knowledge of consequences after injury could improve their anticipation on patients’ need.
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Affiliation(s)
- Eva Visser
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
- * E-mail:
| | - Brenda Leontine Den Oudsten
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Marjan Johanna Traa
- Department of Medical Psychology; ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopaedics, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Jolanda De Vries
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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31
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de Munter L, Polinder S, Havermans RJM, Steyerberg EW, de Jongh MAC. Prognostic factors for recovery of health status after injury: a prospective multicentre cohort study. BMJ Open 2021; 11:e038707. [PMID: 33408198 PMCID: PMC7789437 DOI: 10.1136/bmjopen-2020-038707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To determine prognostic factors for health status and recovery patterns during the first 2 years after injury in the clinical trauma population. DESIGN A prospective longitudinal cohort study. SETTING Ten participating hospitals in Brabant, the Netherlands. PARTICIPANTS Injured adult patients admitted to a hospital between August 2015 and November 2016 were followed: 4883 (50%) patients participated. MAIN OUTCOME MEASURES Primary outcome was health status, measured with the EuroQol-5-dimensions-3-levels (EQ-5D), including a cognition item and the EuroQol Visual Analogue Scale. Health status was collected at 1 week, 1, 3, 6, 12 and 24 months after injury. Potential prognostic factors were based on literature and clinical experience (eg, age, sex, pre-injury frailty (Groningen Frailty Index), pre-injury EQ-5D). RESULTS Health status increased mainly during the first 6 months after injury with a mean EQ-5D utility score at 1 week of 0.49 and 0.79 at 24 months. The dimensions mobility, pain/discomfort and usual activities improved up to 2 years after injury. Lower pre-injury health status, frailty and longer length of stay at the hospital were important prognostic factors for poor recovery. Spine injury, lower and upper extremity injury showed to be prognostic factors for problems after injury. Traumatic brain injury was a prognostic factor for cognitive problems. CONCLUSION This study contributes to the increase in knowledge of health recovery after injury. It could be a starting point to develop prediction models for specific injury classifications and implementation of personalised medicine. TRIAL REGISTRATION NUMBER NCT02508675.
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Affiliation(s)
- Leonie de Munter
- Trauma TopCare, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Suzanne Polinder
- Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roos J M Havermans
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
| | - Ewout W Steyerberg
- Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Mariska A C de Jongh
- Trauma TopCare, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
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Jacoby SF, Robinson AJ, Webster JL, Morrison CN, Richmond TS. The feasibility and acceptability of mobile health monitoring for real-time assessment of traumatic injury outcomes. Mhealth 2021; 7:5. [PMID: 33634188 PMCID: PMC7882274 DOI: 10.21037/mhealth-19-200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 07/08/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Traumatic injuries are a health event that can begin a trajectory towards chronic health and social challenges. Mobile technology-based prevention and treatment interventions have been used to monitor and transform outcomes across a myriad of health conditions, but their potential in long-term injury recovery is unexplored. The goal of this pilot study was to assess the acceptability and feasibility of mobile health monitoring for long-term outcomes in a population of trauma patients with known barriers to health and social care after injury. METHODS We re-recruited 25 individuals, 12-36 months after acute hospitalization, from a recently concluded study of psychological outcomes in seriously injured Black men in Philadelphia, Pennsylvania. This mixed- methods pilot study was conducted in three phases: (I) qualitative interviews and development of a pilot monitoring platform; (II) a 3-month feasibility trial of mobile monitoring of patient-reported outcomes and biometric data using a wrist-worn commercial fitness monitor (n=18); (III) post-implementation qualitative interviews. RESULTS Analysis of data from pre-implementation interviews indicated that the majority of participants used smartphones as a primary means of communicating with their social network and to access the internet. The 90-day pilot trial of mobile monitoring indicated participants' preference text-delivered communication and survey elicitation. Response rates for 12 automated surveys ranged from 84-92%. Twenty-four hours a day adherence to optional biometric monitoring was generally lower than 50% but ranged widely indicating both very low adherence and very high adherence. Four of 25 participants, 2 who had opted for Fitbit monitoring, were lost to follow-up at the end of the 90-day pilot trial. In post-implementation assessments, participants endorsed the acceptability of mobile monitoring highlighting the benefit of its convenience and flexibility over in-person outcome monitoring. Participants also perceived its potential benefit in long-term engagement with health and social services to assist with the challenges they faced when attempting to achieve physical, psychological, social, and financial recovery after hospitalization. These findings were reinforced through qualitative interviews which highlighted, in addition to acceptability, the perceived value of self-monitoring through the use of wearable devices to track health data like physical activity and sleep. CONCLUSIONS This study indicates the feasibility and acceptability of mobile health monitoring used to examine long-term injury sequalae. Future research may leverage this novel strategy, refining its application to address current limitations in the reliability and accuracy of commercially available wearable technology, relative costs and benefits of different mobile data collection strategies, integration within current clinical paradigms and generalizability across injured populations and socio-ecological environments.
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Affiliation(s)
- Sara F. Jacoby
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew J. Robinson
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica L. Webster
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher N. Morrison
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Therese S. Richmond
- University of Pennsylvania Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Kirven JC, Everhart JS, DiBartola AC, Jones J, Flanigan DC, Harrison R. Interventional Efforts to Reduce Psychological Distress After Orthopedic Trauma: A Systematic Review. HSS J 2020; 16:250-260. [PMID: 33088239 PMCID: PMC7534886 DOI: 10.1007/s11420-019-09731-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Unanticipated severe injury to part of the musculoskeletal system, referred to as orthopedic trauma, can be debilitating. It can also be accompanied by equally debilitating psychological distress, but little is known about the effective interventions for psychological sequelae of orthopedic trauma. QUESTIONS/PURPOSES We sought to determine the effectiveness of interventions on psychological outcomes, such as post-traumatic stress disorder (PTSD), depression, and pain catastrophizing (feelings of helplessness, excessive rumination, and exaggerated description of pain), after major orthopedic trauma. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement as guidelines, we systematically searched Scopus, PubMed, and Google Scholar. Studies included for review were English-language interventional studies in an orthopedic trauma population that included assessment of post-injury psychological distress or disability as either a primary or secondary aim. RESULTS Twelve studies were identified, including six randomized trials, three prospective cohort studies, and three retrospective cohort studies. Study sample sizes ranged from 48 to 569 patients, the mean age ranged from 29 to 52.8 years, and the percentage of male patients ranged from 38 to 90%. We examined four categories of interventions. Peer group treatment (one study) significantly reduced rates of depression but had low participation rates. Brief interventions to teach coping and self-efficacy skills (two studies) decreased depression, pain catastrophizing, and anxiety scores while increasing self-efficacy on short-term follow-up. Individualized counseling and rehabilitation (four studies) resulted in a consistent reduction in the risk of PTSD. Early amputation was found to result in lower rates of PSTD than limb salvage in US military personnel (four studies). One study examined surgeons' confidence in dealing with possible psychological distress; surgeons who participated in a program on collaborative care were significantly more confident that they could help their patients with such issues. CONCLUSION Interventional strategies, including group interventions, brief individual interventions, longitudinal counseling, and consideration of early amputation in selected populations have proved effective in reducing negative psychological sequelae of major orthopedic trauma. Further research that determines the effects of interventions in this population is needed.
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Affiliation(s)
- James C. Kirven
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811Sports Medicine, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Joshua S. Everhart
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - Alex C. DiBartola
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - Jeremy Jones
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - David C. Flanigan
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811Sports Medicine, Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Cartilage Restoration Program, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Ryan Harrison
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
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Factors Associated With Long-term Outcomes After Injury: Results of the Functional Outcomes and Recovery After Trauma Emergencies (FORTE) Multicenter Cohort Study. Ann Surg 2020; 271:1165-1173. [PMID: 30550382 DOI: 10.1097/sla.0000000000003101] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine factors associated with patient-reported outcomes, 6 to 12 months after moderate to severe injury. SUMMARY OF BACKGROUND DATA Due to limitations of trauma registries, we have an incomplete understanding of factors that impact long-term patient-reported outcomes after injury. As 96% of patients survive their injuries, several entities including the National Academies of Science, Engineering and Medicine have called for a mechanism to routinely follow trauma patients and determine factors associated with survival, patient-reported outcomes, and reintegration into society after trauma. METHODS Over 30 months, major trauma patients [Injury Severity Score (ISS) ≥9] admitted to 3 Level-I trauma centers in Boston were assessed via telephone between 6 and 12 months after injury. Outcome measures evaluated long-term functional, physical, and mental-health outcomes. Multiple regression models were utilized to identify patient and injury factors associated with outcomes. RESULTS We successfully followed 1736 patients (65% of patients contacted). More than half (62%) reported current physical limitations, 37% needed help for at least 1 activity of daily living, 20% screened positive for posttraumatic stress disorder (PTSD), all SF-12 physical health subdomain scores were significantly below US norms, and 41% of patients who were working previously were unable to return to work. Age, sex, and education were associated with long-term outcomes, while almost none of the traditional measures of injury severity were. CONCLUSION The long-term sequelae of trauma are more significant than previously expected. Collection of postdischarge outcomes identified patient factors, such as female sex and low education, associated with worse recovery. This suggests that social support systems are potentially at the core of recovery rather than traditional measures of injury severity.
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Brouwers L, de Jongh MAC, de Munter L, Edwards M, Lansink KWW. Prognostic factors and quality of life after pelvic fractures. The Brabant Injury Outcome Surveillance (BIOS) study. PLoS One 2020; 15:e0233690. [PMID: 32525901 PMCID: PMC7289384 DOI: 10.1371/journal.pone.0233690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/10/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Pelvic fractures can have long-term consequences for health-related quality of life (HRQoL). The main purpose of this study is to provide insight into short-term HRQoL in the first year after pelvic injury and to identify short-term prognostic factors of decreased outcome. Methods This is a prospective, observational, multicenter, follow-up cohort study in which HRQoL and functional outcomes were assessed during 12-month follow-up of injured adult patients admitted to 1 of 10 hospitals in the county of Noord-Brabant, the Netherlands. The data were collected by self-reported questionnaires at 1 week (including preinjury assessment) and 1, 3, 6 and 12 months after injury. The EuroQoL-5D (EQ-5D), visual analog scale (VAS), Merle d’Aubigné Hip Score (MAHS) and Majeed Pelvic Score (MPS) were used. Multivariable mixed models were used to examine the course of the HRQoL and the prognostic factors for decreased HRQoL and functional outcomes over time. Results A total of 184 patients with pelvic fractures were identified between September 2015–September 2016; the fractures included 71 Tile A, 44 Tile B and 10 Tile C fractures and 59 acetabular fractures. At the pre-injury, 1 week, and 1, 3, 6 and 12 months after injury time points, the mean EQ-5D Index values were 0.90, 0.26, 0.45, 0.66, 0.77 and 0.80, respectively, and the mean EQ-VAS values were 83, 45, 57, 69, 75 and 75, respectively. At 6 and 12 months after injury, 22 and 25% of the MPS < 65 year group, 38 and 47% of the MPS ≥ 65 year group and 34 and 51% of the MAHS group, respectively, reached the maximum score. Pre-injury score, female gender and high Injury Severity Score (ISS) were important prognostic factors for a decreased HRQoL, and the EQ-5D VAS β = 0.43 (95% CI: 0.31 − 0.57), -6.66 (95% CI: -10.90 − -0.43) and -7.09 (95% CI: -6.11 − -5.67), respectively. Discussion Patients with pelvic fractures experience a reduction in their HRQoL. Most patients do not achieve the HRQoL of their pre-injury state within 1 year after trauma. Prognostic factors for decreased HRQoL are a low pre-injury score, high ISS and female gender. We do not recommend using the MAHS and MPS in mid- or long-term follow-up of pelvic fractures because of ceiling effects. Trial registration number NCT02508675.
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Affiliation(s)
- L. Brouwers
- Network Emergency Care Brabant, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
- * E-mail:
| | - M. A. C. de Jongh
- Network Emergency Care Brabant, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
- Department Trauma Topcare, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
| | - L. de Munter
- Department Trauma Topcare, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
| | - M. Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - K. W. W. Lansink
- Department Trauma Topcare, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
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Sanjuán Marín JF, Medina R, Botache Capera WF, Montoya F, Ruiz G, García Marín AF, Badiel M, Ordoñez Delgado CA. Tendencia de los años perdidos de vida potencial por trauma en Colombia: análisis de un periodo de nueve años. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El trauma es reconocido como una epidemia global que varía según las regiones donde se presenta. Una parte de la carga de la enfermedad está determinada por los años perdidos de vida potencial, la cual es una estimación de amplio uso para la vigilancia en salud pública; sin embargo, existe poca información disponible en relación a esto. El objetivo de este estudio fue determinar la tendencia de los años perdidos de vida potencial por el trauma en un período de nueve años. Métodos. La información se obtuvo del Instituto Nacional de Medicina Legal y Ciencias Forenses en un período de nueve años (2007-2015). La población de referencia se determinó con base en las proyecciones del Departamento Administrativo Nacional de Estadística, que indicaron una expectativa de vida de 75 años. Resultados. En el 2015, a las lesiones por traumatismos en Colombia les correspondieron 1.920,7 años perdidos de vida potencial por cada 100.000 personas. Durante el período de estudio, las principales causas fueron los homicidios (rango, 51 a 68 %) y los accidentes de tránsito (rango, 19 a 28 %); la relación entre hombres y mujeres fue de 7:1, y la tendencia estadística fue hacia la disminución de los años perdidos de vida potencial. Conclusiones. Los homicidios siguen aportando el mayor número de lesiones por trauma y años perdidos de vida potencial. Los hombres jóvenes continuaron siendo la población mayormente afectada. Se conceptúa la necesidad de incrementar los esfuerzos para mejorar la vigilancia en salud pública y ahondar en las intervenciones oportunas relacionadas con el trauma.
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Soeker MS, Darries Z. The experiences of women with traumatic brain injury about the barriers and facilitators experienced after vocational rehabilitation in the Western Cape Metropole, South Africa. Work 2019; 64:477-486. [PMID: 31658081 DOI: 10.3233/wor-193009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Traumatic Brain Injury (TBI) is a serious global public health problem. Globally and annually, at least 10 million individuals live with TBI that is serious enough to result in death or hospitalisationOBJECTIVE:This study aimed to explore and describe the experiences of women with traumatic brain injury, in their work environments utilising the Model of Occupational Self-efficacy as a vocational rehabilitation approachMETHOD:Ten females with mild to moderate traumatic brain injury participated in the study. Semi-structured interviews were conducted and data were analysed utilising a qualitative approach to elucidate themes. Semi-structured interviews were also conducted with two occupational therapists who served as key informants. RESULTS Two themes emerged depicting the participants' experiences and perceptions of barriers and facilitators which influenced their return to work: (1) Barriers to work participation for women with TBI, 2) Re-establishing a worker identity by means of vocational rehabilitation. CONCLUSION Both personal and environmental factors emerged as hindrances to returning to work for women with traumatic brain injury. Vocational rehabilitation proved successful in establishing a worker identity amongst participants; however, particular focus should be placed on the function-dysfunction continuum of the process of work place integration to further develop and enhance sustainable return to work programmes for women with traumatic brain injury.
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Affiliation(s)
| | - Zareena Darries
- Occupational Therapy Department, University of the Western Cape, South Africa
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Hernefalk B, Eriksson N, Larsson S, Borg T. Patient-reported Outcome in Surgically Treated Pelvic Ring Injuries at 5 Years Post-surgery. Scand J Surg 2019; 110:86-92. [PMID: 31537176 DOI: 10.1177/1457496919877583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Long-term prospective data on patient-reported outcome after surgical treatment of pelvic ring injuries are scarce. This study aimed at describing results at 5 years post-surgery using validated outcome measures. PATIENTS AND METHODS Patients admitted for surgical treatment of pelvic ring injuries were prospectively included and asked to report their outcome at 1, 2 and 5 years post-surgery using two patient-reported outcome measures: the generic Short-Form 36 and the condition-specific pelvic discomfort index. Data were evaluated using mixed-effects linear models. RESULTS There were 108 patients (68 males and 40 females), mean age 38 years. Injury type according to the AO/OTA-classification was B-type in 68 patients and C-type in 40 patients. No domain of the Short-Form 36 reached norm values at 5 years post-surgery. Females reported a worse outcome than males concerning general health (p < 0.01) at 5 years. Recovery of physical function (p < 0.01), mental health (p = 0.04), and pain (p = 0.01) was observed for males at 5 years compared to earlier assessments, while females on the contrary described more pain at this time-point (p = 0.03). Mean pelvic discomfort index at 5 years was 27, indicating moderate residual pelvic discomfort overall. Males reported less pelvic discomfort than females at 5 years (p = 0.02) and improved when compared to results at 2 years (p = 0.02), while females did not. Influence of age, fracture type, and presence of associated injuries on patient-reported outcome was limited. CONCLUSION Surgically treated pelvic ring injuries are associated with long-standing negative effects on patient-reported outcome. Males report a better outcome than females at 5 years post-surgery.
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Affiliation(s)
- B Hernefalk
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - N Eriksson
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - S Larsson
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - T Borg
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
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Johnson L, Lodge C, Vollans S, Harwood PJ. Predictors of psychological distress following major trauma. Injury 2019; 50:1577-1583. [PMID: 31196596 DOI: 10.1016/j.injury.2019.05.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/25/2019] [Accepted: 05/30/2019] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to identify variables that may predict later psychological distress in patients following admission to a Major Trauma Centre (MTC) and to determine whether a psychological screening tool, the Posttraumatic Adjustment Screen (PAS), administered on admission was able to contribute to this. METHODS Patients referred to the MTC clinical psychology service completed the PAS during their inpatient stay over an eight-month period. Following discharge from hospital, patients were telephoned (1 month, 3 months and 6 months post injury) by a member of the clinical psychology team and asked two validated questionnaires; the Impact of Events Scale revised (IES-R) (measure of posttraumatic stress symptoms) and the CORE-10 (measure of global psychological distress). In addition, patients' data from the local Trauma Audit & Research Network (TARN) database was reviewed to identify information related to injury and other demographic data. Patients were divided into groups for comparison based upon their PAS scores using previously described severity cut offs for posttraumatic stress symptoms and depression. Receiver Operator Characteristic and Multiple Linear Regression analysis was used to examine for significant baseline predictors of psychological distress during follow up according to the IES and CORE-10 scores. RESULTS One hundred and fourteen patients completed the PAS over the study period. Follow-up psychological data was available for 63 (56%) of patients. Except for the patient's home address, no baseline parameter examined in this study regarding patient demographics, injury or treatment was associated with reported psychological symptoms in the first six months post injury as measured by the IES-R or CORE-10 scores. Multiple linear regression analysis revealed that both PAS-P and PAS-D were significant predictor variables for patients reporting significant symptoms of posttraumatic stress and global psychological distress (according to IES-R and CORE-10 scores) in the first six months post injury. CONCLUSIONS Psychological screening on admission may be helpful in identifying patients admitted to MTCs who are at risk at developing posttraumatic stress symptoms and psychological distress following major trauma.
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Affiliation(s)
- L Johnson
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom.
| | - C Lodge
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom
| | - S Vollans
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom
| | - P J Harwood
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom
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Maher J, Charles N, Wolkowitz C. Working mothers, injury and embodied care work. GENDER WORK AND ORGANIZATION 2019. [DOI: 10.1111/gwao.12270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vu HM, Dang AK, Tran TT, Vu GT, Truong NT, Nguyen CT, Doan AV, Pham KTH, Tran TH, Tran BX, Latkin CA, Ho CSH, Ho RCM. Health-Related Quality of Life Profiles among Patients with Different Road Traffic Injuries in an Urban Setting of Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081462. [PMID: 31022979 PMCID: PMC6517995 DOI: 10.3390/ijerph16081462] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/18/2019] [Accepted: 04/20/2019] [Indexed: 11/21/2022]
Abstract
Road traffic injuries (RTIs) cause a substantial disease burden in Vietnam. Evaluating health-related quality of life (HRQOL) among patients having a diversity of RTIs informs an integral part of treatment effectiveness. This study aims to examine HRQOL of patients suffering different RTIs in Vietnam’s urban areas. A cross-sectional study was conducted on 408 patients from October to December 2018 in six hospitals in Thai Binh. The EuroQol-5 dimensions-5 levels (EQ-5D-5L) and visual analog scale (VAS) were used to assess the HRQOL of patients. Multivariable Tobit regression was applied to measure the difference of HRQOL among different kinds of injuries. The mean EQ-5D-5L and VAS score was 0.40–0.66, respectively. Mean EQ-5D-5L index was lowest in patients with oral and facial injuries (0.22) and fracture injuries (0.23), while patients having hand injuries had the highest EQ-5D-5L index (0.54). EQ-5D-5L index had a negative association with oral, facial, and fracture injuries. Meanwhile, patients with brain, fracture, and multiple injuries tended to have lower VAS score. Poor HRQOL among patients injured in road traffic were observed. Pain management, early rehabilitation, and mental health counseling services should be considered during treatment time, especially among those having the brain, oral and facial trauma, fracture, and multiple injuries.
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Affiliation(s)
- Hai Minh Vu
- Department of Trauma, Thai Binh University of Medicine and Pharmacy, Thai Binh 410000, Vietnam.
| | - Anh Kim Dang
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Tung Thanh Tran
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam.
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam.
| | - Nu Thi Truong
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam.
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Anh Van Doan
- Department of Trauma, Thai Binh University of Medicine and Pharmacy, Thai Binh 410000, Vietnam.
| | - Kiet Tuan Huy Pham
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000 Vietnam.
| | - Tung Hoang Tran
- Institute of Orthopaedic and Trauma Surgery, Vietnam-Germany Hospital, Hanoi 100000, Vietnam.
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000 Vietnam.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore.
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam.
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, Singapore 119228, Singapore.
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Gross T, Morell S, Amsler F. Gender-Specific Improvements in Outcome 1 and 2 Years After Major Trauma. J Surg Res 2019; 235:459-469. [DOI: 10.1016/j.jss.2018.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 08/29/2018] [Accepted: 10/17/2018] [Indexed: 12/01/2022]
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Dijkink S, Krijnen P, Hage A, Van der Wilden GM, Kasotakis G, Hartog DD, Salim A, Goslings JC, Bloemers FW, Rhemrev SJ, King DR, Velmahos GC, Schipper IB. Differences in Characteristics and Outcome of Patients with Penetrating Injuries in the USA and the Netherlands: A Multi-institutional Comparison. World J Surg 2018; 42:3608-3615. [PMID: 29785695 PMCID: PMC6182736 DOI: 10.1007/s00268-018-4669-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The incidence and nature of penetrating injuries differ between countries. The aim of this study was to analyze characteristics and clinical outcomes of patients with penetrating injuries treated at urban Level-1 trauma centers in the USA (USTC) and the Netherlands (NLTC). METHODS In this retrospective cohort study, 1331 adult patients (470 from five NLTC and 861 from three USTC) with truncal penetrating injuries admitted between July 2011 and December 2014 were included. In-hospital mortality was the primary outcome. Outcome comparisons were adjusted for differences in population characteristics in multivariable analyses. RESULTS In USTC, gunshot wound injuries (36.1 vs. 17.4%, p < 0.001) and assaults were more frequent (91.2 vs. 77.7%, p < 0.001). ISS was higher in USTC, but the Revised Trauma Score (RTS) was comparable. In-hospital mortality was similar (5.0 vs. 3.6% in NLTC, p = 0.25). The adjusted odds ratio for mortality in USTC compared to NLTC was 0.95 (95% confidence interval 0.35-2.54). Hospital stay length of stay was shorter in USTC (difference 0.17 days, 95% CI -0.29 to -0.05, p = 0.005), ICU admission rate was comparable (OR 0.96, 95% CI 0.71-1.31, p = 0.80), and ICU length of stay was longer in USTC (difference of 0.39 days, 95% CI 0.18-0.60, p < 0.0001). More USTC patients were discharged to home (86.9 vs. 80.6%, p < 0.001). Readmission rates were similar (5.6 vs. 3.8%, p = 0.17). CONCLUSION Despite the higher incidence of penetrating trauma, particularly firearm-related injuries, and higher hospital volumes in the USTC compared to the NLTC, the in-hospital mortality was similar. In this study, outcome of care was not significantly influenced by differences in incidence of firearm-related injuries.
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Affiliation(s)
- Suzan Dijkink
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieta Krijnen
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Aglaia Hage
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - George Kasotakis
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, Boston University School of Medicine, Boston, MA USA
| | - Dennis den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ali Salim
- Division of Trauma, Burn and Surgical Critical Care and Emergency General Surgery, Brigham and Women’s Hospital, Boston, MA USA
| | - J. Carel Goslings
- Department of Trauma Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Present Address: Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Frank W. Bloemers
- Department of Trauma Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Steven J. Rhemrev
- Department of Trauma Surgery, Haaglanden Medical Center Westeinde, The Hague, The Netherlands
| | - David R. King
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, USA
| | - George C. Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, USA
| | - Inger B. Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Injuries due to trauma are the leading cause of death in Sweden among people younger than 45 years, and more than 120,000 patients were admitted to hospitals in 2014 as a result of trauma. Patients suffering from less serious physical trauma are often discharged directly from the trauma unit, commonly without any follow-up plans. There is a lack of knowledge about how these patients experience their recovery process.Eight women and 6 men were interviewed 3 months after being directly discharged from a trauma unit. Data were analyzed using the constructive grounded theory approach.The main finding was the core category of social support, the key to recovery. Patients' roads to recapturing their health and to recovery had several barriers, which can be clustered together to either physical or psychological symptoms that enhanced their feelings of ill health and delayed their recovery. Participants described different strategies that they used to deal with these barriers. Most important was the support of others, that is, family, social life, work, and health care (primary health care).The participants in this study described managing the recovery process by themselves as troublesome. This is partly because they do not view themselves as healthy, as the health care providers do, and many are in need of further health care after discharge. Health care providers should give better information on the expected process of recovery and the importance of social support, as it might enable patients to better overcome physical and psychological barriers in their recovery.
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Comparison of the performance of mental health, drug and alcohol comorbidities based on ICD-10-AM and medical records for predicting 12-month outcomes in trauma patients. BMC Health Serv Res 2018; 18:408. [PMID: 29871639 PMCID: PMC5989374 DOI: 10.1186/s12913-018-3248-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/29/2018] [Indexed: 02/08/2023] Open
Abstract
Background Many outcome studies capture the presence of mental health, drug and alcohol comorbidities from administrative datasets and medical records. How these sources compare as predictors of patient outcomes has not been determined. The purpose of the present study was to compare mental health, drug and alcohol comorbidities based on ICD-10-AM coding and medical record documentation for predicting longer-term outcomes in injured patients. Methods A random sample of patients (n = 500) captured by the Victorian State Trauma Registry was selected for the study. Retrospective medical record reviews were conducted to collect data about documented mental health, drug and alcohol comorbidities while ICD-10-AM codes were obtained from routinely collected hospital data. Outcomes at 12-months post-injury were the Glasgow Outcome Scale – Extended (GOS-E), European Quality of Life Five Dimensions (EQ-5D-3L), and return to work. Linear and logistic regression models, adjusted for age and gender, using medical record derived comorbidity and ICD-10-AM were compared using measures of calibration (Hosmer-Lemeshow statistic) and discrimination (C-statistic and R2). Results There was no demonstrable difference in predictive performance between the medical record and ICD-10-AM models for predicting the GOS-E, EQ-5D-3L utility sore and EQ-5D-3L mobility, self-care, usual activities and pain/discomfort items. The area under the receiver operating characteristic (AUC) for models using medical record derived comorbidity (AUC 0.68, 95% CI: 0.63, 0.73) was higher than the model using ICD-10-AM data (AUC 0.62, 95% CI: 0.57, 0.67) for predicting the EQ-5D-3L anxiety/depression item. The discrimination of the model for predicting return to work was higher with inclusion of the medical record data (AUC 0.69, 95% CI: 0.63, 0.76) than the ICD-10-AM data (AUC 0.59, 95% CL: 0.52, 0.65). Conclusions Mental health, drug and alcohol comorbidity information derived from medical record review was not clearly superior for predicting the majority of the outcomes assessed when compared to ICD-10-AM. While information available in medical records may be more comprehensive than in the ICD-10-AM, there appears to be little difference in the discriminative capacity of comorbidities coded in the two sources. Electronic supplementary material The online version of this article (10.1186/s12913-018-3248-x) contains supplementary material, which is available to authorized users.
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Danielsson FB, Schultz Larsen M, Nørgaard B, Lauritsen JM. Quality of life and level of post-traumatic stress disorder among trauma patients: A comparative study between a regional and a university hospital. Scand J Trauma Resusc Emerg Med 2018; 26:44. [PMID: 29859111 PMCID: PMC5984827 DOI: 10.1186/s13049-018-0507-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess outcome in long-term quality of life (QoL) and post-traumatic stress disorder (PTSD) among adult survivors of trauma. Secondary aim was to compare levels of the outcome with injury severity and specialization level of two trauma centres. METHODS A retrospective study included patients received by the trauma response teams at two hospitals in 2013 aged 18 or more at follow-up. We assessed QoL and PTSD with one mailed questionnaire to each patient at either 12 or 24 months of follow-up. Health status was measured by EuroQol EQ-5D and the Glasgow Outcome Scale. PTSD symptoms were classified according to the Post-Traumatic Stress Disorder Checklist (PCL) and Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). RESULTS A questionnaire was mailed to 774 patients at end of 2014 or early 2015, 455 were included for analysis; median age 44 (IQR 25-57; 68% male); median NISS 9 (IQR 2-17); At follow-up 24% (95% CI 20-28) reported a EQ index score value equivalent to the lowest 2.3% in the Danish population norm. Probable PTSD was present in 19% (95% CI 13-27) of patients with severe injuries (NISS> 15), and 23% (95% CI 19-28) of those with NISS < 15. CONCLUSION Severe trauma has substantial impact on QoL and PTSD assessed at 12-24 months after the trauma. The QoL was well below the Danish population norm. The presence of PTSD was independent of injury severity. Trauma Centres should consider to include this as part of the treatment principles.
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Affiliation(s)
- F B Danielsson
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark. .,Department of Orthopaedics, Kolding Hospital, part of Lillebaelt Hospital. Odense Universitetshospital Sdr, Boulevard 29, DK5000, Odense C, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - M Schultz Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - B Nørgaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - J M Lauritsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Visser E, Gosens T, Den Oudsten B, De Vries J. Physical Trauma Patients with Symptoms of an Acute and Posttraumatic Stress Disorder: Protocol for an Observational Prospective Cohort Study. JMIR Res Protoc 2018; 7:e88. [PMID: 29599104 PMCID: PMC5897623 DOI: 10.2196/resprot.9006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 11/24/2022] Open
Abstract
Background Injury, medical treatment, and rehabilitation can have major impacts on patients’ wellbeing. About 25-33% of the patients experience an acute stress disorder (ASD) or a posttraumatic stress disorder (PTSD) after injury. ASD is a relatively new diagnosis. Therefore, knowledge about patients’ experiences, the course of ASD and PTSD, and who is at risk for developing ASD or PTSD is lacking. Objective The aims of this multi-method study are to explore patients’ experiences with injury (and their care) using a focus group study. Then, in the observational study, different courses of ASD, PTSD, and quality of life will be examined. In addition, this study will examine if these courses could be characterized by socio-demographic, clinical, and psychological variables. Consequently, a risk profile will be developed to determine which patients are at risk for developing ASD or PTSD during the 12 months after injury. Methods Trauma patients treated in the shock room (in 2015) of the Elisabeth-TweeSteden Hospital will share their experiences with injury in the focus group study. Open, axial, and selective coding will be used to analyze the data. Concerning the observational study, patients treated in the shock room (during 2016 and 2017, Elisabeth-TweeSteden Hospital and Erasmus Medical Centre) will be asked to participate. The inclusion period is 12 months. Participants will complete the Impact of Event Scale-Revised, MINI-plus, the Hospital Anxiety and Depression Scale, and the World Health Organization Quality of Life-BREF after inclusion and at 3, 6, 9, and 12 months after injury. The NEO-Five Factor Inventory and the State-Trait Anxiety Inventory-Trait are completed after inclusion only. Repeated measures of latent class analysis and linear mixed models will be used to examine the research aims. Results This project was funded in August 2015 by ZonMw. The results of the focus group study are expected in the first trimester of 2018. With regard to the observational study, recruitment is currently underway. Data collection will be completed in November 2018. The first results will be expected in the first trimester of 2019. Conclusions This is the first multi-method study in trauma patients that examines patients’ experiences (qualitative design) as well as psychological disorders (observational prospective). This study will contribute to necessary information on psychological consequences after injury. Moreover, it provides knowledge about which patients to include in future psychological intervention research. Finally, awareness in clinicians about the psychological consequences can be created, so they are able to act more effectively to provide patient-oriented care. Trial Registration Netherlands Trial Registry NTR6258; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6258 (Archived by WebCite at http://www.webcitation.org/6xSCiO1bS)
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Affiliation(s)
- Eva Visser
- Trauma TopCare, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Taco Gosens
- Department of Orthopaedics, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Brenda Den Oudsten
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Jolanda De Vries
- Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
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Analysis of quality of life after major trauma: a spanish follow-up cohort study. Eur J Trauma Emerg Surg 2018; 45:289-297. [DOI: 10.1007/s00068-018-0920-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
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Wad MS, Laursen T, Fruergaard S, Morgen SS, Dahl B. Survival and health related quality of life after severe trauma - a 15 years follow up study. Injury 2018; 49:191-194. [PMID: 29017766 DOI: 10.1016/j.injury.2017.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As the primary treatment of patients with severe trauma continues to improve, increasing interest has been directed towards long-term survival and Health Related Quality of Life (HRQoL). In trauma patients, there are few studies describing long-term outcome using tools specifically directed at HRQoL. HYPOTHESIS HRQoL measured with EQ-5D is significantly reduced compared to the Danish norm score 15 years after severe injury. MATERIALS AND METHODS All patients more than 18 years of age, admitted to a level 1 trauma center from March 1996 to September 1997 were prospectively included and scored with Injury Severity Score (ISS). Survival status was recorded in May 2012 and EQ-5D questionnaires were sent out. RESULTS 95 of the original 154 trauma patients were eligible for participation. The response rate was 66%. The average EQ-5D index score in the trauma population was significantly reduced compared to the index score in the Danish norm population (P=0.00, one-sample t-test). In addition, ISS is associated with HRQoL and ISS≥16 predicts poorer HRQoL. CONCLUSION EQ-5D is significantly reduced 15years after severe trauma High ISS was associated with low HRQoL. Knowledge of the distribution and predictors of long-term disability can be used to develop more efficient prevention policies and to improve trauma care in general.
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Affiliation(s)
- Morten S Wad
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Denmark.
| | - Thomas Laursen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | - Sidsel Fruergaard
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | - Søren Schmidt Morgen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | - Benny Dahl
- Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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Functional Outcomes of Syndesmotic Injuries Based on Objective Reduction Accuracy at a Minimum 1-Year Follow-Up. J Orthop Trauma 2018; 32:43-51. [PMID: 29257779 DOI: 10.1097/bot.0000000000001000] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate whether objective syndesmosis reduction predicts functional outcomes and pain scores in patients with operatively treated syndesmotic injuries at a minimum 1-year follow-up. DESIGN Prospective Cohort. SETTING Urban Level I Trauma Center. PATIENTS Sixty-nine patients with operatively treated syndesmotic injuries were initially identified and consented for inclusion in the study. Nine patients were excluded perioperatively. Twelve patients were lost to follow-up. Forty-eight patients with operatively treated unilateral syndesmotic injuries were available and participated at the final follow-up. INTERVENTION Trans-syndesmotic stabilization with either 1 or 2 quadricortical position screws. Postoperatively, bilateral ankle computed tomography scans were obtained to objectively assess syndesmosis reduction accuracy. MAIN OUTCOME MEASUREMENTS Olerud-Molander Ankle Score, Short Musculoskeletal Function Assessment Dysfunction Index and Bother Index, and Numeric Pain Rating Scales at a minimum 1-year postoperative follow-up. RESULTS At 1-year follow-up, there was no significant difference in functional outcomes between reduced and malreduced groups at the 1.5-, 2-, and 3-mm thresholds for linear measurements. Similarly, there was no functional difference between the reduced and malreduced groups for rotational malreductions at a 10 or 15 degrees threshold. Patients with state-sponsored insurance (Medicaid) had significantly worse functional scores and pain scores when compared with the groups with private insurance, Medicare, or no insurance. CONCLUSIONS At 1-year follow-up, functional outcomes were not related to objective measures of syndesmosis reduction. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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