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Lotfalla A, Halm JA, Schepers T, Giannakópoulos GF. Parameters influencing health-related quality of life after severe trauma: a systematic review (part II). Eur J Trauma Emerg Surg 2024; 50:93-106. [PMID: 37188975 PMCID: PMC10923745 DOI: 10.1007/s00068-023-02276-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION It is increasingly recognized that health-related quality of life (HRQoL) is a relevant outcome to study in populations comprising severely injured patients. Although some studies have readily demonstrated a compromised HRQoL in those patients, evidence regarding factors that predict HRQoL is scarce. This hinders attempts to prepare patient-specific plans that may aid in revalidation and improved life satisfaction. In this review, we present identified predictors of HRQoL in patients that have suffered severe trauma. METHODS The search strategy included a database search until the 1st of January 2022 in the Cochrane Library, EMBASE, PubMed, and Web of Science, and reference checking. Studies were eligible for inclusion when (HR)QoL was studied in patients with major, multiple, or severe injury and/or polytrauma, as defined by authors by means of an Injury Severity Score (ISS) cut-off value. The results will be discussed in a narrative manner. RESULTS A total of 1583 articles were reviewed. Of those, 90 were included and used for analysis. In total, 23 possible predictors were identified. The following parameters predicted reduced HRQoL in severely injured patients and came forward in at least more than three studies: higher age, female gender, lower extremity injuries, higher rate of injury severity, lower achieved educational level, presence of (pre-existing) comorbidities and mental illness, longer duration of hospital stay, and high level of disability. CONCLUSION Age, gender, injured body region, and severity of injury were found to be good predictors of health-related quality of life in severely injured patients. A patient-centered approach, based on individual, demographic, and disease-specific predictors, is highly recommended.
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Affiliation(s)
- Annesimone Lotfalla
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Jens Anthony Halm
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Georgios Fredericus Giannakópoulos
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Park EJ, Lee MS, Bae SM, Kim HS, Hong M, Kim E, Lee SK, Kim J, Bhang SY. Promising Effect of the Children in Disaster: Evaluation and Recovery Intervention on Trauma Symptoms and Quality of Life for Children and Adolescents: A Controlled Study. Psychiatry Investig 2024; 21:123-132. [PMID: 38321890 PMCID: PMC10910171 DOI: 10.30773/pi.2023.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/13/2023] [Accepted: 10/26/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE The Children in Disaster: Evaluation and Recovery (CIDER) program in Korea was developed to treat children and adolescents exposed to trauma. This study aimed to demonstrate the effectiveness of the CIDER through a comparison with controls. METHODS A total of 85 participants consisted of the intervention group (n=41) and control group (n=44). We assessed the changes in trauma-related symptoms, depression, anxiety, and improvements in quality of life before and after the intervention. RESULTS In total, bullying and school violence (44.7%) were the most common trauma, followed by sexual abuse (17.6%). Acute stress disorder and post-traumatic stress disorder (PTSD) accounted for 41.2%, and attention-deficit/hyperactivity disorder (ADHD) and developmental disorder were the most common comorbidities (51.8%). The symptoms of trauma, depression, anxiety, and quality of life improved significantly in the intervention group, while the control group did not show significant changes. CONCLUSION Compared with the control group, the CIDER improved symptoms and quality of life in children and adolescents who had experienced trauma. The CIDER program was practical and easy to apply, even for different ages, types of traumas, and comorbidities.
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Affiliation(s)
- Eun Jin Park
- Jinny Mental Health Clinic, Goyang, Republic of Korea
| | - Mi-Sun Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Eulji Psychiatry and Medical Science Center, Eulji University, Seongnam, Republic of Korea
| | - Seung Min Bae
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Hyun Soo Kim
- Department of Psychiatry, Hanyang University College of Medicine, Myongji Hospital, Goyang, Republic of Korea
| | - Minha Hong
- Department of Psychiatry, Hanyang University College of Medicine, Myongji Hospital, Goyang, Republic of Korea
| | - Eunji Kim
- Maumtodak Psychiatry Clinic, Ansan, Republic of Korea
| | - Seul Ki Lee
- Department of Psychiatry, Gil Hospital, Incheon, Republic of Korea
| | - Jiyoun Kim
- Goodmind Psychiatry Clinic, Suwon, Republic of Korea
| | - Soo-Young Bhang
- Eulji Psychiatry and Medical Science Center, Eulji University, Seongnam, Republic of Korea
- Department of Psychiatry, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
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Sreeharsha P, Kanna RM, Milton R, Shetty AP, Rajasekaran S. Risk factors for thirty-day morbidity and mortality after spinal trauma. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:110-117. [PMID: 36443511 DOI: 10.1007/s00586-022-07476-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/21/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traumatic Spinal Injuries (TSI) often follow high velocity injuries and frequently accompanied by polytrauma. While most studies have focussed on outcomes of spinal cord injuries, the incidence and risk factors that predict morbidity and mortality after TSI has not been well-defined. METHODS Data of consecutive patients of TSI (n = 2065) treated over a 5-year-period were evaluated for demographics, injury mechanisms, neurological status, associated injuries, timing of surgery and co-morbidities. The thirty-day incidence and risk factors for complications, length of stay and mortality were analysed. RESULTS The incidence of spinal trauma was 6.2%. Associated injuries were seen in 49.7% (n = 1028), and 33.5% (n = 692) patients had comorbidities. The 30-day mortality was 0.73% (n = 15). Associated chest injuries (p = 0.0001), cervical spine injury (p = 0.0001), ASIA-A neurology (p < 0.01) and ankylosing spondylitis (p = 0.01) correlated with higher mortality. Peri-operative morbidity was noted in 571 patients (27.7%) and were significantly associated with age > 60 (p = 0.043), ASIA-A neurology (p < 0.05), chest injuries (p = 0.042), cervical and thoracic spine injury (p < 0.0001). The mean length of stay in hospital was 8.87 days. Cervical spine injury (p < 0.0001), delay in surgery > 48 h (p = 0.011), Diabetes mellitus (p = 0.01), Ankylosing spondylitis (p = 0.009), associated injuries of chest, head, pelvis and face (p < 0.05) were independent risk factors for longer hospital stay. CONCLUSION Key predictors of mortality after spinal trauma were cervical spine injury, complete neurological deficit, chest injuries and ankylosing spondylitis, while additionally higher age and thoracic injuries contributed to higher morbidity and prolonged hospitalisation. Notably multi-level injuries, higher age, co-morbidities and timing of surgery did not influence the mortality.
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Lotfalla A, Halm J, Schepers T, Giannakópoulos G. Health-related quality of life after severe trauma and available PROMS: an updated review (part I). Eur J Trauma Emerg Surg 2022; 49:747-761. [PMID: 36445397 PMCID: PMC10175342 DOI: 10.1007/s00068-022-02178-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Introduction
Throughout the years, a decreasing trend in mortality rate has been demonstrated in patients suffering severe trauma. This increases the relevance of documentation of other outcomes for this population, including patient-reported outcome measures (PROMs), such as health-related quality of life (HRQoL). The aim of this review was to summarize the results of the studies that have been conducted regarding HRQoL in severely injured patients (as defined by the articles’ authors). Also, we present the instruments that are used most frequently to assess HRQoL in patients suffering severe trauma.
Methods
A literature search was conducted in the Cochrane Library, EMBASE, PubMed, and Web of Science for articles published from inception until the 1st of January 2022. Reference lists of included articles were reviewed as well. Studies were considered eligible when a population of patients with major, multiple or severe injury and/or polytrauma was included, well-defined by means of an ISS-threshold, and the outcome of interest was described in terms of (HR)QoL. A narrative design was chosen for this review.
Results
The search strategy identified 1583 articles, which were reduced to 113 after application of the eligibility criteria. In total, nineteen instruments were used to assess HRQoL. The SF-36 was used most frequently, followed by the EQ-5D and SF-12. HRQoL in patients with severe trauma was often compared to normative population norms or pre-injury status, and was found to be reduced in both cases, regardless of the tool used to assess this outcome. Some studies demonstrated higher scoring of the patients over time, suggesting improved HRQoL after considerable time after severe trauma.
Conclusion
HRQoL in severely injured patients is overall reduced, regardless of the instrument used to assess it. The instruments that were used most frequently to assess HRQoL were the SF-36 and EQ-5D. Future research is needed to shed light on the consequences of the reduced HRQoL in this population. We recommend routine assessment and documentation of HRQoL in severely injured patients.
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Predictors of 12 month functional outcomes and length of stay of severely injured children in NSW, Australia. A longitudinal multi-centre study. Injury 2022; 53:1684-1689. [PMID: 35031107 DOI: 10.1016/j.injury.2021.12.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/16/2021] [Accepted: 12/31/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The majority of paediatric injury outcomes studies focus on mortality rather than the impact on long-term quality of life, health care use and other health-related outcomes. This study sought to determine predictors of 12-month functional and psychosocial outcomes for children sustaining major injury in NSW. METHODS The study included all children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW at a paediatric trauma centre (PTC). Children were identified through the three PTCs and NSW Trauma Registry. The paediatric Quality of Life Inventory (PedsQL) and EuroQol five-dimensional EQ-5D-Y were used to measure HRQoL post-injury, completed via parent/carer proxy recruited through NSW PTCs. RESULTS There were 510 children treated at the three NSW PTCs during the 15-month study period. The mean (SD) age was 6.7 (6.0) years, with a median NISS (New Injury Severity Score) of 11 (IQR: 9-18). Regression analysis showed worse psychosocial health at twelve months was associated with hospital length of stay (LoS) and number of body regions injured (F2,65 = 5.85, p = 0.005). Physical outcome was associated with LoS and intensive care unit (ICU) admission (F2,66 = 13.48, p < 0.001). Hospital LoS was significantly associated with NISS and head injury (F2,398 = 51.5, p < 0.001). CONCLUSION Hospital length of stay and polytrauma are independent factors that negatively influence psychological and physical outcomes of children with major injuries. Early intervention to enable emotional well-being, discharge home and long-term follow up such as dedicated family support and rehabilitation at home could reduce preventable poor outcomes.
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Martin-Herz SP, McMahon RJ, Malzyner S, Chiang N, Zatzick DF. Impact of posttraumatic stress disorder and depressive symptoms on quality of life in adolescents after general traumatic injury. J Trauma Stress 2022; 35:386-397. [PMID: 34861072 DOI: 10.1002/jts.22750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 11/06/2022]
Abstract
Posttraumatic stress disorder (PTSD) and depressive symptoms have been associated with poorer health-related quality of life in adolescents after general traumatic injuries; few studies have examined the broader construct of postinjury quality of life (QOL). We evaluated the impact of traumatic injury on adolescent QOL and examined factors that potentially contribute to poorer outcomes, using the Youth Quality of Life Instrument-Research Version as the outcome measure. Data were collected within 30 days postinjury and 2, 5, and 12 months postinjury. Mixed-model regression (MMR) was used for the main analyses. Participants (N = 204) were drawn from a prospective cohort study of 12-18-year-olds admitted to a Level 1 trauma center (n = 108) and healthy participants from a local cross-sectional study (n = 116); study group participants were significantly older. The initial MMR indicated that female adolescents had significantly lower QOL, B = -2.69, 95% CI [-4.68, -0.70], and were more likely to score above the cutoffs for PTSD (19.1% vs. 2.0%), χ2 (1, N = 381) = 34.6, p < .001, or depression (32.8% vs. 14.0%), χ2 (1, N = 381) = 18.7, p < .001, on post hoc analyses. Adolescents with mental health conditions in the year postinjury had significant QOL deficits without predicted improvements toward baseline, PTSD: B = -10.05, 95% CI [-15.29, -4.81]; depression: B = -18.00, 95% CI [-21.69, -14.31]. These findings highlight the importance of ongoing mental health monitoring and care for adolescents, particularly female adolescents, following traumatic injury even when physical recovery appears complete.
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Affiliation(s)
- Susanne P Martin-Herz
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Robert J McMahon
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.,B.C. Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | | | - Nikki Chiang
- University of California, Berkeley, Berkeley, California, USA
| | - Douglas F Zatzick
- Department of Psychiatry, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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Yun H, Bae SJ, Lee JI, Lee DH. Epidemiology, injury characteristics and clinical outcomes of bicycle and motorcycle accidents in the under 20 population: South Korea. BMC Emerg Med 2022; 22:56. [PMID: 35361127 PMCID: PMC8973528 DOI: 10.1186/s12873-022-00614-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bicycles and motorcycles are a main means of transportation and leisure for individuals aged under 20 years in South Korea. We aimed to identify the epidemiology of injuries and describe and compare patterns of injury and clinical outcomes of two-wheel vehicle-related accidents in these individuals. METHODS We analysed data obtained from the National Emergency Department Information System for 401 emergency departments (EDs) from January 2016 to December 2018. We included patients aged < 20 years who experienced injuries while driving or a passenger on two-wheeled vehicles. We analysed patients with a bicycle-related injury and those with a motorcycle-related injury, and then compared two groups and performed a regression analysis for factors predicting severe trauma. RESULTS This study enrolled 54,342 two-wheel vehicle injury patients (37,410 bicycle and 16,932 motorcycle-related), of which, 86.8% (bicycle) and 94.9% (motorcycle) were males. External injuries were the most common. ED mortality was 9 (0.0%) for bicycles and 53 (0.3%) for motorcycles. Overall, 3,346 (8.9%) patients were hospitalised with bicycle injuries and 4,096 (24.2%) with motorcycle injuries. Among admitted patients with bicycle-related injuries, 48.7% had upper extremity injuries and among those admitted patients with motorcycle-related injuries, 76.0% had lower extremity injuries. Among hospitalised patients, the mean injury severity score (ISS) was 12.0 ± 12.6 in bicycle-related injury and 17.6 ± 15.4 in motorcycle-related injury. The number of patients with ISS ≥ 16 was 27.6% for bicycle related injuries and 45.2% for motorcycle-related injuries. The mean length of hospital stay was 191.5.8 ± 224.2 h for bicycle injury, and 359.6 ± 416.7 h for motorcycles. Hospital mortality cases were 0.2% with bicycle injury and 1.2% with motorcycle injury. Motorcycle-related injuries had more severe injury (ISS ≥ 16), with an adjusted odds ratio of 2.825 (95% confidence interval 2.610-3.059) compared to bicycle-related injuries. CONCLUSIONS In the population aged under 20 years, two-wheel vehicle-related occurred predominantly in males. When using two-wheeled vehicles, motorcycle injuries were higher in patients aged over 14 years and were associated with higher ISS (≥ 16). Political efforts should be made to educate under 20 years of age for safe driving and to wear protective gear, including helmets to prevent severe injury.
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Affiliation(s)
- Hyeokmin Yun
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, South Korea
| | - Sung Jin Bae
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Jung Il Lee
- Department of Orthopedic Surgery, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, South Korea.
| | - Duk Hee Lee
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, South Korea.
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Dipnall JF, Rivara FP, Lyons RA, Ameratunga S, Brussoni M, Lecky FE, Bradley C, Beck B, Lyons J, Schneeberg A, Harrison JE, Gabbe BJ. Predictors of health-related quality of life following injury in childhood and adolescence: a pooled analysis. Inj Prev 2021; 28:301-310. [PMID: 34937765 DOI: 10.1136/injuryprev-2021-044309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Injury is a leading contributor to the global disease burden in children and places children at risk for adverse and lasting impacts on their health-related quality of life (HRQoL) and development. This study aimed to identify key predictors of HRQoL following injury in childhood and adolescence. METHODS Data from 2259 injury survivors (<18 years when injured) were pooled from four longitudinal cohort studies (Australia, Canada, UK, USA) from the paediatric Validating Injury Burden Estimates Study (VIBES-Junior). Outcomes were the Paediatric Quality of Life Inventory (PedsQL) total, physical, psychosocial functioning scores at 1, 3-4, 6, 12, 24 months postinjury. RESULTS Mean PedsQL total score increased with higher socioeconomic status and decreased with increasing age. It was lower for transport-related incidents, ≥1 comorbidities, intentional injuries, spinal cord injury, vertebral column fracture, moderate/severe traumatic brain injury and fracture of patella/tibia/fibula/ankle. Mean PedsQL physical score was lower for females, fracture of femur, fracture of pelvis and burns. Mean PedsQL psychosocial score was lower for asphyxiation/non-fatal submersion and muscle/tendon/dislocation injuries. CONCLUSIONS Postinjury HRQoL was associated with survivors' socioeconomic status, intent, mechanism of injury and comorbidity status. Patterns of physical and psychosocial functioning postinjury differed according to sex and nature of injury sustained. The findings improve understanding of the long-term individual and societal impacts of injury in the early part of life and guide the prioritisation of prevention efforts, inform health and social service planning to help reduce injury burden, and help guide future Global Burden of Disease estimates.
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Affiliation(s)
- Joanna F Dipnall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Frederick P Rivara
- Departments of Pediatrics and Epidemiology, and the Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Ronan A Lyons
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Health Data Research UK, Swansea University, Swansea, UK.,National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, UK
| | - Shanthi Ameratunga
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Population Health, University of Auckland, Auckland, New Zealand.,Kidz First Hospital and Population Health Directorate, Counties Manukau District Health Board, Auckland, New Zealand
| | - Mariana Brussoni
- Department of Pediatrics, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Fiona E Lecky
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, UK.,Emergency Department, Salford Royal Hospital, Salford, UK
| | - Clare Bradley
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Lyons
- Health Data Research UK, Swansea University, Swansea, UK
| | - Amy Schneeberg
- British Columbia Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - James E Harrison
- Flinders Institute for Health and Medical Research, Flinders University, Adelaide, South Australia, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Health Data Research UK, Swansea University, Swansea, UK
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Krenz U, Timmermann D, Gorbunova A, Lendt M, Schmidt S, von Steinbuechel N. Health-related quality of life after pediatric traumatic brain injury: A qualitative comparison between children's and parents' perspectives. PLoS One 2021; 16:e0246514. [PMID: 33566806 PMCID: PMC7875394 DOI: 10.1371/journal.pone.0246514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 01/20/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Pediatric traumatic brain injury (TBI) may cause a wide range of symptoms, which can negatively affect the quality of life of patients and their entire families. No internationally and simultaneously developed disease-specific instrument exists for assessing pediatric health-related quality of life (HRQoL) after TBI. The aim of the current project is to provide original material from small group interviews with individuals after TBI concerning what they state is relevant for their HRQoL. This material is required for a further study to generate items for age-adapted questionnaires assessing the TBI-specific HRQoL of children and adolescents (C&A): the QOLIBRI-Kiddy/Kid/Ado and proxy versions (Quality of Life after Brain Injury-Kiddy/Kids/Adolescents/Proxy) for individuals aged 6-17 and their parents. METHODS The semi-structured interviews were conducted with separate small groups of C&A (n = 19), divided into three age groups (5-7y, 8-12y, 13-17y), after mild, moderate, and severe TBI, and with groups of the corresponding parents (n = 26). All interviews lasted for about 60 minutes, were recorded and transcribed verbatim. The statements were investigated by qualitative analyses and sorted into categories relevant to the HRQoL of C&A after TBI. Only descriptive group comparisons but no pairwise comparisons between children and corresponding parents were performed. RESULTS The analyses led to 32 subcategories, which were assigned to six main theoretically based HRQoL categories. Many agreements exist between the C&A's and parents' perspectives within the main categories, however their focus on HRQoL differs, especially concerning age-related contents. Parents of the youngest participant group already focus on topics such as autonomy, whereas this only becomes relevant for C&A from the age of eight years on. Interestingly, even 5-year-old children were able to discuss their HRQoL, which indicates the importance of a self-report instrument. CONCLUSIONS Results obtained from this qualitative study identify the content of the HRQoL dimensions important for C&A after TBI and their parents. Both, differences and similarities in the children's and the parents' views were investigated, to get a first insight in valid dimensions for the prospective questionnaires to be developed. In a future study, items for the questionnaires will be deducted from the small group interview material and psychometrically tested in C&A after TBI from Germany. This study will address whether all statements were assigned to the suitable dimensions and whether differences between C&A and parents persist.
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Affiliation(s)
- Ugne Krenz
- Department of Medical Psychology and Medical Sociology, Georg-August University, Göttingen, Germany
| | - Dagmar Timmermann
- Department of Medical Psychology and Medical Sociology, Georg-August University, Göttingen, Germany
| | - Anastasia Gorbunova
- Department of Medical Psychology and Medical Sociology, Georg-August University, Göttingen, Germany
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Meerbusch, Germany
| | - Silke Schmidt
- Department Health and Prevention, University of Greifswald, Greifswald, Germany
| | - Nicole von Steinbuechel
- Department of Medical Psychology and Medical Sociology, Georg-August University, Göttingen, Germany
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Anwar F, Mee H, Allanson J, Mendis E, Hamilton C. Pattern of injuries and management of adolescent trauma in a combined adult and paediatric major trauma centre in United Kingdom. TRAUMA-ENGLAND 2021. [DOI: 10.1177/1460408620921709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Major trauma is a leading cause of death and disability in 16–18-year olds in the UK. Since the launch of major trauma centres (MTCs) in 2012 in UK, survival rates have improved on the whole. The aim of this study was to look at the pathways of 16–18-year olds through one MTC and patterns of rehabilitation provision. Material and methods A retrospective case notes review of all trauma patients aged between 16 and 18 years admitted to one MTC between October 2012 and May 2018. Results One hundred forty-seven young people were identified. 67.3% were male with a mean age of 17.1 years. Motor vehicle accidents were the most common cause of injury (59.2%). Thirty-nine percent had a Glasgow Coma Scale at scene >13. Sixty-three percent were admitted to an adult intensive care unit (ICU), 5.4% to paediatric ICU and 31.3% directly to a ward. Admissions to rehabilitation ward came through adult services with no commissioned equivalent in those admitted to paediatrics. Mean length of stay was 18.1 days. 75.5% of patients were discharged home from the MTC. Discussion The majority of young people were admitted on to adult wards and were able to access commissioned services. However, such services do not provide for the specialist needs of young people, with no access to schooling or parent’s accommodation. Those who were admitted to children’s services missed out on commissioned rehabilitation pathways. Conclusion Young people of transition age often fall between services. For the first time, we illustrate injury patterns and the fragmented services seen in this vulnerable patient group.
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Affiliation(s)
- Fahim Anwar
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - Harry Mee
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - Judith Allanson
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - Elly Mendis
- Major Trauma Service, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Colin Hamilton
- Department of Physiotherapy, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Lee MS, Kim HS, Park EJ, Bhang SY. Efficacy of the 'Children in Disaster: Evaluation and Recovery (CIDER)' Protocol for Traumatized Adolescents in Korea. J Korean Med Sci 2020; 35:e240. [PMID: 32715670 PMCID: PMC7384899 DOI: 10.3346/jkms.2020.35.e240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 06/01/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND We aimed to evaluate the feasibility of trauma-focused group therapy in adolescents exposed to traumatic events in Korea. METHODS We recruited 22 adolescents (mean age, 16 years; standard deviation, 1.43; range, 13-18 years). Children in Disaster: Evaluation and Recovery (CIDER) V1.0 is a trauma-focused group therapy comprising eight 50-minute-long sessions. The effectiveness of the intervention was evaluated using the Korean version of the Children's Response to Traumatic Events Scale-Revised (K-CRTES-R), the Beck Depression Inventory (BDI), the State Anxiety Inventory for Children (SAIC), and the Pediatric Quality of Life Inventory (PedsQL). The data were analyzed by the Wilcoxon signed-rank test. RESULTS A significant improvement was revealed in trauma-related symptom scores (Z = -2.85, P < 0.01), depressive symptom scores (Z = -2.35, P < 0.05) and quality of life scores (Z = -3.08, P < 0.01). Additionally, a marginally significant improvement was found in anxiety symptom scores (Z = -1.90, P = 0.058). CONCLUSION CIDER is a potentially effective intervention for adolescents exposed to traumatic events. Larger controlled trials are needed. TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0004681.
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Affiliation(s)
- Mi Sun Lee
- Department of Meditation Psychology, Nungin University, Hwaseong, Korea
| | - Hyun Soo Kim
- Department of Psychiatry, Myongji Hospital, Goyang, Korea
| | - Eun Jin Park
- Department of Psychiatry, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
- Hallym University Suicide and School Mental Health Institute, Anyang, Korea
| | - Soo Young Bhang
- Hallym University Suicide and School Mental Health Institute, Anyang, Korea
- Department of Psychiatry, Eulji University Hospital, Eulji University School of Medicine, Seoul, Korea.
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12
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Krasnoff CC, Grigorian A, Chin T, Joe V, Kong A, Barrios C, Kuza CM, Nahmias J. Pediatric burn-trauma patients have increased length of stay compared to trauma-only patients: A propensity matched analysis. Burns 2020; 47:78-83. [PMID: 33293153 DOI: 10.1016/j.burns.2020.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Trauma is the leading cause of mortality in children. Burn injury involves intensive resources, especially in pediatric patients. We hypothesized that among pediatric trauma patients, combined burn-trauma (BT) patients have increased length of stay (LOS) and mortality compared to trauma-only (T) patients. METHODS The Pediatric Trauma Quality Improvement Program (2014-2016) was queried and BT patients were 1:2 propensity-score-matched to T patients based on age, gender, hypotension on admission, injury type and severity. RESULTS 93 BT patients were matched to 186 T patients. There were no differences in matched characteristics. BT patients had a longer median LOS (4 vs 2 days, p<0.001) with no difference in mortality (1.1% vs 1.1%, p=1.00), intensive care unit (ICU) LOS (3 vs 3 days, p=0.55), or complications including decubitus ulcer (0% vs 1.1%, p=0.32), deep vein thrombosis (0% vs 0.5%, p=0.48), extremity compartment syndrome (1.1% vs 0%, p=0.16), and urinary tract infection (1.1% vs 1.1%, p=1.00). CONCLUSION Pediatric BT patients had twice the LOS compared to a matched group of pediatric T patients. There was no difference between the cohorts in ICU LOS, complications or mortality rate. When evaluating risk-stratified quality metrics such as LOS, concomitant burn injury should be incorporated.
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Affiliation(s)
- Chloe C Krasnoff
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Theresa Chin
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Victor Joe
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Allen Kong
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Cristobal Barrios
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Catherine M Kuza
- University of Southern California, Department of Anesthesiology, Los Angeles, CA, USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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13
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Parent perspectives and psychosocial needs 2 years following child critical injury: A qualitative inquiry. Injury 2020; 51:1203-1209. [PMID: 31983421 DOI: 10.1016/j.injury.2020.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To provide effective care and promote wellbeing and positive outcomes for parents and families following paediatric critical injury there is a need to understand parent experiences and psychosocial support needs. This study explores parent experiences two years following their child's critical injury. METHODS This multi-centre study used an interpretive qualitative design. Parent participants were recruited from four paediatric hospitals in Australia. Semi-structured interviews were audio recorded and transcribed verbatim. Qualitative data were thematically analysed and managed using NVivo 11. RESULTS Twenty-two parents participated. Three themes were identified through analysis: Recovering from child injury; Managing the emotional impact of child injury; Being resilient and finding ways to adapt. CONCLUSIONS A long-term dedicated trauma family support role is required to ensure continuity of care, integration of support and early targeted intervention to prevent long-term adverse outcomes for critically injured children and their families. Early and ongoing psychosocial intervention would help strengthen parental adaptation and address families' psychosocial support needs following child injury.
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14
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Joubert C, Cungi PJ, Esnault P, Sellier A, de Lesquen H, Avaro JP, Bordes J, Dagain A. Surgical management of spine injuries in severe polytrauma patients: a retrospective study. Br J Neurosurg 2019; 34:370-380. [PMID: 31771363 DOI: 10.1080/02688697.2019.1692787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Optimal surgical management of spinal injuries as part of life-threatening multiple traumas remains challenging. We provide insights into the surgical management of spinal injuries in polytrauma patients. Methods: All patients from our polytrauma care network who both met at least one positive Vittel criteria and an injury severity score (ISS) >15 at admission and who underwent surgery for a spinal injury were included retrospectively. Demographic data, clinical data demonstrating the severity of the trauma and imaging defining the spinal and extraspinal number and types of injuries were collected.Results: Between January 2012 and December 2016, 302 (22.2%) patients suffered from spinal injury (143 total injuries) and 83 (6.1%) met the inclusion criteria. Mean ISS was 36.2 (16-75). Only 48 (33.6%) injuries led to neurological impairment involving the thoracic (n = 23, 16.1%) and lower cervical (n = 15, 10.5%) spine. The most frequent association of injuries involved the thoracic spine (n = 42). 106 spinal surgeries were performed. The 3-month mortality rate was 2.4%.Conclusions: We present data collected on admission and in the early postoperative period referring to injury severity, the priority of injuries, and development of multi-organ failure. We revealed trends to guide the surgical support of spinal lesions in polytrauma patients.
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Affiliation(s)
- C Joubert
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - P-J Cungi
- Department of Intensive Care, Sainte Anne Military Hospital, Toulon, France
| | - P Esnault
- Department of Intensive Care, Sainte Anne Military Hospital, Toulon, France
| | - A Sellier
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - H de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon, France
| | - J-P Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon, France.,Val-de-Grâce French Military Health Service Academy, Paris, France
| | - J Bordes
- Department of Intensive Care, Sainte Anne Military Hospital, Toulon, France.,Val-de-Grâce French Military Health Service Academy, Paris, France
| | - A Dagain
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France.,Val-de-Grâce French Military Health Service Academy, Paris, France
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15
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Beck B, Teague W, Cameron P, Gabbe BJ. Causes and characteristics of injury in paediatric major trauma and trends over time. Arch Dis Child 2019; 104:256-261. [PMID: 30279158 DOI: 10.1136/archdischild-2018-315565] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate causes, characteristics and temporal trends of paediatric major trauma. DESIGN A retrospective review of paediatric major trauma (<16 years of age) was conducted using data from the population-based Victorian State Trauma Registry from 2006 to 2016. Temporal trends in population-based incidence rates were evaluated using Poisson regression. SETTING Victoria, Australia. RESULTS Of the 1511 paediatric major trauma patients, most were male (68%), had sustained blunt trauma (87%) and had injuries resulting from unintentional events (91%). Motor vehicle collisions (15%), struck by/collisions with an object or person (14%) and low falls (13%) were the leading mechanisms of injury. Compared with those aged 1-15 years, a greater proportion of non-accidental injury events were observed in infants (<1 year) (32%). For all patients, isolated head injury (29%), other/multitrauma (27%) and head and other injuries (24%) were the most prevalent injury groups. The incidence of paediatric major trauma did not change over the study period (incidence rate ratio (IRR)=0.97; 95% CI 0.92 to 1.02; p=0.27), which was consistent in all age groups. There was a 3% per year decline in the incidence of transport events (IRR=0.97; 95% CI 0.94 to 0.99; p=0.005), but no change in the incidence of falls of any type (IRR=1.01; 95% CI 0.97 to 1.04; p=0.70) or other events (IRR=1.00; 95% CI 0.97 to 1.02; p=0.79). The overall in-hospital mortality rate was 7.2%. CONCLUSIONS This study demonstrated no change in the incidence of paediatric major trauma over an 11-year period. Given the potential lifelong impacts of serious injury in children, additional investment and coordination of injury prevention activities are required.
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Affiliation(s)
- Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Warwick Teague
- Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Farr Institute, Swansea University Medical School, Swansea University, Swansea, UK
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16
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Alghnam S, Bell TM, Cook LJ, Alqahtani F, Castillo R. Maternal and child health after injuries: a two-year follow-up of a nationally representative sample. Public Health 2019; 168:76-82. [PMID: 30708198 DOI: 10.1016/j.puhe.2018.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/03/2018] [Accepted: 12/16/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to examine the association between childhood injury and health outcomes among survivors and their mothers using a national survey in the United States (US). STUDY DESIGN This was a longitudinal analysis of a nationally representative sample. METHODS Secondary analysis of the 1997-2013 Medical Expenditure Panel Survey (MEPS) was performed. Children (aged 2-18 years) with or without injuries were followed up for two years. Injuries captured in the study were those associated with at least one hospitalization, emergency department visit, or office-based visit. Outcome measures were child and maternal general and mental health status. Multiple mixed-logistic regressions were used with suboptimal health defined as the response of poor or fair health versus good, very good, or excellent health. RESULTS Of the 63,422 children analyzed, 3251 (4.9%) were injured, representing 3.6 million US children. Injured children were more likely to be male, white, and older than those without injuries (P < 0.01). About a fifth of injured children suffered head injuries. Injuries were strongly associated with suboptimal general and mental health status in children (adjusted odds ratios [AORs], 1.35 and 1.36, respectively, P < 0.05). Mothers of children with injuries were also more likely to report suboptimal mental health (AOR, 1.30, P < 0.05). CONCLUSION Injuries among children are associated with lasting adverse effects in general and mental health. To improve health outcomes of pediatric injuries, further follow-up care may be needed to ensure that they return to pre-injury health levels. These results highlight the importance of primary prevention and the long-term impact of injuries on the health of children and their mothers.
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Affiliation(s)
- S Alghnam
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, KAIMRC, KSAU-HS, Riyadh, Saudi Arabia.
| | - T M Bell
- Center for Outcomes Research in Surgery, 702 Rotary Circle, Rm 022A, Indianapolis, IN 46202, USA.
| | - L J Cook
- University of Utah, Department of Pediatrics, 295 Chipeta Way, Salt Lake City, UT 84158, USA.
| | - F Alqahtani
- Department of Pediatrics, Imam Abdulrahman bin Faisal University, P.O: 1982, Dammam 31441, Saudi Arabia.
| | - R Castillo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, HH 544 624 N. Broadway, Baltimore, MD 21205, USA.
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17
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Marek AP, Nygaard RM, Cohen EM, Polites SF, Sirany AME, Wildenberg SE, Elsbernd TA, Murphy S, Dean Potter D, Zielinski MD, Richardson CJ. Rural versus urban pediatric non-accidental trauma: different patients, similar outcomes. BMC Res Notes 2018; 11:519. [PMID: 30055647 PMCID: PMC6064103 DOI: 10.1186/s13104-018-3639-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/24/2018] [Indexed: 11/11/2022] Open
Abstract
Objective Our aim was to compare urban and rural non-accidental trauma for trends and characterize where injury prevention efforts can be focused. Pediatric trauma patients (age 0–14 years) at two level I adult and pediatric trauma centers, one rural and one urban, were included and data from the trauma registries at each center was abstracted. Results Of 857 pediatric admissions, 10% of injuries were considered non-accidental. The mean age for all non-accidental trauma patients was significantly lower than the overall pediatric trauma population (2.6 vs. 7.7 years, P < 0.001). Significantly more fatalities occurred in the non-accidental trauma cohort (5.7% vs. 1% P = 0.007). In nearly half of all non-accidental trauma patients, the primary insurance was government programs (49%) and 46% were commercial insurance. The proportion of government insurance in non-accidental trauma was higher in both urban and rural cohorts. There were similar rates of urban and rural patients sustaining non-accidental trauma who were uninsured (6.5 vs. 5.3%). Patients that were younger, in a rural location, and receiving government insurance were at higher risk of non-accidental trauma on univariable analysis. However, only age remained an independent predictor on multivariable analysis.
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Affiliation(s)
- Ashley P Marek
- Department of Surgery, Hennepin County Medical Center, 701 Park Ave S, P5, Minneapolis, MN, 55415, USA
| | - Rachel M Nygaard
- Department of Surgery, Hennepin County Medical Center, 701 Park Ave S, P5, Minneapolis, MN, 55415, USA.
| | - Ellie M Cohen
- Department of Surgery, Hennepin County Medical Center, 701 Park Ave S, P5, Minneapolis, MN, 55415, USA
| | - Stephanie F Polites
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Anne-Marie E Sirany
- Department of Surgery, Hennepin County Medical Center, 701 Park Ave S, P5, Minneapolis, MN, 55415, USA
| | - Sarah E Wildenberg
- Department of Surgery, Hennepin County Medical Center, 701 Park Ave S, P5, Minneapolis, MN, 55415, USA
| | - Terri A Elsbernd
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sherrie Murphy
- Department of Surgery, Hennepin County Medical Center, 701 Park Ave S, P5, Minneapolis, MN, 55415, USA
| | - D Dean Potter
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Martin D Zielinski
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Chad J Richardson
- Department of Surgery, Hennepin County Medical Center, 701 Park Ave S, P5, Minneapolis, MN, 55415, USA
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18
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Groh EM, Feingold PL, Hashimoto B, McDuffie LA, Markel TA. Temporal Variations in Pediatric Trauma: Rationale for Altered Resource Utilization. Am Surg 2018. [DOI: 10.1177/000313481808400624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trauma is a major cause of morbidity and mortality in the pediatric population. However, temporal variations of trauma have not been well characterized and may have implications for appropriate allocation of hospital resources. Data from patients evaluated at an ACS-verified Level I pediatric trauma center between 2011 and 2015 were retrospectively analyzed. Date and time of injury, type of injury (blunt vs penetrating), and postemergency department disposition were reviewed. To assess temporal trends, heatmaps were constructed and a mixed poisson regression model was used to assess statistical significance. Pediatric trauma from blunt and penetrating injuries occurred at significantly higher rates between the hours of 1800 and 0100, on weekends compared with weekdays, and from May to August compared with November to February. These data provide useful information for hospital resource utilization. The emergency department, operating room, and intensive care unit should be prepared for increased trauma-related volume between May and August, weekends, and evening hours by appropriately increasing staff volume and resource availability.
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Affiliation(s)
- Eric M. Groh
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Paul L. Feingold
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Barry Hashimoto
- Department of International Studies, American University of Sharjah, Sharjah, United Arab Emirates
| | - Lucas A. McDuffie
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Troy A. Markel
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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19
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Ameratunga S, Ramke J, Jackson N, Tin Tin S, Gabbe B. Disparities in Non-Fatal Health Outcomes in Pediatric General Trauma Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 15:ijerph15010043. [PMID: 29280986 PMCID: PMC5800142 DOI: 10.3390/ijerph15010043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/21/2017] [Accepted: 12/25/2017] [Indexed: 12/01/2022]
Abstract
When prevention efforts fail, injured children require high-quality health services to support their recovery. Disparities in non-fatal injury outcomes, an indicator of health-care quality, have received minimal attention. We evaluated the extent to which general trauma follow-up studies published in the peer-reviewed scientific literature provide evidence of socially patterned inequities in health, functional or disability outcomes ≥4 weeks after childhood injuries. Using a systematic search, we identified 27 eligible cohort studies from 13 high-income countries. We examined the extent to which the reported health outcomes varied across the PROGRESS criteria: place of residence, race/ethnicity, occupation, gender/sex, religion, socio-economic status, and social capital. The available evidence on differential outcomes is limited as many studies were compromised by selection or retention biases that reduced the participation of children from demographic groups at increased risk of adverse outcomes, or the analyses mainly focused on variations in outcomes by sex. Given the limited research evidence, we recommend greater attention to systematic collection and reporting of non-fatal injury outcomes disaggregated by socio-demographic indicators in order to identify disparities where these exist and inform equity-focused interventions promoting the recovery of injured children.
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Affiliation(s)
- Shanthi Ameratunga
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Jacqueline Ramke
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Nicki Jackson
- Alcohol Healthwatch, Office Park Building Level 1, 27 Gillies Ave, Auckland 1023, New Zealand.
| | - Sandar Tin Tin
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, School of Public Health and Preventive Medicine, Level 3, 553 St Kilda Road, Melbourne 3004, Australia.
- Farr Institute, Swansea University Medical School, Swansea University, Swansea SA2 8PP, UK.
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20
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Work-Related Injuries and Health-Related Quality of Life Among US Workers: A Longitudinal Study of a Population-Based Sample. J Occup Environ Med 2017; 58:385-90. [PMID: 27058479 DOI: 10.1097/jom.0000000000000667] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study is to examine health-related quality of life (HRQOL) among U.S. injured workers using a longitudinal study of a nationally representative sample. METHODS Employed adults with and without occupational injuries from the 2000 to 2011 Medical Expenditure Panel Survey (MEPS) were included. Outcomes were the physical and mental components of the SF-12. A within-person change using paired tests and a between-person change using multivariable regression were performed. RESULTS We estimate over 1.6 million injured workers per year. Sprains were the most common injury. Relative to noninjured workers, injured workers reported 3.0 and 1.0 points lower physical and mental component scores, respectively. CONCLUSIONS These results confirm that occupational injuries cause significant deficits in the physical component of HRQOL. This highlights the importance of preventing occupational injuries to reduce associated disabilities in the U.S.
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21
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Ogilvie R, Foster K, McCloughen A, Curtis K. The injury trajectory for young people 16-24 years in the six months following injury: A mixed methods study. Injury 2016; 47:1966-74. [PMID: 27282687 DOI: 10.1016/j.injury.2016.04.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 04/13/2016] [Accepted: 04/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adolescents and young people are the population at greatest risk of injury and therefore injury-related mortality and morbidity. Inquiry into the injury trajectory of young people is needed to identify this group's specific needs for healthcare. This paper reports the integration of quantitative and qualitative findings from a sequential explanatory mixed methods study examining young people aged 16-24 years' experience and trajectory of traumatic physical injury in the initial six months. The aim of integration was to address the question: In what ways are injured young peoples' experiences and self-management during the initial six months of the injury trajectory impacted by their injury, family support, and provision of healthcare? METHODS Key findings from epidemiological datasets on young person injuries from hospital and coronial databases (Phase 1) were combined with key findings from qualitative interviews with 12 injured young people and 10 family members (Phase 2). RESULTS The integration of findings from Phase 1 and Phase 2 resulted in three new findings; [1] (Alfred Health, 2014). A young person's perception of the severity of their injury, as well as the amount of time spent in hospital, impacts substantially on the way in which they experience injury, and this is managed differently between genders; [2] (Newnam et al., 2014). Admission to an Intensive care unit, including the intensity and duration of care, is the primary influence on how a family will provide support to the young person in the inpatient period; and [3] (Lyons et al., 2010). Young people's perception and understanding of their recovery from injury is in contrast with how healthcare systems are structured to provide rehabilitation and recovery care. CONCLUSION The injury trajectory and recovery process of young people in the six months following injury have been have conceptualised. These trajectories of recovery can inform the development of anticipatory guidance frameworks for clinicians and guide the provision of and planning for clinical services for injured young people.
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Affiliation(s)
- Rebekah Ogilvie
- Shock Trauma Service at the Canberra Hospital, Building 6, Level 1, The Canberra Hospital, Yamba Drive, Garran ACT 2605, T-6244 2793, Sydney Nursing School, University of Sydney, Australia.
| | - Kim Foster
- Disciplines of Nursing & Midwifery, University of Canberra, Australia
| | | | - Kate Curtis
- Sydney Nursing School, University of Sydney, Trauma Coordinator, St. George Hospital, Sydney, Australia
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Boucher LC, Bing J, Bolte JH. Biofidelity Evaluation of a Prototype Hybrid III 6 Year-Old ATD Lower Extremity. Ann Biomed Eng 2016; 44:2794-804. [PMID: 26864538 DOI: 10.1007/s10439-016-1562-1] [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: 10/26/2015] [Accepted: 02/01/2016] [Indexed: 11/28/2022]
Abstract
Incomplete instrumentation and a lack of biofidelity in the extremities of the 6 year-old anthropomorphic test device (ATD) pose challenges when studying regions of the body known to interact with the vehicle interior. This study sought to compare a prototype Hybrid III 6 year-old ATD leg (ATD-LE), with a more biofidelic ankle and tibia load cell, to previously collected child volunteer data and to the current Hybrid III 6 year-old ATD (HIII). Anthropometry, range of motion (ROM), and stiffness measurements were taken, along with a dynamic evaluation of the ATD-LE using knee-bolster airbag (KBA) test scenarios. Anthropometry values were similar in eight of twelve measurements. Total ankle ROM was improved in the ATD-LE with no bumper compared to the HIII. The highest tibia moments and tibia index values were recorded in KBA scenarios when the toes were positioned in contact with the dashboard prior to airbag deployment, forcing the ankle into axial loading and dorsiflexion. While improvements in the biofidelity of the ATD-LE are still necessary, the results of this study are encouraging. Continued advancement of the 6 year-old ATD ankle is necessary to provide a tool to directly study the behavior of the leg during a motor vehicle crash.
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Affiliation(s)
- Laura C Boucher
- Injury Biomechanics Research Center, Division of Anatomy, The Ohio State University, 279 Hamilton Hall, 1645 Neil Avenue, Columbus, OH, 43210, USA.
| | - Julie Bing
- Injury Biomechanics Research Center, Division of Anatomy, The Ohio State University, 279 Hamilton Hall, 1645 Neil Avenue, Columbus, OH, 43210, USA
| | - John H Bolte
- Injury Biomechanics Research Center, Division of Anatomy, The Ohio State University, 279 Hamilton Hall, 1645 Neil Avenue, Columbus, OH, 43210, USA
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23
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Rowhani-Rahbar A, Simonetti JA, Rivara FP. Effectiveness of Interventions to Promote Safe Firearm Storage. Epidemiol Rev 2016; 38:111-24. [PMID: 26769724 DOI: 10.1093/epirev/mxv006] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/13/2022] Open
Abstract
Despite supportive evidence for an association between safe firearm storage and lower risk of firearm injury, the effectiveness of interventions that promote such practices remains unclear. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, we conducted a systematic review of randomized and quasi-experimental controlled studies of safe firearm storage interventions using a prespecified search of 9 electronic databases with no restrictions on language, year, or location from inception through May 27, 2015. Study selection and data extraction were independently performed by 2 investigators. The Cochrane Collaboration's domain-specific tool for assessing risk of bias was used to evaluate the quality of included studies. Seven clinic- and community-based studies published in 2000-2012 using counseling with or without safety device provision met the inclusion criteria. All 3 studies that provided a safety device significantly improved firearm storage practices, while 3 of 4 studies that provided no safety device failed to show an effect. Heterogeneity of studies precluded conducting a meta-analysis. We discuss methodological considerations, gaps in the literature, and recommendations for conducting future studies. Although additional studies are needed, the totality of evidence suggests that counseling augmented by device provision can effectively encourage individuals to store their firearms safely.
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Family members' experience of providing support for young people with traumatic physical injury during the acute hospital phase of care: A qualitative study. Injury 2015; 46:1834-40. [PMID: 25817164 DOI: 10.1016/j.injury.2015.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/02/2015] [Accepted: 03/07/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to explore how family members perceive and support young people with traumatic physical injury during the acute phase of hospital care. METHODS This study forms part of the qualitative explanatory follow-up phase of a mixed methods study. The paper reports on family members' experiences of providing support to young people 16-24 years admitted with major traumatic injury to an Australian Level 1 Trauma Centre. Semi-structured in-depth interviews with family members were conducted and transcribed verbatim. Data were managed using NVivo software, and thematically analysed. FINDINGS Family support was determined by how family members perceived the injury. Driven by a need to protect the injured young person, family members sought to control potential emotional impacts of injury, creating a buffer between the young person and other people including healthcare professionals. Family members safeguarded the psychological well-being of the young person, in an attempt to facilitate their transition back to independence. CONCLUSION This study identifies iterative changes in family relationships and emotional and practical support provided by family members during the initial injury trajectory, extending understandings of the broader burden of injury. Key elements of family stress theory offer a useful framework for the development of anticipatory guidance for clinicians that are responsive to the emotional needs of patients and families, supporting the need for a family-centred care approach to managing major traumatic injury in young people.
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Ogilvie R, Foster K, McCloughen A, Curtis K. Young peoples' experience and self-management in the six months following major injury: A qualitative study. Injury 2015; 46:1841-7. [PMID: 26036963 DOI: 10.1016/j.injury.2015.05.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/08/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this qualitative study was to explore how young people aged 16-24 years' experience, perceive and manage the effects of major traumatic injury during the initial six months following major traumatic injury. Specifically: (1) how do young people manage the physical and emotional effects of major injury within the trauma system of care? (2) What are young peoples' perceived needs for healthcare and how are these met within the trauma system of care? (3) What do young people perceive as the role of family in supporting them? METHODS This study forms part of the qualitative follow-up phase of an explanatory sequential mixed methods study investigating the characteristics and experience of major traumatic injury for young people 16-24 years, and the role of family in supporting them, in the initial six months following injury. The paper reports on young peoples' (aged 16-24 years) experiences of being admitted with major traumatic injury to two Australian Level 1 Trauma Centres. Twelve injured young people aged 17-23 years (mean=19 years) participated in the study. Two semi-structured in-depth interviews with young people were conducted and transcribed verbatim; the first prior to hospital discharge (n=12), and the second (n=7) within 3 months of hospital discharge. Data were managed using NVivo software, and thematically analysed. FINDINGS During the initial 6 months following injury, young people experienced a complex process of adaptation involving feelings of vulnerability and loss of control over their physicality, environment and life-course. Self-management strategies included use of Information technology as a form of distraction; family and friends to create a sense of familiarity and normality; and information and validation-seeking from health care professionals as a means of understanding and regaining a sense of self. CONCLUSION Key elements of resilience theory applicable to the findings such as problem-based coping, self-efficacy and strong social support offer a useful framework for anticipatory guidance that is responsive to the psychosocial needs of injured young people and facilitates a strength-based patient-centred approach to managing major traumatic injury.
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Affiliation(s)
- Rebekah Ogilvie
- Trauma Coordinator, Shock Trauma Service, Canberra Hospital & Health Services, Building 6, Level 1, The Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia; Sydney Nursing School, University of Sydney, Australia.
| | - Kim Foster
- Disciplines of Nursing & Midwifery, University of Canberra, Australia
| | | | - Kate Curtis
- Sydney Nursing School, University of Sydney, Australia; Trauma Coordinator, St. George Hospital, Sydney, Australia
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Simonetti JA, Rowhani-Rahbar A, Mills B, Young B, Rivara FP. State Firearm Legislation and Nonfatal Firearm Injuries. Am J Public Health 2015; 105:1703-9. [PMID: 26066935 PMCID: PMC4504301 DOI: 10.2105/ajph.2015.302617] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated whether stricter state-level firearm legislation was associated with lower hospital discharge rates for nonfatal firearm injuries. METHODS We estimated discharge rates for hospitalized and emergency department-treated nonfatal firearm injuries in 18 states in 2010 and used negative binomial regression to determine whether strength of state firearm legislation was independently associated with total nonfatal firearm injury discharge rates. RESULTS We identified 26 744 discharges for nonfatal firearm injuries. The overall age-adjusted discharge rate was 19.0 per 100 000 person-years (state range = 3.3-36.6), including 7.9 and 11.1 discharges per 100 000 for hospitalized and emergency department-treated injuries, respectively. In models adjusting for differences in state sociodemographic characteristics and economic conditions, states in the strictest tertile of legislative strength had lower discharge rates for total (incidence rate ratio [IRR] = 0.60; 95% confidence interval [CI] = 0.44, 0.82), assault-related (IRR = 0.58; 95% CI = 0.34, 0.99), self-inflicted (IRR = 0.18; 95% CI = 0.14, 0.24), and unintentional (IRR = 0.53; 95% CI = 0.34, 0.84) nonfatal firearm injuries. CONCLUSIONS There is significant variation in state-level hospital discharge rates for nonfatal firearm injuries, and stricter state firearm legislation is associated with lower discharge rates for such injuries.
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Affiliation(s)
- Joseph A Simonetti
- Joseph A. Simonetti, Ali Rowhani-Rahbar, Brianna Mills, and Frederick P. Rivara are with the Harborview Injury Prevention and Research Center, University of Washington, Seattle. Joseph A. Simonetti and Bessie Young are with the Seattle-Denver Center of Innovation, VA Puget Sound Healthcare System, Seattle, WA. Ali Rowhani-Rahbar and Brianna Mills are with the Department of Epidemiology, University of Washington, Seattle. Bessie Young is with the Kidney Research Institute, University of Washington, Seattle. Frederick P. Rivara is with the Department of Pediatrics, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Joseph A. Simonetti, Ali Rowhani-Rahbar, Brianna Mills, and Frederick P. Rivara are with the Harborview Injury Prevention and Research Center, University of Washington, Seattle. Joseph A. Simonetti and Bessie Young are with the Seattle-Denver Center of Innovation, VA Puget Sound Healthcare System, Seattle, WA. Ali Rowhani-Rahbar and Brianna Mills are with the Department of Epidemiology, University of Washington, Seattle. Bessie Young is with the Kidney Research Institute, University of Washington, Seattle. Frederick P. Rivara is with the Department of Pediatrics, University of Washington, Seattle
| | - Brianna Mills
- Joseph A. Simonetti, Ali Rowhani-Rahbar, Brianna Mills, and Frederick P. Rivara are with the Harborview Injury Prevention and Research Center, University of Washington, Seattle. Joseph A. Simonetti and Bessie Young are with the Seattle-Denver Center of Innovation, VA Puget Sound Healthcare System, Seattle, WA. Ali Rowhani-Rahbar and Brianna Mills are with the Department of Epidemiology, University of Washington, Seattle. Bessie Young is with the Kidney Research Institute, University of Washington, Seattle. Frederick P. Rivara is with the Department of Pediatrics, University of Washington, Seattle
| | - Bessie Young
- Joseph A. Simonetti, Ali Rowhani-Rahbar, Brianna Mills, and Frederick P. Rivara are with the Harborview Injury Prevention and Research Center, University of Washington, Seattle. Joseph A. Simonetti and Bessie Young are with the Seattle-Denver Center of Innovation, VA Puget Sound Healthcare System, Seattle, WA. Ali Rowhani-Rahbar and Brianna Mills are with the Department of Epidemiology, University of Washington, Seattle. Bessie Young is with the Kidney Research Institute, University of Washington, Seattle. Frederick P. Rivara is with the Department of Pediatrics, University of Washington, Seattle
| | - Frederick P Rivara
- Joseph A. Simonetti, Ali Rowhani-Rahbar, Brianna Mills, and Frederick P. Rivara are with the Harborview Injury Prevention and Research Center, University of Washington, Seattle. Joseph A. Simonetti and Bessie Young are with the Seattle-Denver Center of Innovation, VA Puget Sound Healthcare System, Seattle, WA. Ali Rowhani-Rahbar and Brianna Mills are with the Department of Epidemiology, University of Washington, Seattle. Bessie Young is with the Kidney Research Institute, University of Washington, Seattle. Frederick P. Rivara is with the Department of Pediatrics, University of Washington, Seattle
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Sluys KP, Lannge M, Iselius L, Eriksson LE. Six years beyond pediatric trauma: child and parental ratings of children's health-related quality of life in relation to parental mental health. Qual Life Res 2015; 24:2689-99. [PMID: 26001639 PMCID: PMC4592698 DOI: 10.1007/s11136-015-1002-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/26/2022]
Abstract
Purpose To examine the relationship between child self-report and parent proxy report of health-related quality of life (HRQL) and how parents’ mental health status relates to the HRQL ratings 6 years after minor to severe injury of the child. Materials and methods This cross-sectional cohort study was performed at a regional pediatric trauma center in Stockholm, Sweden. The PedsQL 4.0 versions for ages 5–7, 8–12, and 13–18 years were completed by 177 child–parent dyads 6 years after injury to the child. The parents also rated their own mental health through the mental health domain (MH) in the SF-36 Health Survey. Results The children’s median age was 13 years (IQR 10–16 years), 54 % were males, and the median ISS was 5 (IQR 2–9). Most of the parents were female (77 %), born in Sweden (79 %), and half had university degrees. There was no statistically significant difference between child self-report and parent proxy report in any of the PedsQL 4.0 scales or summary scales. The levels of agreement between child self-report and parent proxy reports were excellent (ICC ≥ 0.80) for all scales with the exception of emotional functioning (ICC 0.53) which also was the scale with the lowest internal consistency in child self-report (α 0.60). Multiple regression analyses showed that worse parental mental health status correlated with worse child self-report and parent proxy report of children’s HRQL.
Conclusions Children and their parents’ reports on child’s HRQL were in agreement. Decreased mental health in parents was associated with lower scores on parent proxy reports and child self-reports of HRQL after injury. The current investigation highlights the possible relationship between parent’s mental health status and children’s HRQL long after an injury, which should be considered in future investigations and in clinical care.
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Affiliation(s)
- Kerstin Prignitz Sluys
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, L1:00, Solna, 171 76, Stockholm, Sweden.
- Department of Technology and Welfare, Red Cross University College, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Margaretha Lannge
- Department of Pediatric Emergency Surgery, Astrid Lindgrens' Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Lennart Iselius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases Karolinska University Hospital, Huddinge, Sweden
- School of Health Sciences, City University London, London, UK
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Health-related quality of life following pediatric critical illness. Intensive Care Med 2015; 41:1235-46. [PMID: 25851391 DOI: 10.1007/s00134-015-3780-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 03/25/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE The aims of this focused review of the literature on children surviving critical illness were to (1) determine whether health-related quality of life (HRQL) represents a clinically meaningful outcome measure for children surviving critical illness and (2) evaluate the HRQL measures implemented in pediatric critical care studies to date. METHODS This was a focused review of the literature from 1980 to 2015 based on a search of EMBASE/PubMed, MEDLINE and PsycInfo assessing trends and determinants of HRQL outcomes in children surviving critical illness. We also evaluated the psychometric properties of the HRQL instruments used in the studies identified by examining each measure's reported reliability, validity and sensitivity to clinical change. RESULTS The literature search identified 253 pediatric articles for potential inclusion in the review, among which data from 78 studies were ultimately selected for inclusion. Of the 22 measures utilized in the studies reviewed, only four demonstrated excellent psychometric properties for use in pediatric critical care trials. Trends in HRQL identified in the studies reviewed suggest significant ongoing morbidity for children surviving critical illness. Key determinants of poor HRQL outcomes include reason for PICU admission (sepsis, meningoencephalitis, trauma), antecedents (chronic comorbid conditions), treatments received (prolonged cardiopulmonary resuscitation, long-stay patients, invasive technology), psychological outcomes (post-traumatic stress disorder, parent anxiety/depression) and social and environmental characteristics (low socioeconomic status, parental education and functioning). CONCLUSIONS Validated pediatric HRQL instruments are now available. Significant impact on HRQL has been demonstrated in acute and acute on chronic critical illness. Future pediatric critical care interventional trials should include both mortality as well as long-term HRQL measurements to truly ascertain the full impact of critical illness in children.
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Ewing-Cobbs L, Bloom DR, Prasad MR, Waugh JK, Cox CS, Swank PR. Assessing recovery and disability after physical trauma: the Pediatric Injury Functional Outcome Scale. J Pediatr Psychol 2014; 39:653-65. [PMID: 24748647 PMCID: PMC4061599 DOI: 10.1093/jpepsy/jsu018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 03/11/2014] [Accepted: 03/13/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To establish reliability and validity of the Pediatric Injury Functional Outcome Scale (PIFOS), a brief injury-specific rating scale covering motor, self-care, communication, social-emotional, cognition, physical, and academic areas. METHODS In a prospective longitudinal study, the PIFOS structured interview was administered to parents of children 3-15 years of age at 3 and 12 months after hospitalization for traumatic brain injury (TBI) or orthopedic injury (OI). RESULTS The total score had good internal consistency (α = .90-.93) and inter-rater reliability (α = .90) and correlated significantly with injury severity and neurodevelopmental outcomes. Generalized linear modeling showed the PIFOS was sensitive to the type and severity of injury, showed specific initial and persisting difficulties following TBI and OI, and was responsive to change during the first year after injury. Both groups had residual difficulties with coordination, emotionality, social participation, and discomfort. CONCLUSION The PIFOS is useful in examining recovery in natural history and intervention studies.
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Affiliation(s)
- Linda Ewing-Cobbs
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at HoustonDepartment of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Douglas R Bloom
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Mary R Prasad
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Jane K Waugh
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Charles S Cox
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Paul R Swank
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
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Greeson JKP, Briggs EC, Layne CM, Belcher HME, Ostrowski SA, Kim S, Lee RC, Vivrette RL, Pynoos RS, Fairbank JA. Traumatic childhood experiences in the 21st century: broadening and building on the ACE studies with data from the National Child Traumatic Stress Network. JOURNAL OF INTERPERSONAL VIOLENCE 2014; 29:536-556. [PMID: 24144720 DOI: 10.1177/0886260513505217] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The study objectives were to (a) examine the association between total number of trauma types experienced and child/adolescent behavioral problems and (b) determine whether the number of trauma types experienced predicted youth behavioral problems above and beyond demographic characteristics, using a diverse set of 20 types of trauma. Data came from the National Child Traumatic Stress Network's (NCTSN) Core Data Set (CDS), which includes youth assessed and treated for trauma across the United States. Participants who experienced at least one type of trauma were included in the sample (N = 11,028; age = 1½-18 years; 52.3% girls). Random effects models were used to account for possible intraclass correlations given treatment services were provided at different NCTSN centers. Logistic regression analyses were used to investigate associations among demographic characteristics, trauma, and emotional and behavioral problems as measured by the Child Behavior Checklist (CBCL). Significant dose-response relations were found between total number of trauma types and behavior problems for all CBCL scales, except Sleep, one of the subscales only administered to 1½- to 5-year-olds. Thus, each additional trauma type endorsed significantly increased the odds for scoring above the clinical threshold. Results provide further evidence of strong associations between diverse traumatic childhood experiences and a diverse range of behavior problems, and underscore the need for a trauma-informed public health and social welfare approach to prevention, risk reduction, and early intervention for traumatized youth.
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Ogilvie R, Curtis K, Palmer C, Lam M, McCloughen A, Foster K. Incidence and outcomes of major trauma patients managed in the Australian Capital Territory. ANZ J Surg 2014; 84:433-7. [DOI: 10.1111/ans.12524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Rebekah Ogilvie
- Shock Trauma Service; The Canberra Hospital; Garran Australian Capital Territory Australia
| | - Kate Curtis
- Sydney Nursing School; University of Sydney; Sydney New South Wales Australia
- St George Clinical School; Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Cameron Palmer
- Trauma Service; Royal Children's Hospital Melbourne; Parkville Victoria Australia
| | - Mary Lam
- Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales Australia
| | - Andrea McCloughen
- Sydney Nursing School; University of Sydney; Sydney New South Wales Australia
| | - Kim Foster
- Sydney Nursing School; University of Sydney; Sydney New South Wales Australia
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Life after near death: long-term outcomes of emergency department thoracotomy survivors. J Trauma Acute Care Surg 2013; 74:1315-20. [PMID: 23609284 DOI: 10.1097/ta.0b013e31828c3db4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Predictors of hospital survival after emergency department thoracotomy (EDT) are well established, but little is known of long-term outcomes after hospital survival. Our primary study objective was to analyze the long-term social, cognitive, functional, and psychological outcomes in EDT survivors. METHODS Review of our Level I trauma center registry (2000-2010) revealed that 37 of 448 patients survived hospitalization after EDT. Demographics and clinical characteristics were analyzed. After attempts to contact survivors, 21 patients or caretakers were invited to an outpatient study evaluation; 16 were unreachable (none of whom were present in the Social Security Death Index). Study evaluation included demographic and social data and an outpatient multidisciplinary assessment with validated scoring instruments (Mini-Mental Status Exam, Glasgow Outcome Scores, Timed Get-Up and Go Test, Functional Independence Measure Scoring, SF-36 Health Survey, and civilian posttraumatic stress disorder checklist). RESULTS After extended hospitalization (43 ± 41 days), disposition varied (home, 62%; rehabilitation, 32%; skilled nursing facility, 6%), but readmission was common (33%) in the 37 EDT hospital survivors. Of the 21 contacted, 16 completed the study evaluation, 2 had died, 1 remained in a comatose state, and 2 were available by telephone only. While unemployment (75%), daily alcohol (50%), and drug use (38%) were common, of the 16 patients who underwent the comprehensive, multidisciplinary outpatient assessment after a median of 59 months following EDT, 75% had normal cognition and returned to normal activities, 81% were freely mobile and functional, and 75% had no evidence of posttraumatic stress disorder upon outpatient screening. CONCLUSION Despite the common belief that EDT survivors often live with severe neurologic or functional impairment, we have found that most of our sampled EDT survivors had no evidence of long-term impairment. It is our hope that these results are considered by physicians making life or death decisions regarding the "futility" of EDT in our most severely injured patients.
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Alghnam S, Palta M, L Remington P, Mullahy J, S Durkin M. The association between motor vehicle injuries and health-related quality of life: a longitudinal study of a population-based sample in the United States. Qual Life Res 2013; 23:119-27. [PMID: 23740168 DOI: 10.1007/s11136-013-0444-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE As many as 3 million US residents are injured in traffic-related incidents every year leaving many victims with disabling conditions. To date, limited numbers of studies have examined the effects of traffic-related injuries on self-reported health. This study aims to examine the association between health-related quality of life (HRQOL) and traffic-related injuries longitudinally in a nationally representative sample of US adult population. METHODS/APPROACH This is a longitudinal study of adult participants (age ≥18) from seven panels (2000-2007) of the Medical Expenditure Panel Survey. The dependent variables included the physical and mental components of the SF-12, a measure of self-reported health. The outcome was assessed twice during the follow-up period: round 2 (~4-5 months into the study) and round 4 (~18 months into the study) for 62,298 individuals. Two methods estimate the association between traffic-related injuries and HRQOL: a within person change using paired tests and a between person change using multivariable regression adjusting for age, sex, income and educational level. RESULTS Nine hundred and ninety-three participants reported traffic-related injuries during the follow-up period. Compared to their pre-crash HRQOL, these participants lost 2.7 of the physical component score while their mental component did not change. Adjusted results showed significant deficits in the physical component (-2.84, p value = <.001) but not the mental component (-0.07, p value = .83) of HRQOL after controlling for potential confounders. CONCLUSION Traffic injuries were significantly associated with the physical component of HRQOL. These findings highlight the individual and societal burden associated with motor vehicle crash-related disability in the United States.
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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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Martin-Herz SP, Zatzick DF, McMahon RJ. Health-related quality of life in children and adolescents following traumatic injury: a review. Clin Child Fam Psychol Rev 2012; 15:192-214. [PMID: 22527775 DOI: 10.1007/s10567-012-0115-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This paper comprehensively reviews the published literature investigating health-related quality of life (HRQOL) following general traumatic injury in individuals between birth and 18 years. Studies were not considered if they primarily compared medical treatment options, evaluated physical function but not other aspects of HRQOL, or focused on non-traumatic wounds. Specific injury types (e.g., burn injury) were also not included. A total of 16 studies met criteria. Participants were age 1-18 years, with 12 studies considering children 5 years of age or older. Males were overrepresented. Injury severity averaged mostly in the moderate range. HRQOL deficits were noted in injured samples in all studies except the two with the longest time to follow-up (6-11 years). Some improvement was seen 6 months to 2 years after injury. Factors associated with HRQOL deficits were investigated, with acute and posttraumatic stress disorder symptoms showing the strongest relationship. Research to date in this area is impressive, particularly the number of studies using prospective longitudinal investigations and validated measures. Challenges remain regarding methodologic differences, assessment of preinjury status, retention of participants, and management of missing data. Suggested future directions include extension of follow-up duration, utilization of pediatric self-report when possible, inclusion of younger children, and development of intervention programs.
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Abstract
Infrastructure, processes of care and outcome measurements are the cornerstone of quality care for pediatric trauma. This review aims to evaluate current evidence on system organization and concentration of pediatric expertise in the delivery of pediatric trauma care. It discusses key quality indicators for all phases of care, from pre-hospital to post-discharge recovery. In particular, it highlights the importance of measuring quality of life and psychosocial recovery for the injured child.
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Affiliation(s)
- Amelia J Simpson
- Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA, USA
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Ogilvie R, McCloughen A, Curtis K, Foster K. The experience of surviving life-threatening injury: a qualitative synthesis. Int Nurs Rev 2012; 59:312-20. [DOI: 10.1111/j.1466-7657.2012.00993.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ferguson AR, Stück ED, Nielson JL. Syndromics: a bioinformatics approach for neurotrauma research. Transl Stroke Res 2011; 2:438-54. [PMID: 22207883 PMCID: PMC3236294 DOI: 10.1007/s12975-011-0121-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 10/14/2011] [Accepted: 10/18/2011] [Indexed: 12/25/2022]
Abstract
Substantial scientific progress has been made in the past 50 years in delineating many of the biological mechanisms involved in the primary and secondary injuries following trauma to the spinal cord and brain. These advances have highlighted numerous potential therapeutic approaches that may help restore function after injury. Despite these advances, bench-to-bedside translation has remained elusive. Translational testing of novel therapies requires standardized measures of function for comparison across different laboratories, paradigms, and species. Although numerous functional assessments have been developed in animal models, it remains unclear how to best integrate this information to describe the complete translational "syndrome" produced by neurotrauma. The present paper describes a multivariate statistical framework for integrating diverse neurotrauma data and reviews the few papers to date that have taken an information-intensive approach for basic neurotrauma research. We argue that these papers can be described as the seminal works of a new field that we call "syndromics", which aim to apply informatics tools to disease models to characterize the full set of mechanistic inter-relationships from multi-scale data. In the future, centralized databases of raw neurotrauma data will enable better syndromic approaches and aid future translational research, leading to more efficient testing regimens and more clinically relevant findings.
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Affiliation(s)
- Adam R. Ferguson
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110 USA
| | - Ellen D. Stück
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110 USA
| | - Jessica L. Nielson
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110 USA
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Zatzick DF, Grossman DC. Association between traumatic injury and psychiatric disorders and medication prescription to youths aged 10-19. PSYCHIATRIC SERVICES (WASHINGTON, D.C.) 2011. [PMID: 21363897 DOI: 10.1176/appi.ps.62.3.264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Few clinical epidemiologic investigations have assessed whether youths exposed to a traumatic injury demonstrate elevations in the full spectrum of provider-recognized psychiatric disorders compared with unexposed, noninjured youths. METHODS In a population-based prospective cohort study, data for children and adolescents aged ten to 19 who were enrolled in the Group Health Cooperative health plan were screened for injury visits in the index year of 2001 (N=20,507). Psychiatric diagnoses, including anxiety and acute stress, depressive, substance use, and disruptive behavior disorders, given to these youths over the next three years (2002-2004) were documented, as were psychotropic medication prescriptions. Regression analyses assessed for an independent association between injury and psychiatric disorders and prescription of psychotropic medication. RESULTS In adjusted regression analyses, injury in the index year was independently associated with significantly increased odds of receiving a diagnosis of anxiety or acute stress (odds ratio [OR]=1.21, 95% confidence interval [CI]=1.02-1.44), depression (OR=1.30, CI=1.10-1.53), and a substance use disorder (OR=1.56, CI=1.21-2.00) and of receiving a psychotropic medication prescription (OR=1.37, CI=1.20-1.57). Youths with traumatic brain injuries also were significantly more likely to receive psychotropic medication prescriptions. CONCLUSIONS Traumatic injury was independently associated with an increased risk of receiving a full spectrum of anxiety, depressive, and substance use diagnoses among youths aged ten to 19. Population-based surveillance procedures that incorporate screening and stepped-care interventions targeting the spectrum of postinjury emotional disturbances have the potential to improve the quality of mental health care for youths treated in general medical settings.
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Affiliation(s)
- Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington Harborview Medical Center, 325 9th Ave., Seattle, WA 98104-2499, USA.
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Functional outcome and quality of life in victims of terrorist explosions as compared to conventional trauma. Eur J Trauma Emerg Surg 2011; 37:31-6. [PMID: 26814747 DOI: 10.1007/s00068-010-0020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 01/30/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Following trauma, the number of preventable deaths is low. Outcome should also be measured in terms of quality of life (QoL). Studies analyzing QoL in trauma patients have been published, but little is known about the long term QoL of victims of terrorist attacks. METHODS This is a case-control study of casualties of the March 11, 2004 attacks in Madrid. Patients treated for other trauma with similar age and Injury Severity Score (ISS), served as controls. Patients were assessed using the POLO-Chart (VAS, SF-36 and TOP). RESULTS Fifty-eight patients were included, 32 casualties admitted following the March 11, 2004 attacks and 26 controls. Both groups were comparable in age (average = 37), ISS (average = 23) and time from trauma (average = 1,770 days). Subjects demonstrated lower scores for the VAS, and the SF-36 clusters social functioning, role emotional and mental health. There was a tendency towards higher prevalence of symptoms associated to posttraumatic stress disorder (PTSD) in subjects (p = 0.056). Subjects suffered from higher residual pain in the head region (p = 0.032). Strong association was found between the presence of symptoms associated to depression, anxiety and PTSD and worse QoL (p < 0.001). CONCLUSION Subjects present more emotional distortions, residual pain in the head region and a tendency towards a worsened perception of their own health and wellness. They also present symptoms associated to PTSD more frequently. The presence of symptoms associated to PTSD, depression or anxiety was an independent variable related to lower QoL in both groups.
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Zatzick DF, Rivara FP, Jurkovich GJ, Hoge CW, Wang J, Fan MY, Russo J, Trusz SG, Nathens A, Mackenzie EJ. Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments. ACTA ACUST UNITED AC 2011; 67:1291-300. [PMID: 21135329 DOI: 10.1001/archgenpsychiatry.2010.158] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI). OBJECTIVES To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity. DESIGN Multisite US prospective cohort study. SETTING Eighteen level I trauma centers and 51 non-trauma center hospitals. PATIENTS A total of 3047 (weighted n = 10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years. MAIN OUTCOME MEASURES Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury. RESULTS At the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD. CONCLUSIONS More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.
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Affiliation(s)
- Douglas F Zatzick
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, 98104, USA.
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Lyons RA, Finch CF, McClure R, van Beeck E, Macey S. The injury List Of All Deficits (LOAD) Framework – conceptualising the full range of deficits and adverse outcomes following injury and violence. Int J Inj Contr Saf Promot 2010; 17:145-59. [DOI: 10.1080/17457300903453104] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
PURPOSE OF REVIEW Pediatric injury results in significant preventable morbidity and functional limitations, with long-term impact on the quality of life of children and their families. The purpose of this review is to outline recent research in health-related quality of life (HRQOL) in pediatric trauma, with an emphasis on identification of predictors of outcome that will impact interventions and allocation of resources to optimize recovery. RECENT FINDINGS Studies of HRQOL in pediatric trauma use a variety of generic measurement tools that have now been validated in this patient population. Most children experience rapid recovery of physical and psychological functioning after injury, but children with traumatic brain injury continue to demonstrate long-term impairments. Decrease in HRQOL of children after trauma contributes to increase in caregiver stress and family burden of injury. There is increasing recognition of post-traumatic stress disorder (PTSD) in pediatric trauma, correlating with and impacting HRQOL. SUMMARY Evaluation of HRQOL in children after trauma should become incorporated into standards of care, with development of family-centered interventions and evidence-based allocation of resources for high-risk children and families to optimize long-term outcomes.
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Janssens L, Gorter JW, Ketelaar M, Kramer WLM, Holtslag HR. Long-Term Health-Related Quality of Life in Major Pediatric Trauma: A Pilot Study. Eur J Trauma Emerg Surg 2009; 35:371-7. [DOI: 10.1007/s00068-009-8217-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 03/22/2009] [Indexed: 11/30/2022]
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Walker JL, Knapp D, Minter C, Boakes JL, Salazar JC, Sanders JO, Lubicky JP, Drvaric DM, Davids JR. Adult outcomes following amputation or lengthening for fibular deficiency. J Bone Joint Surg Am 2009; 91:797-804. [PMID: 19339563 DOI: 10.2106/jbjs.g.01297] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fibular deficiency results in a small, unstable foot and ankle as well as a limb-length discrepancy. The purpose of this study was to assess outcomes in adults who, as children, had had amputation or limb-lengthening, commonly used treatments for fibular deficiency. METHODS Retrospective review of existing data collected since 1950 at six pediatric orthopaedic centers identified 248 patients with fibular deficiency who were twenty-one years of age or older at the time of the review. Excluding patients with other anomalies and other treatments (with the excluded group including six who had had lengthening and then amputation), we identified ninety-eight patients who had had amputation or limb-lengthening for the treatment of isolated unilateral fibular deficiency. Sixty-two patients (with thirty-six amputations and twenty-six lengthening procedures) completed several questionnaires, including one asking general demographic questions, the Beck Depression Inventory-II, the Quality of Life Questionnaire, and the American Academy of Orthopaedic Surgeons Lower Limb Questionnaire including the Short Form-36. A group of twenty-eight control subjects completed the Beck Depression Inventory-II and the Quality of Life Questionnaire. RESULTS There were forty men and twenty-two women. The average age at the time of the interview was thirty-three years. There were more amputations in those with fewer rays and less fibular preservation. Lengthening resulted in more surgical procedures (6.3 compared with 2.4 in patients treated with amputation) and more days in the hospital (184 compared with sixty-three) (both p<0.0001). However, when we compared treatment outcomes we did not find differences between groups with regard to education, employment, income, public assistance or disability payments, pain or use of pain medicine, sports participation, activity restriction, comfort wearing shorts, dislike of limb appearance, or satisfaction with treatment. No patient who had been treated for fibular deficiency reported signs of depression. The only significant difference between treatment groups shown by the Quality of Life Questionnaire was in the scores on the Job Satisfiers content scale, with the amputees scoring better than the patients treated with lengthening (p=0.015). The American Academy of Orthopaedic Surgeons Lower Limb Module did not demonstrate differences in health-related quality of life or physical function. CONCLUSIONS The patients who were treated with lengthening had started out with more residual foot rays and more fibular preservation than the amputees. They also required more surgical intervention than did those with an amputation. While patients with an amputation spent less of their childhood undergoing treatment, they were found to have a better outcome in terms of only one of seventeen quality-of-life parameters. Both groups of patients who had had treatment of fibular deficiency were functioning at high levels, with an average to above-average quality of life compared with that of the normal adult population.
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Affiliation(s)
- Janet L Walker
- Shriners Hospitals for Children, 1900 Richmond Road, Lexington, KY 40502, USA
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Janssens L, Gorter JW, Ketelaar M, Kramer WLM, Holtslag HR. Health-related quality-of-life measures for long-term follow-up in children after major trauma. Qual Life Res 2008; 17:701-13. [PMID: 18437531 PMCID: PMC2440951 DOI: 10.1007/s11136-008-9339-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 03/30/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Our objective was to review measures of health-related quality of life (HRQL) for long-term follow up in children after major trauma and to determine the measures that are suitable for a large age range, reliable and valid, and cover a substantial amount of the domains of functioning using the International Classification of Functioning, Disability, and Health (ICF) of the World Health Organization (WHO). METHODS The Medline and EMBASE databases were searched in all years up to October 2007 for generic HRQL measures suitable for children aged 5-18 years old and validated in English or Dutch. Measures were reviewed with respect to the age range for which the measure was suitable and reliability, validity, and content related to the ICF. RESULTS The search resulted in 1,235 hits and 21 related articles. Seventy-nine papers met the inclusion criteria, describing in total 14 measures: Child Health and Illness Profile Adolescent and Child Edition (CHIP-AE/CE), Child Health Questionnaire Child and Parent Forms (CHQ-CF87/PF50/PF28), DISABKIDS, Functional Status II (FS II)(R), Health Utilities Index Mark 2 (HUI 2), KIDSCREEN 52/27, KINDL, Pediatric Quality of Life Inventory (PedsQL), TNO Institute of Prevention and Health and the Leiden University Hospital (TNO-AZL), TNO-AZL Children's Quality Of Life (TACQOL), and Youth Quality of Life Instrument--Research Version (YQOL-R). Measures that were suitable for a large age range were CHQ-PF50/PF28, DISABKIDS, FS II(R), HUI 2, KIDSCREEN, PedsQL, and TACQOL. All measures had moderate to good psychometric properties, except for CHQ-PF50/PF28, KINDL, and TACQOL, which had either low internal consistency or bad test-retest reliability. The measures that covered more than six chapters of the ICF domains were CHIP-AE/CE, CHQ-CF87/PF50, DISABKIDS, KIDSCREEN-52, PedsQL, and TACQOL. CONCLUSIONS DISABKIDS, KIDSCREEN 52, and PedsQL are suitable for long-term follow-up measurement of HRQL in children after major trauma. They cover a large age range, have good psychometric properties, and cover the ICF substantially.
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Affiliation(s)
- Loes Janssens
- Department of Rehabilitation and Sports Medicine, University Medical Center Utrecht, PO Box 85500, HP F00.810, 3508 GA Utrecht, The Netherlands
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Measuring children's health-related quality of life after trauma. ACTA ACUST UNITED AC 2008; 63:S122-9; discussion S130-5. [PMID: 18091203 DOI: 10.1097/ta.0b013e31815accdf] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Consideration of children's health-related quality of life (HRQOL) after injury is a critical aspect of outcome in assessing the effectiveness of trauma care. Numerous instruments are available today for measuring the HRQOL of injured children. HRQOL instruments reflect the subjective perspective of the impact an injury or disease has on a child's physical, emotional, and social well being. Most studies to date have examined children's HRQOL during the first year postinjury, relatively little is known about children's long-term HRQOL after trauma. Most trauma outcome studies have included children with heterogeneous injuries so the impact of specific injuries on HRQOL outcomes has not been well established. The majority of outcome studies have focused on injured children who have been hospitalized, however the research should be extended to the emergency department because a large proportion of injured children are treated and released from there. In addition to documenting recovery, investigators should use HRQOL instruments to evaluate the quality of care we offer injured children and their families. Rigorously conducted HRQOL assessment will provide valuable information that we can use to successfully optimize children's recovery after trauma.
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Distribution of Spinal and Associated Injuries in Multiple Trauma Patients. Eur J Trauma Emerg Surg 2007; 33:476-81. [PMID: 26814932 DOI: 10.1007/s00068-007-7124-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 08/31/2007] [Indexed: 02/06/2023]
Abstract
Injury to the spinal column and cord are often part of life-threatening multiple trauma. Epidemiological data could help to establish an evidence-based assessment and therapy of these patients. We present a retrospective chart analysis of 590 multiple traumatized patients admitted within a 4-year-period. Patients suffering from injuries of the spinal column were analysed regarding mechanism and distribution of their injuries to all body regions. Thirty-one percent (n = 183) of polytraumatized patients displayed a spine injury. Distribution analysis showed peaks in the cervical spine and the thoraco-lumbar junction. The risk of relevant associated injuries is mainly influenced from anatomical vicinity to the injured spinal segment. Injuries to the spinal column are frequent in the multiple trauma patients population. Diagnosed injuries to distinct body regions should make the trauma team suspicious of injury to the nearby spinal column. Appropriate treatment includes thorough assessment of all injuries to clarify the damage and carry on special protection of these spinal regions preventing from deterioration.
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