Health related outcomes of patients with serious traumatic injury: Results of a longitudinal follow-up program delivered by trauma clinicians

IF 2.2 3区 医学 Q3 CRITICAL CARE MEDICINE
Kate Dale , Charlotte Winkleman , Ian Hughes , Katharine Heathcote , Elizabeth Wake
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Abstract

Introduction

The routine collection of long-term patient health outcomes after serious traumatic injury at the health service level is uncommon. In 2019, we implemented the longitudinal Trauma Service Follow Up (TSFU) program at a level I trauma centre. Delivered by the trauma service clinicians involved in inpatient care, it assesses quality of life and disability. This study reports the 6- and 12-month outcomes of the first two years of operation of the TSFU program.

Methods

This is a prospective cohort study of seriously injured adult trauma patients admitted to a level I trauma centre with 6- and 12-months post-discharge outcome assessments. Outcomes were quality of life and function/disability as measured using the EQ-5D-5L and WHODAS 2.0 validated instruments. Changes from 6 to 12 months were assessed using generalised estimating equations methods. Logistic regression models were used to identify factors associated with ongoing problems at each time point.

Results

Five-hundred and eight seriously injured patients were eligible for the TSFU program with follow-up rates over 80 % at both 6- and 12-month timepoints. At six months, ongoing problems with pain (69.9 %), anxiety and depression (49 %) and carrying out usual activities (57.5 %) were highly prevalent; at 12 months problems with pain (61.4 %) and anxiety and depression (43.8 %) persisted. Lower extremity and/or pelvic surgery was associated with ongoing pain, odds ratio (OR) = 3.77 (95 % CI 1.54–9.21, p=0.01), anxiety and depression (OR 1.95, 95 % CI 1.09–3.48, p=0.02) and problems carrying out their usual activities (OR 3.19, 95 % CI 0.75–13.5, p=0.11) at six months. These patterns mostly persisted at 12 months. Similar associations between surgical intervention and high levels of disability were evident at both time points.

Conclusion

Persistent impairments in physical and emotional health continues to affect many people following serious traumatic injury. The collection of longitudinal health outcomes by trauma clinicians enables identification of factors that contribute to disability and a reduction in quality of life. This in turn can drive quality improvement initiatives within the hospital trauma system. Longitudinal follow-up programs may provide a platform to provide ongoing specialist trauma-informed care after hospital discharge.
严重创伤患者的健康相关结果:由创伤临床医生实施的纵向随访计划的结果。
导言:在医疗服务层面常规收集严重创伤后患者的长期健康结果并不常见。2019 年,我们在一家一级创伤中心实施了纵向创伤服务随访(TSFU)计划。该计划由参与住院治疗的创伤服务临床医生实施,评估生活质量和残疾情况。本研究报告了 TSFU 计划实施头两年的 6 个月和 12 个月的结果:这是一项前瞻性队列研究,研究对象是入住一级创伤中心的重伤成年创伤患者,并对出院后 6 个月和 12 个月的结果进行评估。研究结果是使用 EQ-5D-5L 和 WHODAS 2.0 有效工具测量的生活质量和功能/残疾情况。使用广义估计方程法评估了6至12个月的变化。采用逻辑回归模型确定与各时间点持续存在的问题相关的因素:五百零八名重伤患者符合 TSFU 计划的条件,在 6 个月和 12 个月的时间点上,随访率均超过 80%。6个月时,疼痛(69.9%)、焦虑和抑郁(49%)以及日常活动(57.5%)等问题依然普遍存在;12个月时,疼痛(61.4%)、焦虑和抑郁(43.8%)等问题依然存在。下肢和/或骨盆手术与持续疼痛(几率比 (OR) = 3.77 (95 % CI 1.54-9.21, p=0.01))、焦虑和抑郁(OR 1.95, 95 % CI 1.09-3.48, p=0.02)以及六个月后进行日常活动的问题(OR 3.19, 95 % CI 0.75-13.5, p=0.11)有关。这些模式在 12 个月时仍然存在。在这两个时间点上,手术干预与高度残疾之间的关联都很明显:结论:严重创伤后,许多人的身体和情绪健康会持续受到影响。创伤临床医生通过收集纵向健康结果,可以识别导致残疾和生活质量下降的因素。这反过来又能推动医院创伤系统内的质量改进措施。纵向随访计划可为出院后提供持续的专科创伤知情护理提供一个平台。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.00
自引率
8.00%
发文量
699
审稿时长
96 days
期刊介绍: Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.
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