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Jacq G, Crepon B, Resche-Rigon M, Schenck M, Geeraerts T, Meziani F, Megarbane B, Chaffaut C, Cariou A, Legriel S. Clinician-Reported Physical and Cognitive Impairments After Convulsive Status Epilepticus: Post Hoc Study of a Randomized Controlled Trial. Neurocrit Care 2024; 40:495-505. [PMID: 37286846 DOI: 10.1007/s12028-023-01758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Clinician-reported outcome (ClinRO) measures are emerging as useful contributors to assessments of treatment benefits. The objective of this study was to collect ClinRO measures of physical and cognitive impairments after convulsive status epilepticus (CSE) requiring intensive care unit admission. METHODS We conducted a post hoc analysis of the data from HYBERNATUS, a multicenter open-label controlled trial that randomized 270 critically ill patients with CSE requiring mechanical ventilation in 11 French intensive care units to therapeutic hypothermia (32-34 °C for 24 h) plus standard care or standard care alone. We included all patients who attended a day 90 in-person neurologist visit with measurement of the functional independence measure (FIM) score (range from 18 [total assistance] to 126 [total independence]), Mini-Mental State Examination (MMSE) score (range 0-30), and Glasgow outcome scale (GOS) score (1, death; 2, vegetative state; 3, severe disability; 4, moderate disability; and 5, mild or no disability). These three scores were compared across groups defined by several patient and CSE characteristics. RESULTS Of 229 patients with GOS scores ≥ 3 on day 90 (male sex, 58.2%; median age, 56 years [47-67]), 67 (29%) attended an in-person neurologist visit. Twenty-nine (43%) patients had a previous history of epilepsy, and 16 (24%) patients had a primary brain insult. CSE was refractory in 22 (33%) patients. On day 90 after CSE onset, median FIM and MMSE scores were 121 (112-125) and 26.0 (24.0-28.8), respectively. The GOS score was 3 in 16 (33.8%) patients, 4 in 9 (13.4%) patients, and 5 in 42 (62.7%) patients. Worse GOS score values were significantly associated with worse FIM and MMSE scores. CONCLUSIONS In patients attending the in-person neurologist visit on day 90 after CSE onset, ClinRO measures indicated that the main impairments were cognitive. FIM and MMSE scores were associated with GOS scores. Further studies are needed to evaluate the possible impact of neuroprotective and rehabilitation strategies on disability and cognitive impairments in survivors of CSE. Clinical trial registration NCT01359332.
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Affiliation(s)
- Gwenaëlle Jacq
- Intensive Care Department, Centre Hospitalier de Versailles - Site André Mignot, 177 Rue de Versailles, 78150, Le Chesnay Cedex, France.
- IctalGroup, Le Chesnay, France.
- CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Benoit Crepon
- Neurology Department, Centre Hospitalier de Versailles - Site André Mignot, 177 Rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Matthieu Resche-Rigon
- SBIM Biostatistics and Medical Information, Assistance Publique-Hôpitaux de Paris, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, Paris, France
- Université Paris Diderot, Paris, France
- ECSTRA Team (Epidémiologie Clinique et Statistiques Pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Maleka Schenck
- Medical Intensive Care Unit, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Geeraerts
- Anesthesiology and Critical Care Department, Toulouse University Hospital, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Ferhat Meziani
- Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Bruno Megarbane
- Medical Intensive Care Unit, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cendrine Chaffaut
- SBIM Biostatistics and Medical Information, Assistance Publique-Hôpitaux de Paris, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, Paris, France
- Université Paris Diderot, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, Hôpitaux Universitaires-Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne Paris Cité-Medical School, Paris Descartes University, Paris, France
- INSERM U970, Paris Cardiovascular Research Center, Paris, France
| | - Stephane Legriel
- Intensive Care Department, Centre Hospitalier de Versailles - Site André Mignot, 177 Rue de Versailles, 78150, Le Chesnay Cedex, France
- IctalGroup, Le Chesnay, France
- CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
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Renne A, Proaño-Zamudio JA, Pinkes N, Sanchez SE, Velmahos GC, Salim A, Herrera-Escobar JP, Hwabejire JO. Loss of independence after traumatic injury: A patient-centered study. Surgery 2023; 174:1021-1025. [PMID: 37517894 DOI: 10.1016/j.surg.2023.06.002] [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: 03/01/2023] [Revised: 05/23/2023] [Accepted: 06/18/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Patient-reported outcomes of postdischarge functional status can provide insight into patient recovery experiences not typically reflected in trauma registries. Injuries may be characterized by a long-term loss of independence. We sought to examine factors predictive of patient-reported, postdischarge loss of independence in trauma patients. METHODS Trauma patients admitted to 1 of 3 level I trauma centers were contacted by phone between 6 to 12 months after hospital discharge to complete the Revised Trauma Quality of Life survey. Loss of independence was defined as a new need for assistance with at least one activity of daily living or transition to living in an institutional setting. Patients with severe traumatic brain injury or spinal cord injury were excluded. Multivariable logistic regression analyses were performed to identify predictors of loss of independence. RESULTS 801 patients were included. The median age was 65 (interquartile range: 46-76) years, 46.1% were female, and the median Injury Severity Score was 9 (interquartile range: 9-13). Two hundred seventy-one patients (33.8%) experienced a loss of independence, most commonly requiring assistance walking up stairs. The main predictors of loss of independence were persistent daily pain (odds ratio: 3.83, 95% confidence interval: [2.90-5.04], P < .001), length of hospital stay (odds ratio: 1.04, 95% confidence interval: [1.01-1.09], P = .021) and income below the national median (odds ratio: 1.46, 95% confidence interval: [1.12-1.91], P = .006). Perceived social support (odds ratio: 0.75, 95% confidence interval: [0.66-0.85], P < .001) was protective against loss of independence. CONCLUSION Injury is associated with a relatively high rate of long-term loss of independence. Ensuring adequate social support systems for patients postdischarge may help them regain functional independence after injury.
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Affiliation(s)
- Angela Renne
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Jefferson A Proaño-Zamudio
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. https://www.twitter.com/Jefferson
| | - Nathaniel Pinkes
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Sabrina E Sanchez
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Ali Salim
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Juan Pablo Herrera-Escobar
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA.
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Meyer MA, van den Bosch T, Haagsma JA, Heng M, Leenen LPH, Hietbrink F, Houwert RM, Kromkamp M, Nelen SD. Influence of psychiatric co-morbidity on health-related quality of life among major trauma patients. Eur J Trauma Emerg Surg 2022; 49:965-971. [PMID: 36152068 DOI: 10.1007/s00068-022-02114-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/17/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to compare 1-year post-discharge health-related quality of life (HRQL) between trauma patients with and without psychiatric co-comorbidity. METHODS A retrospective single-center cohort study identified all severely injured adult trauma patients admitted to a Level 1 trauma center between 2018 and 2019. Bivariate analysis compared patients with and without psychiatric co-morbidity, which was defined as prior diagnosis by a healthcare provider or acute psychiatric consultation for new or chronic mental illness. HRQL metrics included the EuroQol-5D-5L (EQ-5D) questionnaire, visual analogue scale (EQ-VAS), and overall index score. A multiple linear regression model was utilized to identify predictors of EQ-5D index scores. RESULTS Analysis of baseline characteristics revealed significantly greater rates of substance abuse, severe extremity injuries, inpatient morbidity, and hospital length-of-stay among patients with psychiatric illness. At 1-year follow-up, patients with psychiatric co-morbidity had lower median EQ-5D index scores compared to the control group (0.71, interquartile range [IQR] 0.32 vs. 0.79, IQR 0.22, p = 0.03). There were no differences between groups in individual EQ-5D dimensions, nor in EQ-VAS scores. Presence of psychiatric co-morbidity was not found to independently predict EQ-5D index scores in the linear regression model. Instead, Injury Severity Score (standardized regression coefficient [SRC] - 0.15, 95% confidence interval [CI] - 0.010 to - 0.001) and American Society of Anesthesiologists Physical Status score (SRC - 0.13, 95% CI - 0.08 to - 0.004) predicted poor HRQL 1-year after injury. CONCLUSIONS Psychiatric co-morbidity does not independently predict low HRQL 1 year after injury. Instead, lower HRQL scores among patients with psychiatric co-morbidity appear to be mediated by baseline health status and injury severity.
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Affiliation(s)
- Maximilian A Meyer
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, White Building 535, Boston, MA, 02114, USA.
| | - Tijmen van den Bosch
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marilyn Heng
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, White Building 535, Boston, MA, 02114, USA
| | - Loek P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marjan Kromkamp
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stijn D Nelen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Calthorpe S, Kimmel LA, Fitzgerald MC, Webb MJ, Holland AE. Reliability, Validity, Clinical Utility, and Responsiveness of Measures for Assessing Mobility and Physical Function in Patients With Traumatic Injury in the Acute Care Hospital Setting: A Prospective Study. Phys Ther 2021; 101:6330027. [PMID: 34324692 DOI: 10.1093/ptj/pzab183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 02/01/2021] [Accepted: 05/04/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The longer-term impact of injury is increasingly recognized, but the early phases of recovery are less well understood. The best tools to measure early recovery of mobility and physical function following traumatic injury are unclear. The purpose of this study was to assess the clinical utility, validity, reliability, and responsiveness of 4 mobility and physical function measures in patients following traumatic injury. METHODS In this cohort, measurement-focused study (n = 100), the modified Iowa Level of Assistance Score, Acute Care Index of Function, Activity Measure for Post-Acute Care "6 Clicks" short forms, and Functional Independence Measure were completed during first and last physical therapy sessions. Clinical utility and floor and ceiling effects were documented. Known-groups validity (early vs late in admission and by discharge destination), predictive validity (using 6-month postinjury outcomes data), and responsiveness were established. Interrater reliability was assessed in 30 patients with stable mobility and function. RESULTS Participants had a median age of 52 years (interquartile range = 33-68 years), and 68% were male. The modified Iowa Level of Assistance Score, Acute Care Index of Function, and "6 Clicks" short forms were quick to administer (an extra median time of 30 seconds-1 minute), but the Functional Independence Measure took much longer (extra median time of 5 minutes). At the last physical therapy session, ceiling effects were present for all measures except the Functional Independence Measure (18%-33% of participants). All had strong known-groups validity (early vs late in admission and by discharge destination). All were responsive (effect sizes >1.0) and had excellent interrater reliability (intraclass correlation coefficients = 0.79-0.94). CONCLUSION All 4 measures were reliable, valid, and responsive; however, their clinical utility varied, and ceiling effects were common at physical therapy discharge. IMPACT This study is an important step toward evidence-based measurement in acute trauma physical therapy care. It provides critical information to guide assessment of mobility and physical function in acute trauma physical therapy, which may facilitate benchmarking across different hospitals and trauma centers and further progress the science and practice of physical therapy following traumatic injury.
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Affiliation(s)
- Sara Calthorpe
- Department of Physiotherapy, The Alfred Hospital, Prahran, Melbourne, VIC 3181, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, The Alfred Hospital, Prahran, Melbourne, VIC 3181, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark C Fitzgerald
- National Trauma Research Institute, Monash University, Melbourne, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Australia
| | - Melissa J Webb
- Department of Physiotherapy, The Alfred Hospital, Prahran, Melbourne, VIC 3181, Australia
| | - Anne E Holland
- Department of Physiotherapy, The Alfred Hospital, Prahran, Melbourne, VIC 3181, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
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5
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Burd RS, Jensen AR, VanBuren JM, Alvey JS, Richards R, Holubkov R, Pollack MM. Long-Term Outcomes after Pediatric Injury: Results of the Assessment of Functional Outcomes and Health-Related Quality of Life after Pediatric Trauma Study. J Am Coll Surg 2021; 233:666-675.e2. [PMID: 34592405 DOI: 10.1016/j.jamcollsurg.2021.08.693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Disability and impaired health-related quality of life can persist for months among injured children. Previous studies of long-term outcomes have focused mainly on children with specific injury types rather than those with multiple injured body regions. This study's objective was to determine the long-term functional status and health-related quality of life after serious pediatric injury, and to evaluate the associations of these outcomes with features available at hospital discharge. STUDY DESIGN We conducted a prospective observational study at 7 Level I pediatric trauma centers of children treated for at least 1 serious (Abbreviated Injury Scale severity 3 or higher) injury. Patients were sampled to increase the representation of less frequently injured body regions and multiple injured body regions. Six-month functional status was measured using the Functional Status Scale (FSS) and health-related quality of life using the Pediatric Quality of Life Inventory. RESULTS Among 323 injured children with complete discharge and follow-up assessments, 6-month FSS score was abnormal in 33 patients (10.2%)-16 with persistent impairments and 17 previously normal at discharge. Increasing levels of impaired discharge FSS score were associated with impaired FSS and lower Pediatric Quality of Life Inventory scores at 6-month follow-up. Additional factors on multivariable analysis associated with 6-month FSS impairment included older age, penetrating injury type, severe head injuries, and spine injuries, and included older age for lower 6-month Pediatric Quality of Life Inventory scores. CONCLUSIONS Older age and discharge functional status are associated with long-term impairment of functional status and health-related quality of life. Although most seriously injured children return to normal, ongoing disability and reduced health-related quality of life remained 6 months after injury. Our findings support long-term assessments as standard practice for evaluating the health impacts of serious pediatric injury.
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Affiliation(s)
- Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Medical Center.
| | | | - John M VanBuren
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Jessica S Alvey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Rachel Richards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Richard Holubkov
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Murray M Pollack
- Department of Pediatrics, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington DC
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Portelli Tremont JN, Bryant MK, Reynolds K, Brittain C, Patel Z, Udekwu PO. "Do You Need a Doctor's Note?" Factors Leading to Delayed Return to Work after Blunt Chest Trauma. J Surg Res 2021; 264:454-461. [PMID: 33848845 DOI: 10.1016/j.jss.2021.03.022] [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: 01/05/2021] [Revised: 02/08/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blunt chest trauma is associated with significant morbidity, but the long-term functional status for these patients is less well-known. Return to work (RTW) is a benchmark for functional recovery in trauma patients, but minimal data exist regarding RTW following blunt chest trauma. MATERIALS AND METHODS Patients ≥ 18 y old admitted to a Level 1 trauma center following blunt chest trauma with ≥ 3 rib fractures and length of stay (LOS) ≥ 3 d were included. An electronic survey assessing RTW was administered to patients after discharge. Patients were stratified as having delayed RTW (> 3 mo after discharge) or self-reported worse activities-of-daily-living (ADL) function after injury. Patient demographics, outcomes, and injury characteristics were compared between groups. RESULTS Median time to RTW was 3 mo (IQR 2,5). Patients with delayed RTW had higher odds of having more rib fractures than those with RTW ≤ 3 mo (median 10 versus 7; OR:1.24, 95%CI:1.04,1.48) as well as a longer LOS (median 13 versus 7 d; OR:1.15, 95% CI:1.04,1.30). Patients with stable ADL after trauma returned to work earlier than those reporting worse ADL (median 2 versus 3.5 mo, P < 0.01). 23.6% of respondents took longer than 5 mo to return to independent functioning, and 50% of respondents' report limitations in daily activities due to physical health after discharge. CONCLUSIONS The significant proportion of patients with poor physical health and functional status suggests ongoing burden of injury after discharge. Patients with longer LOS and greater number of rib fractures may be at highest risk for delayed RTW after injury.
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Affiliation(s)
- Jaclyn N Portelli Tremont
- Department of Surgery, Division of General and Trauma Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina; Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Mary K Bryant
- Department of Surgery, Division of General and Trauma Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina; Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine Reynolds
- Department of Surgery, Division of General and Trauma Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Connor Brittain
- Department of Surgery, Division of General and Trauma Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Zach Patel
- Department of Surgery, Division of General and Trauma Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Pascal Osi Udekwu
- Department of Surgery, Division of General and Trauma Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina; Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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7
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Gabbe BJ, Stewart I, Veitch W, Beck B, Cameron P, Russ M, Bucknill A, Steiger RD, Esser M. Long-term outcomes of major trauma with unstable open pelvic fractures: A population-based cohort study. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620933203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims The aims of this study were to describe the profile and longer-term outcomes of major trauma patients with unstable open pelvic fractures. Patients and methods An observational study was performed using data from the population-based Victorian State Trauma Registry. Adult (≥16 years) major trauma patients who had sustained an unstable open pelvic fracture between 1 July 2010 and 30 June 2017 in Victoria (Australia) were included. Patient demographics, injury event, severity and management data were extracted. Patients were followed up at 6, 12 and 24 months post-injury to collect information about health status, function and return to work. Results There were 67 patients. The mean (SD) age was 41.4 (18.3) years, and 66% were male. Seventy-six per cent were road traffic injuries, 96% were managed at Level 1 trauma centres and all were multi-trauma patients. A third were Tile C fractures and 80% underwent surgical stabilisation of the pelvic injury. Eighty per cent were admitted to intensive care. The in-hospital mortality rate was 9%. Most (89%) survivors were discharged to an inpatient rehabilitation facility. The proportion classified as ‘severe disability’ on the Glasgow Outcome-Scale Extended declined from 38% at 6 months to 19% at 24 months. The overall three-level EuroQoL five-dimensional instrument score increased with time indicating better health status, and 50% of patients returned to work by 24 months. Conclusions Major trauma with unstable, open pelvic fracture is rare. Low in-hospital mortality was observed. Most survived to hospital discharge and outcomes improved with time post-injury, but 75% of patients experienced persistent pain and ongoing mobility and activity restrictions.
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Affiliation(s)
- Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Ian Stewart
- Department of Orthopaedic Surgery, The Alfred, Prahran, Australia
| | - William Veitch
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Faculty of Medicine, Laval University, Quebec City, Canada
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred, Melbourne, Australia
| | - Matthias Russ
- Department of Orthopaedic Surgery, The Alfred, Prahran, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Australia
- Department of Surgery, University of Melbourne, Parkville, Australia
| | - Richard de Steiger
- Department of Surgery, University of Melbourne, Parkville, Australia
- Department of Surgery, Epworth Healthcare, Richmond, Australia
| | - Max Esser
- Department of Orthopaedic Surgery, The Alfred, Prahran, Australia
- Department of Surgery, Monash University, Melbourne, Australia
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8
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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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9
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Trevino CM, Cooros JC, Chesney SA, deRoon-Cassini T, Carver TW, Milia DJ. A Call to Follow-Up: Results Regarding Trauma Clinic Follow-Up Patterns. J Trauma Nurs 2020; 26:290-296. [PMID: 31714489 DOI: 10.1097/jtn.0000000000000467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to assess the current practice pattern regarding posthospitalization follow-up of trauma patients among the members of the Eastern Association for the Surgery of Trauma (EAST). An anonymous online multiple-choice survey of EAST members in 2016 was conducted. Ten questions relating to the follow-up care of injured patients were presented to the Active, Senior, and Associate members of EAST. Data were screened for quantitative concerns prior to analysis. Of the 1,610 members surveyed, 289 responded (18%). Approximately 52% of respondents stated that their institution has a dedicated trauma follow-up clinic where most injured patients are seen after discharge. Less than 20% reported that nontrauma multidisciplinary providers are present in clinics. Most (89.5%) reported that follow-up is a single visit, unless a patient has long-standing issues. Only 3 respondents stated that patients are regularly seen 3+ months out from injury, and a significant minority (17.7%) acknowledged no set follow-up timeline. Only 3.6% of participants indicated that they have a psychologist embedded in the trauma team, and 11.5% reported that no system is currently in place to manage mental health. Despite more than 20 years of literature highlighting the long-term physical and mental health sequelae after trauma, these survey results demonstrate that there is a lack of standardized and multidisciplinary follow-up. Given the improvement in outcomes with the identification and treatment of these sequelae, greater attention should be paid to functional recovery, social and psychological well-being, and chronic pain.
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Affiliation(s)
- Colleen M Trevino
- Medical College of Wisconsin, Milwaukee (Drs Trevino, deRoon-Cassini, Carver, and Milia); Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Dr Cooros); and Marquette University, Milwaukee, Wisconsin (Ms Chesney)
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10
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Sandström L, Engström Å, Nilsson C, Juuso P, Forsberg A. Trauma patients' health-related quality of life and perceptions of care: A longitudinal study based on data from the Swedish Trauma Registry. Int Emerg Nurs 2020; 55:100850. [PMID: 32245684 DOI: 10.1016/j.ienj.2020.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Linda Sandström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
| | - Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Carina Nilsson
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Päivi Juuso
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Angelica Forsberg
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
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Calthorpe S, Kimmel LA, Webb MJ, Gabbe BJ, Holland AE. Measurement of mobility and physical function in hospitalised trauma patients: A systematic review of instruments and their measurement properties. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619879326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
IntroductionIt is well recognised that organised trauma systems reduce trauma patient mortality. As established systems mature, there is an increasing need to better understand the patient recovery trajectory. Mobility and physical function are key aspects of recovery, but the optimal instruments for measurement in the acute hospital setting remain unclear.MethodsA systematic review was undertaken to identify and describe mobility and physical function instruments scored by direct patient assessment, in adult trauma patients in an acute hospital setting. Databases were searched with no date restrictions. Instruments that were specific to subgroups or related to individual conditions, diseases or joints were excluded. The consensus-based standards for the selection of health measurement instruments checklist was used to assess risk of bias where relevant. Clinimetric properties were reported where possible, including reliability, validity and responsiveness.ResultsFourteen thousand one hundred and fourteen articles were identified with 37 eligible for final review, including six instruments. None had been specifically designed for use in a heterogeneous range of trauma patients. The Functional Independence Measure was the most commonly cited (n = 10 studies), with evidence of construct validity, responsiveness and minimal floor/ceiling effects (<3%). The Acute Care Index of Function (n = 1 study) was found to be valid and responsive whilst the modified Iowa Level of Assistance (n = 2 studies) was reliable and responsive, but ceiling effects ranged from 26% to 37%. Little clinimetric data were available for other measures.ConclusionEvidence from a few studies show promise for the use of the Functional Independence Measure, Acute Care Index of Function and modified Iowa Level of Assistance to measure mobility and physical function in trauma patients, however comprehensive clinimetric data are lacking. Future research should test these scores in specifically designed clinimetric property studies in defined trauma patient populations. This would enable the identification of a gold standard measure for evaluating treatment effectiveness, enabling benchmarking between centres, allow prediction of recovery pathways and optimise trauma patient outcomes.
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Affiliation(s)
- Sara Calthorpe
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melissa J Webb
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, UK
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
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Vella MA, Warshauer A, Tortorello G, Fernandez-Moure J, Giacolone J, Chen B, Cabulong A, Chreiman K, Sims C, Schwab CW, Reilly PM, Lane-Fall M, Seamon MJ. Long-term Functional, Psychological, Emotional, and Social Outcomes in Survivors of Firearm Injuries. JAMA Surg 2020; 155:51-59. [PMID: 31746949 PMCID: PMC6902182 DOI: 10.1001/jamasurg.2019.4533] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/02/2019] [Indexed: 11/14/2022]
Abstract
Importance The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied. Objective To determine the long-term functional, psychological, emotional, and social outcomes among survivors of firearm injuries. Design, Setting, and Participants This prospective cohort study assessed patient-reported outcomes among GSW survivors from January 1, 2008, through December 31, 2017, at a single urban level I trauma center. Attempts were made to contact all adult patients (aged ≥18 years) discharged alive during the study period. A total of 3088 patients were identified; 516 (16.7%) who died during hospitalization and 45 (1.5%) who died after discharge were excluded. Telephone contact was made with 263 (10.4%) of the remaining patients, and 80 (30.4%) declined study participation. The final study sample consisted of 183 participants. Data were analyzed from June 1, 2018, through June 20, 2019. Exposures A GSW sustained from January 1, 2008, through December 31, 2017. Main Outcomes and Measures Scores on 8 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (Global Physical Health, Global Mental Health, Physical Function, Emotional Support, Ability to Participate in Social Roles and Activities, Pain Intensity, Alcohol Use, and Severity of Substance Use) and the Primary Care PTSD (posttraumatic stress disorder) Screen for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Results Of the 263 patients who survived a GSW and were contacted, 183 (69.6%) participated. Participants were more likely to be admitted to the hospital compared with those who declined (150 [82.0%] vs 54 [67.5%]; P = .01). Participants had a median time from GSW of 5.9 years (range, 4.7-8.1 years) and were primarily young (median age, 27 years [range, 21-36 years]), black (168 [91.8%]), male (169 [92.3%]), and employed before GSW (pre-GSW, 139 [76.0%]; post-GSW, 113 [62.1%]; decrease, 14.3%; P = .004). Combined alcohol and substance use increased by 13.2% (pre-GSW use, 56 [30.8%]; post-GSW use, 80 [44.0%]). Participants had mean (SD) scores below population norms (50 [10]) for Global Physical Health (45 [11]; P < .001), Global Mental Health (48 [11]; P = .03), and Physical Function (45 [12]; P < .001) PROMIS metrics. Eighty-nine participants (48.6%) had a positive screen for probable PTSD. Patients who required intensive care unit admission (n = 64) had worse mean (SD) Physical Function scores (42 [13] vs 46 [11]; P = .045) than those not requiring the intensive care unit. Survivors no more than 5 years after injury had greater PTSD risk (38 of 63 [60.3%] vs 51 of 119 [42.9%]; P = .03) but better mean (SD) Global Physical Health scores (47 [11] vs 43 [11]; P = .04) than those more than 5 years after injury. Conclusions and Relevance This study's results suggest that the lasting effects of firearm injury reach far beyond mortality and economic burden. Survivors of GSWs may have negative outcomes for years after injury. These findings suggest that early identification and initiation of long-term longitudinal care is paramount.
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Affiliation(s)
- Michael A. Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- currently affiliated with Division of Acute Care Surgery and Trauma, University of Rochester Medical Center, Rochester, New York
| | - Alexander Warshauer
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Gabriella Tortorello
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Joseph Fernandez-Moure
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Joseph Giacolone
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- currently affiliated with Department of Surgery, Stanford University, Palo Alto, California
| | - Bofeng Chen
- medical student, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alexander Cabulong
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Kristen Chreiman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Carrie Sims
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - C. William Schwab
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Patrick M. Reilly
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Meghan Lane-Fall
- Department of Anesthesia and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Mark J. Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Lee JM, Herrera-Escobar J, Apoj M, Al Rafai SS, Han K, Nehra D, Salim A, Brasel K, Kasotakis G, Velmahos G, Haider A, Kaafarani HM. The impact of in-hospital complications on the long-term functional outcome of trauma patients: A multicenter study. Surgery 2019; 166:398-402. [DOI: 10.1016/j.surg.2019.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
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Wihlke G, Strömmer L, Troëng T, Brattström O. Long-term follow-up of patients treated for traumatic injury regarding physical and psychological function and health-related quality of life. Eur J Trauma Emerg Surg 2019; 47:129-135. [PMID: 31236642 DOI: 10.1007/s00068-019-01170-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Trauma patients often suffer for long time after their injury with physical and psychological problems. Patient-reported outcome measurements (PROM) help us to understand outcomes beyond mortality. The aim of the study was to describe a sample of Swedish trauma patients, regarding their physical function, psychological morbidity, and quality of life after trauma. METHODS The study population was sourced from the Swedish Trauma Register: taking 1 month of data from five hospitals, over three consecutive years. 218 patients met the inclusion criteria, 147 data sets were used. Inclusion criteria included: age ≥ 18; New Injury Severity Scale (NISS) ≥ 9; and discharged alive. Data were collected at 3, 6, and 12 months after the trauma. EuroQol-5D (EQ-5D), Posttraumatic Symptom Scale-10 (PTSS-10) questionnaires and Glasgow Outcome Score (GOS) instrument were used with additional questions about pain and return to work. RESULTS 12 months after the trauma: full functional recovery (GOS 5) was seen in 68% of the patients; 59% reported difficult or moderate pain or discomfort; and 44.5% of the patients had returned to work. In EQ-5D mobility dimension, no recovery was evident between 6 and 12 months. Twenty percent of the patients had significant symptoms for PTSD after 6 months and 16% after 3 months and 12 months. CONCLUSION Trauma patients had decreased physical function and psychological morbidity up to 1 year after the initial injury. Incorporating PROM in the follow-up after trauma is important to understand the patient's perspective of care and treatment.
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Affiliation(s)
- Gunilla Wihlke
- Trauma and Reparative Medicine, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden. .,Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176, Stockholm, Sweden.
| | - Lovisa Strömmer
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, 141 86, Stockholm, Sweden
| | - Thomas Troëng
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Olof Brattström
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176, Stockholm, Sweden.,Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, 141 86, Stockholm, Sweden
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Routine incorporation of longer-term patient-reported outcomes into a Dutch trauma registry. Qual Life Res 2019; 28:2731-2739. [PMID: 31098797 PMCID: PMC6761083 DOI: 10.1007/s11136-019-02211-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 11/23/2022]
Abstract
Purpose Routine collection of post-discharge patient-reported outcomes within trauma registries can be used to benchmark quality of trauma care. This process is dependent on geographic and cultural context, but results are lacking regarding the European experience. We aimed to investigate the feasibility of routine inclusion of longer-term patient-reported health-related quality of life (HRQoL) in a Dutch National Trauma Database (DNTD) and to characterize these outcomes in a prospective cohort study. Methods All adult patients (≥ 18 years) who presented for traumatic injury in 2015–2016 and met the inclusion criteria of the DNTD were included. Inclusion criteria of the DNTD are presence of traumatic injury, hospital presentation within 48 h from trauma and hospital admission for treatment of traumatic injury or immediate mortality from traumatic injury after presentation. Exclusion criteria were death, mental impairment, insufficient command of Dutch language and residency outside the Netherlands. Primary outcomes were process-related measures of feasibility (response rate, response methods and reasons for non-response). Secondary outcomes were HRQoL measures [EuroQOL 5-Dimensions 3-Level (EQ-5D-3L) with added cognitive dimension and Visual Analogue Scale (EQ-VAS)]. Results 2025 unique patients met the initial inclusion criteria, with 1753 patients eligible for follow-up. Of these, 1315 patients participated (response rate 75%). The majority of questionnaires, 990 (75%), were completed on paper, with an additional 325 (25%) through telephone interviews. Primary reason for non-response was lack of contact information (245/438 non-responders; 56%). Median EQ-5D score was 0.81 (IQR 0.68–1.00) (mean 0.74; SD 0.31) and median EQ-VAS score was 78 (IQR 65–90). Compared to a Dutch reference population (mean EQ-5D = 0.87), EQ-5D scores were significantly lower (p < 0.001). Conclusions Routine collection of HRQoL is feasible within European health systems, like in the Netherlands. Further integration of these measures into trauma registries may aid worldwide benchmarking of trauma care quality.
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16
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de Graaf MW, Reininga IHF, Heineman E, El Moumni M. The development and internal validation of a model to predict functional recovery after trauma. PLoS One 2019; 14:e0213510. [PMID: 30870451 PMCID: PMC6417777 DOI: 10.1371/journal.pone.0213510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/17/2019] [Indexed: 12/05/2022] Open
Abstract
Objective To develop and internally validate the PROgnosis of functional recovery after Trauma (PRO-Trauma) prediction model. Design A prospective single-center longitudinal cohort study. Patients were assessed at 6 weeks and 12 months post-injury. Methods Patients that presented at the emergency department with an acute traumatic injury, were prompted for participation. Patients that completed the assessments at 6 weeks and 12 months post injury were included. Exclusion criteria: age < 18, age > 65, pathologic fractures, injuries that resulted in severe neurologic deficits. The predicted outcome, functional recovery, was defined as a Short Musculoskeletal Function Assessment (SMFA-NL) Problems with Daily Activities (PDA) subscale ≤ 12.2 points at 12 months post-injury (Dutch population norm). Predictors were: gender, age, living with partner, number of chronic health conditions, SMFA-NL PDA score 6 weeks post-injury, ICU admission, length of stay in hospital, injury severity score, occurrence of complications and treatment type. All predictors were obtained before 6 weeks post-injury. Missing data were multiply imputed. Predictor variables were selected using backward stepwise multivariable logistic regression. Hosmer-Lemeshow tests were used to evaluate calibration. Bootstrap resampling was used to internally validate the final model. Results A total of 246 patients were included, of which 104 (44%) showed functional recovery. The predictors in the final PRO-Trauma model were: living with partner, the number of chronic health conditions, SMFA-NL PDA subscale score at 6 weeks post-injury and length of stay in hospital. The apparent R2 was 0.33 [0.33;0.34], the c-statistic was 0.79 [0.79;0.80]. Hosmer-Lemeshow test indicated good calibration (p = 0.92). Optimism-corrected R2 was 0.28 [0.27;0.29] and the optimism-corrected Area Under the Curve was 0.77 [0.77;0.77]. Conclusion The PRO-Trauma prediction model can be used to obtain valid predictions of attaining functional recovery after trauma at 12 months post-injury. The PRO-Trauma prediction model showed acceptable calibration and discrimination.
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Affiliation(s)
- Max W. de Graaf
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Inge H. F. Reininga
- 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
| | - Mostafa El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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17
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So C, Lage DE, Slocum CS, Zafonte RD, Schneider JC. Utility of Functional Metrics Assessed During Acute Care on Hospital Outcomes: A Systematic Review. PM R 2019; 11:522-532. [PMID: 30758920 PMCID: PMC10108704 DOI: 10.1002/pmrj.12013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/10/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Traditionally, illness severity, social factors, and comorbid conditions have been examined as predictors of hospital outcomes. However, recent research in the rehabilitation setting demonstrated that physical function outperformed comorbidity indices as a predictor of 30-day readmission. The purpose of this study was to review the literature examining the association between acute hospital physical function and various hospital outcomes and health care utilization. TYPE: Systematic review. LITERATURE SURVEY A review of the MEDLINE database was performed. Search terms included acute functional outcomes and frailty outcomes. Studies up to September 2017 were included if they were in English and examined how functional metrics collected at acute care hospitalization affected hospital outcomes. METHODOLOGY Cohort characteristics and measures of associations were extracted from the studies. Outcomes include hospital readmission, length of stay, mortality, discharge location, and physical function post acute care. The studies were assessed for potential confounders as well as selection, attrition, and detection bias. SYNTHESIS A total of 30 studies were identified (hospital readmissions: 6; discharge location: 11; length of stay: 4; mortality: 15; function: 6). Thirteen different metrics assessed function during acute care. Lower function during acute care was associated with statistically significant higher odds of hospital readmission, lower likelihood of discharge to home, longer hospital length of stay, increased mortality, and worse functional recovery when compared to patients with higher function during acute care, when adjusted for age and gender. The Barthel Index may be a useful marker for mortality in the elderly whereas the Functional Independence Measure instrument may be valuable for examining discharge location. CONCLUSIONS There is increasing evidence that function measured during acute care predicts a broad array of meaningful clinical outcomes. Further research would help direct the use of practical, yet parsimonious functional metrics that effectively screen high-need, high-cost patients to deliver optimal care. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Conan So
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,University of Maryland School of Medicine, Baltimore, MD
| | - Daniel E Lage
- Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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The Association of Judgement Ability and Functional Status in Older Adult Rehabilitation Inpatients. BRAIN IMPAIR 2018. [DOI: 10.1017/brimp.2018.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose: Older adults have an increased likelihood of requiring rehabilitative care due to cognitive and physical risk factors. Research has found a link between executive functioning performance and functional outcomes; however, there is a dearth of research on the assessment of judgement ability. In the current pilot study, we investigated the clinical utility of the Test of Practical Judgment (TOP-J) in an older adult rehabilitation sample.Methods: Inpatients of mixed diagnoses (n= 25, mean age = 72.60) completed the TOP-J and Functional Independence Measure (FIM). We assessed TOP-J performance in the entire sample and in those with intact vs. impaired global cognition (on the Mini-Mental State Examination; MMSE). Correlational analyses were conducted between the TOP-J, MMSE and relevant FIM items.Results: TOP-J performance fell between the means typically observed in individuals with mild cognitive impairment and mild Alzheimer's disease. Participants with intact global cognition obtained significantly higher TOP-J scores than those with impaired global cognition. Moderate to strong positive correlations emerged between TOP-J, MMSE and FIM items of problem solving, comprehension and memory.Conclusions: Results provide support for the clinical utility and validity of the TOP-J among older adults in the rehabilitation setting. Administering the TOP-J may help identify patients at risk for future injury and facilitate role transitions.
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Sakran JV, Jehan F, Joseph B. Trauma Systems: Standardization and Regionalization of Care Improve Quality of Care. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0113-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Palmer CS, Gabbe BJ, Cameron PA. Revised Functional Capacity Index as a predictor of outcome following injury. Br J Surg 2017; 104:1874-1883. [PMID: 29023636 DOI: 10.1002/bjs.10638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/26/2017] [Accepted: 05/31/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Assessment of functional outcomes in survivors of severe injury is an identified priority for trauma systems. The predictive Functional Capacity Index (pFCI) within the 2008 Abbreviated Injury Scale dictionary (pFCI08) offers a widely available tool for predicting functional outcomes without requiring long-term follow-up. This study aimed to assess the 12-month functional outcome predictions of pFCI08 in a major trauma population, and to test the assumptions made by its developers to ensure population homogeneity. METHODS Patients with major trauma from Victoria, Australia, were followed up using routine telephone interviews. Assessment of survivors 12 months after injury included the Glasgow Outcome Scale - Extended (GOS-E). κ scores were used to measure agreement between pFCI08 and assessed GOS-E scores. RESULTS Of 20 098 patients with severe injury, 12 417 had both pFCI08 and GOS-E scoring available at 12 months. The quadratic weighted κ score across this population was 0·170; this increased to 0·244 in the subgroup of 1939 patients who met all pFCI assumptions. However, expanding the age range used in this group did not significantly affect κ scores until patients over the age of 70 years were included. DISCUSSION The pFCI08 has only a slight agreement with outcomes following major trauma. However, the age limits in the pFCI development assumptions are unnecessarily restrictive. The pFCI08 may be able to contribute to future systems predicting functional outcomes following severe injury, but is likely to explain only a small proportion of the variability in patient outcomes.
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Affiliation(s)
- C S Palmer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Trauma Service, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - B J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Farr Institute - Centre for Improving Population Health through E-Health Research (CIPHER), College of Medicine, Swansea University, Swansea, UK
| | - P A Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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Celik S, Dursun R, Aycan A, Gönüllü H, Adanaş C, Eryılmaz M, Gönüllü E, Akyol ME, Keskin S, Güloğlu C. The dynamics of prehospital/hospital care and modes of transport during civil conflict and terrorist incidents. Public Health 2017; 152:108-116. [PMID: 28886492 DOI: 10.1016/j.puhe.2017.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/17/2017] [Accepted: 07/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Prehospital and hospital care during incidents of mass violence and civil conflict involve a number of aspects that distinguish it from care during times of peace. We aimed to analyze the dynamics and outcomes of prehospital and hospital care during ongoing conflicts. STUDY DESIGN Multicentric prospective observational study. METHOD Patients enrolled in the study, which was conducted in Turkey, were all injured in armed conflict and taken to level 1 trauma centers. On admittance, patients were requested to complete a semistructured questionnaire containing questions on patient demographics, transport type, weapons used, injury severity score (ISS), and other incident-related factors. We analyzed patient outcomes (mortality, morbidity, complications, and length of hospital stay) and transfers of patients between hospitals. The present study evaluated the cases of 390 victims enrolled over a 9-month period and followed up for 6 months. RESULTS The majority of patients were transported by ambulances (n = 334, 85.6%); other transport modes were helicopters (n = 32, 8.2%) and private vehicles (n = 24, 6.2%). Nearly half of patients (48.7%) did not benefit by changing hospitals. During transport to hospitals, 4.1% of the vehicles in the study were involved in accidents. Using multiple regression analysis, only ISS (odds ratio [OR]: 1.098, 95% confidence interval [CI]: 1.044-1.156) and the Glasgow Coma Scale (OR: 0.744, 95% CI: 0.639-0.866) were found to affect mortality. In Receiver-operator characteristic analysis, a cutoff value of 22.5 for ISS had a sensitivity of 100% and a specificity of 89.6% for mortality. CONCLUSIONS Despite lower ISS values, patient outcomes were worse in terror incidents/civil conflicts. Transport modes did not significantly affect outcomes, whereas hospital transport was found to be inefficiently used.
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Affiliation(s)
- S Celik
- Department of General Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey.
| | - R Dursun
- Department of Emergency Medicine, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - A Aycan
- Department of Neurosurgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | - H Gönüllü
- Department of Emergency Medicine, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | - C Adanaş
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | - M Eryılmaz
- Department of Emergency Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - E Gönüllü
- Anesthesiology and Reanimation Clinic, Van Research and Training Hospital, Van, Turkey
| | - M E Akyol
- Department of Neurosurgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | - S Keskin
- Department of Biostatistics, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | - C Güloğlu
- Department of Emergency Medicine, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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Routine inclusion of long-term functional and patient-reported outcomes into trauma registries. J Trauma Acute Care Surg 2017; 83:97-104. [DOI: 10.1097/ta.0000000000001490] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Palmer CS, Cameron PA, Gabbe BJ. A review of the revised Functional Capacity Index as a predictor of 12 month outcomes following injury. Injury 2017; 48:591-598. [PMID: 28118984 DOI: 10.1016/j.injury.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/26/2016] [Accepted: 01/01/2017] [Indexed: 02/02/2023]
Abstract
The measurement of functional outcomes following severe trauma has been widely recognised as a priority for countries with developed trauma systems. In this respect, the Functional Capacity Index (FCI), a multi-attribute index which has been incorporated into the most recent Abbreviated Injury Scale (AIS) dictionary, is potentially attractive as it offers 12-month functional outcome predictions for patients captured by existing AIS-coded datasets. This review paper outlines the development, construction and validation of the predictive form of the FCI (termed the pFCI), the modifications made which produced the currently available 'revised' pFCI, and the extent to which the revised pFCI has been validated and used. The original pFCI performed poorly in validation studies. The revised pFCI does not address many of the identified limitations of the original version, and despite the ready availability of a truncated version in the AIS dictionary, it has only been used in a handful of studies since its introduction several years ago. Additionally, there is little evidence for its validity. It is suggested that the pFCI should be better validated, whether in the narrow population group of young, healthy individuals for which it was developed, or in the wider population of severely injured patients. Methods for accounting for the presence of multiple injures (of which two have currently been used) should also be evaluated. Many factors other than anatomical injury are known to affect functional outcomes following trauma. However, it is intuitive that any model which attempts to predict the ongoing morbidity burden in a trauma population should consider the effects of the injuries sustained. Although the revised pFCI potentially offers a low-cost assessment of likely functional limitations resulting from anatomical injury, it must be more rigorously evaluated before more comprehensive predictive tools can be developed from it.
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Affiliation(s)
- Cameron S Palmer
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Trauma Service, Royal Children's Hospital Melbourne, Parkville, Australia.
| | - Peter A Cameron
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Belinda J Gabbe
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Farr Institute - CIPHER, College of Medicine, Swansea University, Swansea, United Kingdom.
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Flynn-O'Brien KT, Fallat ME, Rice TB, Gall CM, Nance ML, Upperman JS, Gourlay DM, Crow JP, Rivara FP. Pediatric Trauma Assessment and Management Database: Leveraging Existing Data Systems to Predict Mortality and Functional Status after Pediatric Injury. J Am Coll Surg 2017; 224:933-944.e5. [PMID: 28235647 DOI: 10.1016/j.jamcollsurg.2017.01.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/04/2017] [Accepted: 01/30/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Efforts to improve pediatric trauma outcomes need detailed data, optimally collected at lowest cost, to assess processes of care. We developed a novel database by merging 2 national data systems for 5 pediatric trauma centers to provide benchmarking metrics for mortality and non-mortality outcomes and to assess care provided throughout the care continuum. STUDY DESIGN Trauma registry and Virtual Pediatric Systems, LLC (VPS) from 5 pediatric trauma centers were merged for children younger than 18 years discharged in 2013 from a pediatric ICU after traumatic injury. For inpatient mortality, we compared risk-adjusted models for trauma registry only, VPS only, and a combination of trauma registry and VPS variables (trauma registry+VPS). To estimate risk-adjusted functional status, we created a prediction model de novo through purposeful covariate selection using dichotomized Pediatric Overall Performance Category scale. RESULTS Of 688 children included, 77.3% were discharged from the ICU with good performance or mild overall disability and 17.6% with moderate or severe overall disability or coma. Inpatient mortality was 5.1%. The combined dataset provided the best-performing risk-adjusted model for predicting mortality, as measured by the C-statistic, pseudo-R2, and Akaike Information Criterion, when compared with the trauma registry-only model. The final Pediatric Overall Performance Category model demonstrated adequate discrimination (C-statistic = 0.896) and calibration (Hosmer-Lemeshow goodness-of-fit p = 0.65). The probability of poor outcomes varied significantly by site (p < 0.0001). CONCLUSIONS Merging 2 data systems allowed for improved risk-adjusted modeling for mortality and functional status. The merged database allowed for patient evaluation throughout the care continuum on a multi-institutional level. Merging existing data is feasible, innovative, and has potential to impact care with minimal new resources.
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Affiliation(s)
- Katherine T Flynn-O'Brien
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; Department of Surgery, Division of General Surgery, University of Washington, Seattle, WA.
| | - Mary E Fallat
- Hiram C Polk, Jr Department of Surgery, Division of Pediatric Surgery, University of Louisville and Norton Children's Hospital, Louisville, KY
| | - Tom B Rice
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI; Virtual Pediatric Systems, LLC, Los Angeles, CA
| | | | - Michael L Nance
- Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jeffrey S Upperman
- Department of Surgery, Division of General Pediatric Surgery, Children's Hospital of Los Angeles and USC Keck School of Medicine, Los Angeles, CA
| | - David M Gourlay
- Department of Surgery, Division of General Pediatric Surgery, Children's Hospital of Wisconsin, Milwaukee, WI
| | - John P Crow
- Department of Surgery, Division of General Pediatric Surgery, Akron Children's Hospital and Pediatric Surgery Center, Akron, OH
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA
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Wynell-Mayow W, Guevel B, Quansah B, O'Leary R, Carrothers AD. Cambridge Polytrauma Pathway: Are we making appropriately guided decisions? Injury 2016; 47:2117-2121. [PMID: 27496722 DOI: 10.1016/j.injury.2016.05.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 05/29/2016] [Indexed: 02/02/2023]
Abstract
Addenbrooke's Hospital, the Major Trauma Centre for the East of England Trauma Network, received 1070 major trauma patients between 1st January and 31st December 2014. In order to improve care, an audit was performed of 59 patients meeting our own selection criteria for orthopaedic polytrauma between 1st January 2013 and 31st December 2013. The Cambridge Polytrauma Pathway was devised through NCEPOD guidelines, literature review, internal and external discussion. It facilitates provision of best practice Early Appropriate Care, encompassing - multidisciplinary consultant decisions around the patient in our Neurological and Trauma Critical Care Unit, early full body trauma CT scans, serial measurements of lactate and fibrinogen levels, and out-of-hours orthopaedic theatre reserved for life-and-limb threatening injuries. Re-audit was conducted of 15 patients meeting selection criteria, admitted between 1st October 2014 and 31st March 2015. Significant improvements in recording of lactate and fibrinogen were demonstrated, both on admission (lactate - p<0.000, fibrinogen - p=0.015), and preoperatively (lactate - p=0.003, fibrinogen - p=0.030). Time to trauma CT was unchanged (p=0.536) with a median time to CT of 0.53h at re-audit (IQR 0.48-0.75). The number of patients receiving definitive orthopaedic intervention out-of-hours reduced from 8 to zero (p=0.195). The approach of facilitating management decisions to be made at early daytime MDT meetings has been adopted. It is anticipated that this pathway will improve outcomes in orthopaedic polytrauma patients and it is recommended that either the GOS-E, or the EQ-5D scoring systems be introduced to assess this.
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Affiliation(s)
- William Wynell-Mayow
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge CB2 0QQ, UK
| | - Borna Guevel
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge CB2 0QQ, UK
| | - Benjamin Quansah
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge CB2 0QQ, UK
| | - Ronan O'Leary
- Neurosciences and Trauma Critical Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge CB2 0QQ, UK
| | - Andrew D Carrothers
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge CB2 0QQ, UK.
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Wu J, Faux SG, Harris I, Poulos CJ, Alexander T. Record linkage is feasible with non-identifiable trauma and rehabilitation datasets. Aust N Z J Public Health 2016; 40:245-9. [DOI: 10.1111/1753-6405.12510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/01/2015] [Accepted: 11/01/2015] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jane Wu
- St. Vincent's Hospital; New South Wales
| | | | | | | | - Tara Alexander
- Australian Health Services Research Institute; University of Wollongong; New South Wales
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Morshed S, Knops S, Jurkovich GJ, Wang J, MacKenzie E, Rivara FP. The impact of trauma-center care on mortality and function following pelvic ring and acetabular injuries. J Bone Joint Surg Am 2015; 97:265-72. [PMID: 25695975 PMCID: PMC6948797 DOI: 10.2106/jbjs.n.00008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lower mortality and improved physical function following major polytrauma have been associated with treatment at level-I trauma centers compared with that at hospitals without a trauma center (nontrauma centers). This study investigated the impact of trauma-center care on outcomes after pelvic and acetabular injuries. METHODS Mortality and quality-of-life-related scores were compared among patients treated in eighteen level-I trauma centers and fifty-one nontrauma centers in fourteen U.S. states. Complete data were obtained on 829 adult trauma patients (eighteen to eighty-four years old) who had at least one pelvic ring or acetabular injury (Orthopaedic Trauma Association [OTA] classification of 61 or 62). We used inverse probability of treatment weighting to adjust for observable confounding. RESULTS After adjusting for case mix, we found that, for patients with more severe acetabular injuries (OTA 62-B or 62-C), in-hospital mortality was significantly lower at trauma centers compared with nontrauma centers (relative risk [RR], 0.10; 95% confidence interval [CI], 0.02 to 0.47), as was death within ninety days (RR, 0.10; 95% CI, 0.02 to 0.47) and within one year (RR, 0.21; 95% CI, 0.06 to 0.76). Patients with combined pelvic ring and acetabular injuries treated at a trauma center had lower mortality at ninety days (RR, 0.34; 95% CI, 0.14 to 0.82) and at one year (RR, 0.30; 95% CI, 0.14 to 0.68). Care at trauma centers was also associated with mortality risk reduction for those with unstable pelvic ring injuries (OTA 61-B or 61-C) at one year (RR, 0.71; 95% CI, 0.24 to 0.91). Seventy-eight percent of included subjects discharged alive were available for interview at twelve months. For those with more severe acetabular injuries, average absolute differences in the Short Form-36 (SF-36) physical function component and the Musculoskeletal Function Assessment at one year were 11.4 (95% CI, 5.3 to 17.4) and 13.2 (1.7 to 24.7), respectively, indicating statistically and clinically significant improved outcomes following treatment at a trauma center for those patients. CONCLUSIONS Mortality was reduced for patients with unstable pelvic and severe acetabular injuries when care was provided in a trauma center compared with a nontrauma center. Moreover, those with severe acetabular fractures experienced improved physical function at one year. Patients with these injuries represent a well-defined subset of trauma patients for whom our findings suggest preferential triage or transfer to a level-I trauma center.
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Affiliation(s)
- Saam Morshed
- Orthopaedic Trauma Institute, Departments of Orthopaedic Surgery and of Epidemiology and Biostatistics, University of California, San Francisco and San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110. E-mail address for S. Morshed:
| | - Simon Knops
- Orthopaedic Trauma Institute, Departments of Orthopaedic Surgery and of Epidemiology and Biostatistics, University of California, San Francisco and San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110. E-mail address for S. Morshed:
| | - Gregory J. Jurkovich
- Denver Health Medical Center, 777 Bannock Street, Mail Code 0206, Denver, CO 80204
| | - Jin Wang
- University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359660, Seattle, WA 98140
| | - Ellen MacKenzie
- John Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 462, Baltimore, MD 21205
| | - Frederick P. Rivara
- University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359660, Seattle, WA 98140
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Maas AI, Lingsma HF, Roozenbeek B. Predicting outcome after traumatic brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2015; 128:455-74. [DOI: 10.1016/b978-0-444-63521-1.00029-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Hansen L, Shaheen A, Crandall M. Outpatient follow-up after traumatic injury: Challenges and opportunities. J Emerg Trauma Shock 2014; 7:256-60. [PMID: 25400385 PMCID: PMC4231260 DOI: 10.4103/0974-2700.142612] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 07/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background: It has been shown that rates of ambulatory follow-up after traumatic injury are not optimal, but the association with insurance status has not been studied. Aims: To describe trauma patient characteristics associated with completed follow-up after hospitalization and to compare relative rates of healthcare utilization across payor types. Setting and Design: Single institution retrospective cohort study. Materials and Methods: We compared patient demographics and healthcare utilization behavior after discharge among trauma patients between April 1, 2005 and April 1, 2010. Our primary outcome of interest was outpatient provider contact within 2 months of discharge. Statistical Analysis: Multivariate logistic regression was used to determine the association between characteristics including insurance status and subsequent ambulatory and acute care. Results: We reviewed the records of 2906 sequential trauma patients. Patients with Medicaid and those without insurance were significantly less likely to complete scheduled outpatient follow-up within 2 months, compared to those with private insurance (Medicaid, OR 0.67, 95% CI 0.51-0.88; uninsured, OR 0.29, 95% CI 0.23-0.36). Uninsured and Medicaid patients were twice as likely as privately insured patients to visit the Emergency Department (ED) for any reason after discharge (uninsured patients (Medicaid, OR 2.6, 95% CI 1.50-4.53; uninsured, OR 2.10, 94% CI 1.31-3.36). Conclusion: We found marked differences between patients in scheduled outpatient follow-up and ED utilization after injury associated with insurance status; however, Medicaid seemed to obviate some of this disparity. Medicaid expansion may improve outpatient follow-up and affect patient outcome disparities after injury.
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Affiliation(s)
- Luke Hansen
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Aisha Shaheen
- Department of Surgery, Albert Einstein University, New York, USA
| | - Marie Crandall
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
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Hakkarainen TW, Burkette Ikebata N, Bulger E, Evans HL. Moving beyond survival as a measure of success: understanding the patient experience of necrotizing soft-tissue infections. J Surg Res 2014; 192:143-9. [PMID: 24923631 DOI: 10.1016/j.jss.2014.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/15/2014] [Accepted: 05/02/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Necrotizing soft tissue infections (NSTIs) represent a devastating spectrum of disease with high case mortality and resource intensive care. Treatment consists of wide surgical debridement and often prolonged periods of intensive care unit care. Major complications are common. The severity of the disease and the aggressive treatment requirements put survivors at risk for significant long-term sequelae related to the trauma of both disease and treatment. Information about the postdischarge impact of NSTIs on survivors is extremely limited. Qualitative approaches are typically used to explore new phenomena and to capture individuals' thoughts, feelings, or interpretations of meaning and process. Therefore, qualitative methods are ideally suited for hypothesis generation to guide future quantitative study and ensure measured outcomes are patient-centered. MATERIALS AND METHODS Semistructured interviews were conducted with survivors of NSTIs from a single regional referral center. Stratified purposive sampling was used to select interview candidates based on severity of illness. Descriptive thematic analysis was performed to identify major themes described by the patients. RESULTS Interviews with 18 survivors identified three primary domains of experience: (1) individual factors, (2) relational factors, and (3) societal factors. These domains were split into the following two categories: factors effecting the disease process and recovery, and factors that were outcomes of the disease process. Each category yielded between one and seven themes. Themes identified included physical, psychological, relationship, and employment aspects. CONCLUSIONS Patient's reported quality of life was significantly affected by their disease and recovery. The results demonstrate that many outcomes of importance for patients are not easily assessed by traditional measures of outcomes. This work illustrates the multidimensional nature of recovery from critical illness, and shows that it represents a massive transition period in the lives of survivors that affects the patient, their family, and the patient's ability to interact with society. Interviews with survivors ensure that the patient voice is heard before developing tools to assess long-term outcomes.
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Affiliation(s)
- Timo W Hakkarainen
- Department of Surgery, University of Washington Medical Center, Seattle, WA.
| | | | - Eileen Bulger
- Department of Surgery, University of Washington Medical Center, Seattle, WA
| | - Heather L Evans
- Department of Surgery, University of Washington Medical Center, Seattle, WA
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Moran C, Kipen E, Chan P, Niggemeyer L, Scharf S, Hunter P, Fitzgerald M, Gruen R. Understanding post-hospital morbidity associated with immobilisation of cervical spine fractures in older people using geriatric medicine assessment techniques: A pilot study. Injury 2013; 44:1838-42. [PMID: 23680282 DOI: 10.1016/j.injury.2013.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 01/17/2013] [Accepted: 04/13/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is a paucity of research into the outcomes and complications of cervical spine immobilisation (hard collar or halothoracic brace) in older people. AIMS To identify morbidity and mortality outcomes using geriatric medicine assessment techniques following cervical immobilisation in older people with isolated cervical spine fractures. PATIENTS AND METHODS We identified participants using an injury database. We completed a questionnaire measuring pre-admission medical co-morbidities and functional independence. We recorded the surgical plan and all complications. A further questionnaire was completed three months later recording complications and functional independence. RESULTS Sixteen patients were recruited over a three month period. Eight were immobilised with halothoracic brace, 8 with external hard collar. Three deaths occurred during the study. Lower respiratory tract infection was the most common complication (7/16) followed by delirium (6/16). Most patients were unable to return home following the acute admission, requiring sub-acute care on discharge. The majority of patients were from home prior to a fall, 6/16 were residing there at 3 months. Most participants had an increase in their care needs at 3 months. There was no difference in the type or incidence of complications between the different modes of immobilisation. CONCLUSIONS Geriatric medicine assessment techniques identified the morbidity and functional impairment associated with cervical spine immobilisation. This often results in a prolonged length of stay in supported care. This small pilot study recommends a larger study over a longer period using geriatric medicine assessment techniques to better define the issues.
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Affiliation(s)
- Chris Moran
- Caulfield Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Australia.
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Hill B, Kahn M, Pallant J, Williams G. Assessment of the internal construct validity of the revised High-Level Mobility Assessment Tool for traumatic orthopaedic injuries. Clin Rehabil 2013; 28:491-8. [PMID: 24113726 DOI: 10.1177/0269215513502798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether the revised High-Level Mobility Assessment Tool (HiMAT) was valid for measuring mobility for people with multi-trauma orthopaedic lower limb injuries. DESIGN Cross-sectional study. SUBJECTS Participants with lower limb multi-trauma orthopaedic injuries. METHODS One complete revised HiMAT was obtained for 106 people within 12 weeks of being allowed to fully weight bear. Rasch analysis was used to assess the overall fit of the model for individuals and items, differential item functioning, local dependency, targeting of items and dimensionality. RESULTS The mean revised HiMAT score was 10.5 (SD = 6.8) with a range of 5-30. Rasch analysis of revised HiMAT showed adequate overall fit to the model (P = 0.29) with no misfitting items (fit residual SD = 0.69) or persons (fit residual SD = 0.62). The scale showed good internal consistency (Person Separation Index = 0.91). One item (hopping) demonstrated disordered thresholds, however this item had good fit to the model in all other aspects. The revised HiMAT was unidimensional, and no differential item functioning was detected for gender or age. The revised HiMAT was well targeted for this group with a range of items across all ability levels. CONCLUSION The results of this study support the internal construct validity of the revised HiMAT as a well-targeted, unidimensional measure of high-level mobility with no ceiling or floor effect for males and females recovering from multi-trauma orthopaedic lower limb injuries.
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Affiliation(s)
- Bridget Hill
- 1Epworth Monash Rehabilitation Medicine Unit, Epworth HealthCare, Melbourne, Victoria, Australia
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Williams G, Hill B, Kahn M. The concurrent validity and responsiveness of the high-level mobility assessment tool for mobility limitations in people with multitrauma orthopedic injuries. PM R 2013; 6:235-40. [PMID: 24056162 DOI: 10.1016/j.pmrj.2013.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/05/2013] [Accepted: 09/11/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the concurrent validity, responsiveness, and ceiling effect of the revised High-Level Mobility Assessment Tool (HiMAT) in persons after orthopedic multitrauma. DESIGN Cross-sectional sample of convenience. SETTING A large tertiary rehabilitation hospital. PARTICIPANTS Forty-three participants with orthopedic multitrauma lower limb injuries that resulted from motor vehicle accidents. METHODS This study compared the concurrent validity, responsiveness, and ceiling effects of the revised HiMAT, motor subsection of the Functional Independence Measure (FIM) instrument. Performances for all participants were concurrently scored on the motor FIM, revised HiMAT, and the Lower Extremity Functional Scale (LEFS) at initial testing, and 6 and 12 weeks after the decision to fully bear weight. MAIN OUTCOME MEASUREMENTS Revised HiMAT, motor FIM, and LEFS. RESULTS The correlation between the revised HiMAT and the motor FIM was moderate (r = 0.49; P <.001) and partly induced by a ceiling effect in the motor FIM. After 12 weeks of full weight bearing, 51.2% of participants achieved the maximum score on the motor FIM. The correlation between the revised HiMAT and LEFS was weak (r = 0.39; P = .012), which indicated a weak relationship between self-reported mobility problems and actual performance. The revised HiMAT was more responsive than the motor FIM and the LEFS, based on the proportion of persons who exceeded the minimal detectable change score over a period of 6 and 12 weeks. CONCLUSION The revised HiMAT is more responsive to change than the LEFS and motor FIM, and less susceptible to a ceiling effect than the motor FIM for persons with orthopedic multitrauma. It has poor-to-moderate concurrent validity with the LEFS and motor FIM, which suggests that it may be measuring a different aspect of mobility.
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Affiliation(s)
- Gavin Williams
- Physiotherapy Department, Epworth Hospital, 89 Bridge Rd, Richmond, 3121, Victoria, Australia; School of Physiotherapy, The University of Melbourne, Melbourne, Australia; School of Physiotherapy, La Trobe University, Melbourne, Australia(∗).
| | - Bridget Hill
- Physiotherapy Department, Epworth Hospital, Victoria, Australia(†)
| | - Michelle Kahn
- Physiotherapy Department, Epworth Hospital, Victoria, Australia(‡)
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Klein AM, Howell K, Vogler J, Grill E, Straube A, Bender A. Rehabilitation outcome of unconscious traumatic brain injury patients. J Neurotrauma 2013; 30:1476-83. [PMID: 23477301 PMCID: PMC3751265 DOI: 10.1089/neu.2012.2735] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Outcome prediction of traumatic brain injury (TBI) patients with severe disorders of consciousness (DOC) at the end of their time in an intensive care setting is important for clinical decision making and counseling of relatives, and constitutes a major challenge. Even the question of what constitutes an improved outcome is controversially discussed. We have conducted a retrospective cohort study for the rehabilitation dynamics and outcome of TBI patients with DOC. Out of 188 patients, 37.2% emerged from a minimally conscious state (MCS) and 16.5% achieved at least partial functional independence after a mean observation period of 107 days (range 1-399 days). This reflects that emergence from MCS is much easier to achieve than functional independence. Logistic regression analysis identified age and level of consciousness upon admission to neurorehabilitation as independent prognostic factors for both outcomes. The group who reached at least partial functional independence started to improve significantly more than the corresponding outcome group by post-injury week 7, and the average time to reach this functional status was 18 weeks. In contrast, the group who emerged from MCS started to improve after 6 weeks. The longest delay between brain injury and the beginning of functional improvement (measured by biweekly Functional Independence Measure [FIM] scores) still compatible with reaching at least partial functional independence was 18 weeks. In conclusion, despite a strong negative selection, a substantial proportion of severe TBI patients with DOC achieve functional improvements or at least emerge from MCS within the inpatient rehabilitation phase. In order to avoid self-fulfilling prophecies in decision making, it is important to be aware of the fact that the beginning of clinical improvement may take several months after brain injury. In this study, separation of both of the functional outcome groups started by 7 weeks post-injury.
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Affiliation(s)
- Anke-Maria Klein
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Kaitlen Howell
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Jana Vogler
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Eva Grill
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
- Integrated Center for Research and Treatment of Vertigo, Balance and Ocular Motor Disorders, Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Straube
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Bender
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, Therapiezentrum Burgau, Burgau, Germany
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Lewis JA, Vint H, Pallister I. Pilot study assessing functional outcome of tibial pilon fractures using the VSTORM method. Injury 2013; 44:1112-6. [PMID: 23570704 DOI: 10.1016/j.injury.2013.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 02/07/2013] [Accepted: 02/15/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The importance of long-term function and quality of life after trauma is well recognised, but gathering data is difficult. The Victoria State Trauma Registry (VSTORM) collects patient-reported outcome data after major trauma using telephone interview, following prospective enrolment. Key components of the VSTORM interview include use of the Glasgow Outcome Scale-Extended (GOS-E), collection of pre-injury demographics, use of 12-Item Short Form Health Survey (SF-12) and EQ-5D instruments as well as a pain numerical rating scale. The aim of this pilot study was to determine whether this methodology would capture clinically relevant data for a population sustaining a severe fracture associated with a wide range of potential outcomes. METHODS Following ethical approval, patients with surgically managed tibial pilon fractures sustained between March 2002 and January 2010 were identified from the logbook of the senior author (IP) and contacted by post. After obtaining consent, a structured telephone interview was performed using the VSTORM questionnaire. RESULTS Twenty-six of 45 patients consented to interview and 23/26 patients were contactable (13 male, 10 female, mean age 44 years). There were 17 Arbeitsgemeinschaft für Osteosynthesefragen (AO) Type C fractures, six Type B and seven Grade III open injuries. The mean visual analogue scale (VAS) score for health pre-injury was 88.9 (range 50-100, median 92) versus 71.5 (range 35-100, median 75) post-injury. Seven of 18 patients in full-time employment prior to injury did not return to work. Only one patient returned to previous employment. Nine of 23 patients reported moderate - to-extreme pain interfering with work; 16/23 patients had problems with mobility; 9/23 reported problems climbing stairs; and 14/23 of patients could not resume regular social/leisure activities. CONCLUSIONS Prospective enrolment at the time of injury may improve follow-up. In those who participated, a credible range of outcomes were reported, comparable to recently published studies. This method appears efficient and acceptable to patients, and hence warrants larger-scale prospective evaluation.
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Affiliation(s)
- James A Lewis
- Department of Trauma and Orthopaedics, Morriston Hospital, Swansea, UK.
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Palmer CS, Davey TM, Mok MT, McClure RJ, Farrow NC, Gruen RL, Pollard CW. Standardising trauma monitoring: the development of a minimum dataset for trauma registries in Australia and New Zealand. Injury 2013; 44:834-41. [PMID: 23265787 DOI: 10.1016/j.injury.2012.11.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 11/14/2012] [Accepted: 11/25/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma registries are central to the implementation of effective trauma systems. However, differences between trauma registry datasets make comparisons between trauma systems difficult. In 2005, the collaborative Australian and New Zealand National Trauma Registry Consortium began a process to develop a bi-national minimum dataset (BMDS) for use in Australasian trauma registries. This study aims to describe the steps taken in the development and preliminary evaluation of the BMDS. METHODS A working party comprising sixteen representatives from across Australasia identified and discussed the collectability and utility of potential BMDS fields. This included evaluating existing national and international trauma registry datasets, as well as reviewing all quality indicators and audit filters in use in Australasian trauma centres. After the working party activities concluded, this process was continued by a number of interested individuals, with broader feedback sought from the Australasian trauma community on a number of occasions. Once the BMDS had reached a suitable stage of development, an email survey was conducted across Australasian trauma centres to assess whether BMDS fields met an ideal minimum standard of field collectability. The BMDS was also compared with three prominent international datasets to assess the extent of dataset overlap. Following this, the BMDS was encapsulated in a data dictionary, which was introduced in late 2010. RESULTS The finalised BMDS contained 67 data fields. Forty-seven of these fields met a previously published criterion of 80% collectability across respondent trauma institutions; the majority of the remaining fields either could be collected without any change in resources, or could be calculated from other data fields in the BMDS. However, comparability with international registry datasets was poor. Only nine BMDS fields had corresponding, directly comparable fields in all the national and international-level registry datasets evaluated. CONCLUSION A draft BMDS has been developed for use in trauma registries across Australia and New Zealand. The email survey provided strong indications of the utility of the fields contained in the BMDS. The BMDS has been adopted as the dataset to be used by an ongoing Australian Trauma Quality Improvement Program.
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Affiliation(s)
- Cameron S Palmer
- Trauma Service, The Royal Children's Hospital Melbourne, Melbourne, Australia.
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Life after near death: Long-term outcomes of emergency department thoracotomy survivors. J Trauma Acute Care Surg 2013. [DOI: 10.1097/01586154-201305000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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[Trauma registries: a health priority, a strategic project for the SEMICYUC]. Med Intensiva 2013; 37:284-9. [PMID: 23507334 DOI: 10.1016/j.medin.2013.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 01/23/2013] [Indexed: 02/03/2023]
Abstract
The most efficient approach to traumatologic disease is prevention, but physicians also must supervise care of the victims. An operational and effective trauma registry requires financial support, adequate software, a well-defined population, personnel committed to training, and a detailed process for data collection, reporting, validation and the maintenance of confidentiality. Above all, however, motivation is required. Registries can offer many benefits in relation to these highly prevalent disorders, with an impact in terms of health promotion and even advantages in the form of cost reductions, as well as relief from the suffering caused by trauma (mortality, disability)-contributing to improve the efficiency and quality of critical trauma care. The SEMICYUC has demonstrated its ability to establish and maintain records of national interest, and this should become a priority project.
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Trauma care in Scotland: the importance of functional outcomes and quality of life. Surgeon 2012; 10:247-8. [PMID: 22835280 DOI: 10.1016/j.surge.2012.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/10/2012] [Accepted: 05/21/2012] [Indexed: 02/03/2023]
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Gabbe BJ, Sutherland AM, Hart MJ, Cameron PA. Re: Mitchell R, Watson W, Curtis K, Harris I, McDougall P. Difficulties in establishing long-term trauma outcomes data collections. Could trauma outcomes be routinely monitored in New South Wales, Australia: Piloting a 3 month follow-up? doi:10.1016/j.injury.2011.01.006. Injury 2012; 43:1229-30. [PMID: 22209171 DOI: 10.1016/j.injury.2011.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 09/14/2011] [Accepted: 12/08/2011] [Indexed: 02/02/2023]
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Sánchez AI, Krafty RT, Weiss HB, Rubiano AM, Peitzman AB, Puyana JC. Trends in survival and early functional outcomes from hospitalized severe adult traumatic brain injuries, pennsylvania, 1998 to 2007. J Head Trauma Rehabil 2012; 27:159-69. [PMID: 21386713 PMCID: PMC3143237 DOI: 10.1097/htr.0b013e3182074c41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE : To determine trends for in-hospital survival and functional outcomes at acute care hospital discharge for patients with severe adult traumatic brain injury (SATBI) in Pennsylvania, during 1998 to 2007. METHODS : Secondary analysis of the Pennsylvania trauma outcome study database. MAIN OUTCOME MEASURES : Survival and functional status scores of 5 domains (feeding, locomotion, expression, transfer mobility, and social interaction) fitted into logistic regression models adjusted for age, sex, race, comorbidities, injury mechanism, extracranial injuries, severity scores, hospital stay, trauma center, and hospital level. Sensitivity analyses for functional outcomes were performed. RESULTS : There were 26 234 SATBI patients. Annual numbers of SATBI increased from 1757 to 3808 during 1998 to 2007. Falls accounted for 47.7% of all SATBI. Survival increased significantly from 72.5% to 82.7% (odds ratio [OR] = 1.10, 95% CI: 1.08-1.11, P < .001). In sensitivity analyses, trends of complete independence in functional outcomes increased significantly for expression (OR = 1.01, 95% CI: 1.00-1.02, P = .011) and social interaction (OR = 1.01, 95% CI: 1.00-1.03, P = .002). There were no significant variations over time for feeding, locomotion, and transfer mobility. CONCLUSIONS : Trends for SATBI served by Pennsylvania's established trauma system showed increases in rates but substantial reductions in mortality and significant improvements in functional outcomes at discharge for expression and social interaction.
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Affiliation(s)
- Alvaro I Sánchez
- Departments of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Mitchell R, Watson WL, Curtis K, Harris I, McDougall P. Difficulties in establishing long-term trauma outcomes data collections. Could trauma outcomes be routinely monitored in New South Wales, Australia: piloting a 3 month follow-up? Injury 2012; 43:96-102. [PMID: 21272880 DOI: 10.1016/j.injury.2011.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 01/05/2011] [Accepted: 01/05/2011] [Indexed: 02/02/2023]
Abstract
Injuries represent a significant health burden in Australia. In New South Wales (NSW), no routine follow-up of post-injury health outcomes is conducted. This article describes the development of a protocol and the conduct of a pilot study to collect information on trauma outcomes at 3 months post-injury at two trauma centres. A modified Victorian model of trauma outcomes monitoring was adopted, with potential participants required to 'opt in' to the collection. Fifty-three percent of individuals contacted consented to opt in, with 75% of these completing an interview. The data items collected were able to provide an indicator of the impact of trauma on individuals. This study has highlighted that there are important methodological issues to be addressed in terms of recruitment in establishing long-term trauma outcomes data collections that are representative of the trauma population. Ultimately, information from a long-term trauma outcomes collection could be linked to data collections to conduct research across the injury continuum.
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Affiliation(s)
- Rebecca Mitchell
- NSW Injury Risk Management Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
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Gruen RL, Gabbe BJ, Stelfox HT, Cameron PA. Indicators of the quality of trauma care and the performance of trauma systems. Br J Surg 2011; 99 Suppl 1:97-104. [DOI: 10.1002/bjs.7754] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Valid and reliable measures of trauma system performance are needed to guide improvement activities, benchmarking and public reporting, future investment and research. Traditional measures of in-hospital mortality fail to take into account prehospital and posthospital care, recovery after discharge, and the nature and costs of long-term disability.
Methods
Drawing on recent systematic reviews, an overview was conducted of existing and emerging trauma care performance indicators. Changes in the nature and purpose of indicators were assessed.
Results
Among a large number of existing, mostly locally developed performance indicators, only peer review of deaths has evidence of validity or reliability. The usefulness of the traditional performance measure of in-hospital mortality has been challenged. There is an emerging shift in focus from mortality to non-mortality outcomes, from hospital-based to long-term community-based outcome assessment, and from single measures of trauma centre performance to measures better suited to monitoring the performance of systems of care spanning the entire patient journey. As a result, a new generation of indicators is emerging that are both feasible and potentially more useful for commissioners and payers of population-based services.
Conclusion
A global endeavour is now under way to agree on a set of standardized performance indicators that are meaningful to patients, carers, clinicians, managers and service funders, are likely to contribute to desired outcomes, and are valid, reliable and have a strong evidence base.
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Affiliation(s)
- R L Gruen
- National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - B J Gabbe
- National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - H T Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - P A Cameron
- National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Polinder S, Haagsma JA, Lyons RA, Gabbe BJ, Ameratunga S, Cryer C, Derrett S, Harrison JE, Segui-Gomez M, van Beeck EF. Measuring the population burden of fatal and nonfatal injury. Epidemiol Rev 2011; 34:17-31. [PMID: 22113244 DOI: 10.1093/epirev/mxr022] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The value of measuring the population burden of fatal and nonfatal injury is well established. Population health metrics are important for assessing health status and health-related quality of life after injury and for integrating mortality, disability, and quality-of-life consequences. A frequently used population health metric is the disability-adjusted life-year. This metric was launched in 1996 in the original Global Burden of Disease and Injury study and has been widely adopted by countries and health development agencies alike to identify the relative magnitude of different health problems. Apart from its obvious advantages and wide adherence, a number of challenges are encountered when the disability-adjusted life-year is applied to injuries. Validation of disability-adjusted life-year estimates for injury has been largely absent. This paper provides an overview of methods and existing knowledge regarding the population burden of injury measurement. The review of studies that measured burden of injury shows that estimates of the population burden remain uncertain because of a weak epidemiologic foundation; limited information on incidence, outcomes, and duration of disability; and a range of methodological problems, including definition and selection of incident and fatal cases, choices in selection of assessment instruments and timings of use for nonfatal injury outcomes, and the underlying concepts of valuation of disability. Recommendations are given for methodological refinements to improve the validity and comparability of future burden of injury studies.
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Affiliation(s)
- Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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Ahmad Z, Nouraei R, Holmes S. Towards a classification system for complex craniofacial fractures. Br J Oral Maxillofac Surg 2011; 50:490-4. [PMID: 22000633 DOI: 10.1016/j.bjoms.2011.09.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 09/26/2011] [Indexed: 11/29/2022]
Abstract
The complexity of facial fractures has changed considerably in recent years together with more commonly observed high velocity trauma. Traditional classification systems describe fractures in an isolated manner but fail to recognise those that affect more than one region. We applied four conceptual scoring systems for craniofacial trauma to a cohort of patients in east London. We exposed the limitations of the systems and developed a new scoring system that encompasses elements of all of the models and is capable of overcoming previous limitations.
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Comparing the Responsiveness of Functional Outcome Assessment Measures for Trauma Registries. ACTA ACUST UNITED AC 2011; 71:63-8. [DOI: 10.1097/ta.0b013e31820e898d] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Min L, Ubhayakar N, Saliba D, Kelley-Quon L, Morley E, Hiatt J, Cryer H, Tillou A. The vulnerable elders survey-13 predicts hospital complications and mortality in older adults with traumatic injury: a pilot study. J Am Geriatr Soc 2011; 59:1471-6. [PMID: 21718276 DOI: 10.1111/j.1532-5415.2011.03493.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether the Vulnerable Elders Survey (VES)-13, a survey based on functional status that has been validated in uninjured older populations, will predict complications and mortality in injured older adults. DESIGN Prospective observational pilot study. SETTING Level 1 trauma center. PARTICIPANTS Sixty-three older adults (≥65) with a traumatic injury who survived and required inpatient care for at least 24 hours. MEASUREMENTS PREDICTOR preinjury VES-13 score (0-10 points, higher=greater risk) obtained by interviewing participants or proxies. OUTCOMES composite outcome of one or more medical complications (e.g., aspiration pneumonia, respiratory failure) or death, discharge destination (home, nursing home, death), length of stay, hospital charges. Covariates: Charlson Comorbidity Index (CCI), Injury Severity Score (ISS), and sex. RESULTS Of the 63 participants, 30 (48%) were discharged to home and 28 (44%) to a nursing facility, 21 (33%) developed one or more complications, and four (6%) died. In a model that also controlled for ISS and comorbidity, each additional VES-13 point was associated with greater risk of complication or death (odds ratio=1.53 per point, 95% confidence interval=1.12-2.07). CONCLUSION The VES-13, in combination with injury severity, may be useful early in the hospital course to predict complications and death in older adults with traumatic injury, potentially identifying candidates who may benefit from additional inpatient geriatric services.
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Affiliation(s)
- Lillian Min
- Division of Geriatrics, Medical School, University of Michigan, Ann Arbor, Michigan, USA.
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Functional and Health-Related Quality of Life Outcomes After Pediatric Trauma. ACTA ACUST UNITED AC 2011; 70:1532-8. [PMID: 21427613 DOI: 10.1097/ta.0b013e31820e8546] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schluter PJ. The Trauma and Injury Severity Score (TRISS) revised. Injury 2011; 42:90-6. [PMID: 20851394 DOI: 10.1016/j.injury.2010.08.040] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 08/25/2010] [Accepted: 08/26/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Trauma and Injury Severity Score (TRISS) remains the most commonly used tool for benchmarking trauma fatality outcome. Recently, it was demonstrated that the predictive power of TRISS could be substantially improved by re-classifying the component variables and treating the variable categories nominally. This study aims to develop revised TRISS models using re-classified variables, to assess these models’ predictive performances against existing TRISS models, and to identify and recommend a preferred TRISS model. MATERIALS AND METHODS Revised TRISS models for blunt and penetrating injury mechanism were developed on an adult (aged 15 years) sample from the National Trauma Data Bank National Sample Project (NSP), using 5-category variable classifications and weighted logistic regression. Their predictive performances were then assessed against existing TRISS models on the unweighted NSP, National Trauma Data Bank (NTDB), and New Zealand Database (NZDB) samples using area under the Receiver Operating Characteristic curve (AUC) and Bayesian Information Criterion (BIC) statistics. RESULTS The weighted NSP sample included 1,124,001 adults with blunt or penetrating injury mechanism events and known discharge status, of whom 1,061,709 (94.5%) survived to discharge. Complete information for all TRISS variables was available for 896,212 (79.7%). Revised TRISS models that included main-effects and two-factor interaction terms had superior AUC and BIC statistics to main effects models and existing TRISS models for patients with complete data in NSP, NTDB and NZDB samples. Predictive performance decreased as the number of variables with missing values included within revised TRISS models increased, but model performances generally remained superior to existing TRISS models. DISCUSSION Revised TRISS models had importantly improved predictive capacities over existing TRISS models. Additionally, they were easily computed, utilised only those variables already collected for existing TRISS models, and could be applied and produce meaningful survival probabilities when one or more of the predictor variables contained missing values. The preferred revised TRISS model included main-effects and two-factor interaction terms and allowed for missing values in all predictor variables. A strong case exists for replacing existing TRISS models in trauma scoring systems benchmarking software with this preferred revised TRISS model.
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Affiliation(s)
- Philip J Schluter
- AUT University, School of Public Health and Psychosocial Studies, Auckland, New Zealand.
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Polinder S, Haagsma JA, Belt E, Lyons RA, Erasmus V, Lund J, van Beeck EF. A systematic review of studies measuring health-related quality of life of general injury populations. BMC Public Health 2010; 10:783. [PMID: 21182775 PMCID: PMC3019196 DOI: 10.1186/1471-2458-10-783] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 12/23/2010] [Indexed: 11/30/2022] Open
Abstract
Background It is important to obtain greater insight into health-related quality of life (HRQL) of injury patients in order to document people's pathways to recovery and to quantify the impact of injury on population health over time. We performed a systematic review of studies measuring HRQL in general injury populations with a generic health state measure to summarize existing knowledge. Methods Injury studies (1995-2009) were identified with main inclusion criteria being the use of a generic health status measure and not being restricted to one specific type of injury. Articles were collated by study design, HRQL instrument used, timing of assessment(s), predictive variables and ability to detect change over time. Results Forty one studies met inclusion criteria, using 24 different generic HRQL and functional status measures (most used were SF-36, FIM, GOS, EQ-5D). The majority of the studies used a longitudinal design, but with different lengths and timings of follow-up (mostly 6, 12, and 24 months). Different generic health measures were able to discriminate between the health status of subgroups and picked up changes in health status between discharge and 12 month follow-up. Most studies reported high prevalences of health problems within the first year after injury. The twelve studies that reported HRQL utility scores showed considerable but incomplete recovery in the first year after discharge. Conclusion This systematic review demonstrates large variation in use of HRQL instruments, study populations, and assessment time points used in studies measuring HRQL of general injury populations. This variability impedes comparison of HRQL summary scores between studies and prevented formal meta-analyses aiming to quantify and improve precision of the impact of injury on population health over time.
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Affiliation(s)
- Suzanne Polinder
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.
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