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AIM:To investigate posttraumatic cytokine alterations and their value for predicting complications and mortality in polytraumatized patients. METHODS:Studies on the use of specific cytokines to predict the development of complications and mortality were identified in MEDLINE, EMBASE, Web of Science and the Cochrane Library. Of included studies, relevant data were extracted and study quality was scored. RESULTS:Forty-two studies published between 1988 and 2015 were identified, including 28 cohort studies and 14 "nested" case-control studies. Most studies investigated the cytokines interleukin (IL)-6, IL-8, IL-10 and tumor necrosis factor (TNF-a). IL-6 seems related to muliorgan dysfunction syndrome, multiorgan failure (MOF) and mortality; IL-8 appears altered in acute respiratory distress syndrome, MOF and mortality; IL-10 alterations seem to precede sepsis and MOF; and TNF-a seems related to MOF. CONCLUSION:Cytokine secretion patterns appear to be different for patients developing complications when compared to patients with uneventful posttraumatic course. More research is needed to strengthen the evidence for clinical relevance of these cytokines.

Background: Thoughts affect pain intensity and the magnitude of activity intolerance for a given nociception. The Negative Pain Thoughts Questionnaire (NPTQ) measures common unhelpful cognitive biases regarding pain. A shorter version of the NPTQ could be used in daily practice to improve health by identifying important misconceptions. Methods: One hundred and thirty-seven patients seeking specialty musculoskeletal care completed questionnaires addressing demographics, negative pain thoughts, worst-case thinking, resiliency, the magnitude of self-reported activity intolerance, and pain intensity. Patients were randomly allocated to a learning cohort (110 patients, 80%) and a validation cohort (27 patients, 20%). Based on factor analysis of the learning cohort, 4 questions were selected to create the NPTQ short form (NPTQ-SF). Floor and ceiling effects of the NPTQ and NPTQ-SF were analyzed. Psychometric properties of the NPTQ-SF were tested with use of Spearman correlations with the NPTQ. The internal consistency of the NPTQ and NPTQ-SF was analyzed with use of the Cronbach α coefficient. To test external validity, we calculated Spearman correlations with pain intensity, activity intolerance, the Pain Catastrophizing Scale, and the Brief Resiliency Scale in the validation cohort. Results: The Cronbach α was 0.90 for the NPTQ and 0.85 for the NPTQ-SF. The Spearman correlation between NPTQ and NPTQ-SF scores was 0.91 in the learning cohort and 0.93 in the validation cohort. In the validation cohort, there was no difference in the strength of the correlations of the NPTQ and NPTQ-SF with other questionnaires. Conclusions: These findings support the use of a brief, 4-question measure of unhelpful cognitive biases regarding pain in both research and patient care. The NPTQ-SF would benefit from external validation in an independent cohort. Clinical Relevance: The notable influence of common misconceptions (i.e., cognitive bias) on musculoskeletal symptoms can be measured with a brief questionnaire and used as a point of discussion with patients.

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