Factors Associated With Long-term Outcomes After Injury

Abstract

Objective: The aim of this study was to determine factors associated with patient-reported outcomes, 6 to 12 months after moderate to severe injury. Summary of Background Data: Due to limitations of trauma registries, we have an incomplete understanding of factors that impact long-term patient-reported outcomes after injury. As 96% of patients survive their injuries, several entities including the National Academies of Science, Engineering and Medicine have called for a mechanism to routinely follow trauma patients and determine factors associated with survival, patient-reported outcomes, and reintegration into society after trauma. Methods: Over 30 months, major trauma patients [Injury Severity Score (ISS) ≥9] admitted to 3 Level-I trauma centers in Boston were assessed via telephone between 6 and 12 months after injury. Outcome measures evaluated long-term functional, physical, and mental-health outcomes. Multiple regression models were utilized to identify patient and injury factors associated with outcomes. Results: We successfully followed 1736 patients (65% of patients contacted). More than half (62%) reported current physical limitations, 37% needed help for at least 1 activity of daily living, 20% screened positive for posttraumatic stress disorder (PTSD), all SF-12 physical health subdomain scores were significantly below US norms, and 41% of patients who were working previously were unable to return to work. Age, sex, and education were associated with long-term outcomes, while almost none of the traditional measures of injury severity were. Conclusion: The long-term sequelae of trauma are more significant than previously expected. Collection of postdischarge outcomes identified patient factors, such as female sex and low education, associated with worse recovery. This suggests that social support systems are potentially at the core of recovery rather than traditional measures of injury severity.

Sex differences in the treatment and outcome of emergency general surgery

“…Physiologically it is hypothesized that higher levels of estrogen may lower inflammatory responses post trauma [33], which has also been hypothesized to explain why younger [1], but not older women [34, 35] have lower rates of mortality in ICU settings. Moreover, long-term (6–12 months) functional decline has been shown to be higher in females [36]. In addition, men had higher respiratory complications, including acute lung injury or respiratory failure, which is consistent with other studies [37].…”

Experiences of recovery and posthospital care needs of working-age adults after physical trauma: a qualitative focus group study

“…The awareness of poor long-term outcomes for people with injuries has greatly increased in recent years 7 8. Studies on unmet care needs during the early phases of recovery emphasise the importance of providing comprehensive care after hospital discharge.…”

Reduced chronic pain: Another benefit of recovery at an inpatient rehabilitation facility over a skilled nursing facility?

“…Although in the United States we are not currently routinely collecting long-term outcomes after injury 9 there have been a few concerted efforts over the last 20 years to collect such outcomes including the National Study on Cost and Outcomes of Trauma (NSCOT), 10 the Trauma Recovery Project 11 and more recently the FORTE project. 4 Such efforts, and other related studies, have brought to light the fact that it is not an easy road forward for the millions of injured patients who survive to hospital discharge. We are increasingly aware of the fact that these individuals commonly suffer from reduced quality of life, poor functional outcomes, psychologic disturbances, chronic pain and social disintegration long after their injury.…”

“…Further details regarding the patient recruitment and data collection procedures for the FORTE project have been described previously. 3,4 For the present study we included patients from the FORTE registry who were discharged from the trauma center to an IRF or a SNF and were interviewed over the 32-month period between December 2015 and July 2018. Data on post-discharge outcomes from the FORTE registry was combined with demographic and clinical data from the index hospitalization obtained from the institutional trauma registries.…”