Long-term changes of patient-reported quality of life after major trauma: The importance of the time elapsed after injury

Fleischhacker, Evi; Trentzsch, Heiko; Kuppinger, David; Meigel, Franziska; Beyer, Felix; Hartl, Wolfgang H.

doi:10.1016/j.injury.2017.10.020

Cited by 17 publications

(20 citation statements)

References 38 publications

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“…HRQoL of patients suffering severe trauma was below population norms [40,53,57,64,76,88,97,167,171,176,178,185,191,194,198] and lower than pre-injury HRQoL [44,47,55,56,185,186,[192][193][194] in most studies. Furthermore, patients with an ISS ≥ 16 reported a lower HRQoL than did patients with an ISS < 16 [53,55].…”

Section: Eq-5dmentioning

confidence: 81%

Health-related quality of life after severe trauma and available PROMS: an updated review (part I)

Lotfalla

Halm

Schepers

et al. 2022

Eur J Trauma Emerg Surg

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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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Section: Eq-5dmentioning

confidence: 81%

Health-related quality of life after severe trauma and available PROMS: an updated review (part I)

Lotfalla

Halm

Schepers

et al. 2022

Eur J Trauma Emerg Surg

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“…Moreover, when comparing our response rate to that reported in earlier studies, it is clear that low response rates are a common occurrence (4)(5)(6)9) in studies regarding post-injury quality of life. Furthermore, the attrition rate has been shown to become even greater as time passes by (11).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it is well described that in both minor (4,5) and severe injuries (6)(7)(8)(9)(10), the injury has a signi cant negative impact on the post-injury HR-QoL of the injured person. It is also apparent that the negative effect on HR-QoL after severe injury is a long-lasting condition/phenomenon (9,11). It may be, however, that a person's psychosocial factors have more of an effect on post-injury HR-QoL than the injury pattern or the severity of the injury itself (6).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Pre-Trauma Alcohol Use on Post-Traumatic Quality of Life in Severely Injured Trauma Patients

Riuttanen

Jokihaara²,

Huttunen³

et al. 2020

Preprint

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Background From one third up to half of all injured patients admitted to emergency rooms have a positive blood alcohol level (BAL). Frequent alcohol use also has negative effects on a person’s quality of life. Even though alcohol use among injury patients is common, the effects of pre-injury alcohol use on Health-Related Quality of Life (HR-QoL) have not previously been studied. The primary objective of this study was to evaluate whether pre-injury alcohol use has an influence on an injured patient’s HR-QoL and reported problems. A secondary objective was to compare injured patient’s HR-QoL with the population norm of Finland. Methods Retrospective analysis of all trauma patients treated at Tampere University Hospital’s (TAUH) Intensive Care Unit (ICU) or High Dependence Unit (HDU) in 2013. The following inclusion criteria were used: patient treated at TAUH’s ICU or HDU, age ≥ 18 years, NISS ≥ 16 and possesses a valid Finnish personal identification number to enable comprehensive follow-up. From a total of 373 patients, 227 patients met the inclusion criteria. HR-QoL was assessed with the EQ-5D questionnaire during the patients’ stay in the ICU/HDU and one year after the injury. The EQ-5D index value was further compared with the index values of the age-matched population norms of Finland. Results Thirty-four percent (77/227) of all patients tested positive for alcohol at the time of the injury with a mean blood alcohol content (BAC) of 1.9 g/L. Twenty-nine patients (N= 29/227) died within 1 year of injury, and therefore 198 patients were contacted for post-injury EQ-5D questionnaires. Complete data sets with both pre- and post-injury EQ-5D questionnaires were available for 111 (56%) patients. Patients with positive BAL expressed notably more anxiety and depression (45%) before trauma compared to both patients with negative BAL (11%) and the reference population of Finland (14%). Overall, pre-injury HR-QoL was also poorer in BAL positive patients than BAL negative patients. The amount of anxiety and depression in BAL positive patients decreased after injury. In both groups, the relative number of reported problems after injury exceeded the relative number of reported problems of the reference population of Finland in all five EQ-5D dimensions. Conclusions Patients with positive BAL upon admission report overall lower HR-QoL than patients with negative BAL. This finding is most likely explained by the excessive amount of anxiety and depression, which had decreased one year after injury. We speculate that this may partly be explained by a possible reduction in alcohol use, which has been reported to happen in injury patients. As has previously been reported, the impact of severe injury on post-injury QoL in general is detrimental and long-lasting and overall HR-QoL remains lower than the population norm.

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“…Fleischhacker et al untersuchten die gesundheitsbezogene Lebensqualität mit dem EQ-5D und stellten fest, dass im Mittel 3,6 Jahre nach einem schweren Trauma 43,5 % der Patienten eine niedrige Lebensqualität aufwiesen, definiert als ein EQ-5D-Index-Wert kleiner als 0,6. Die niedrigste Lebensqualität wurde etwa 4-5 Jahre nach dem Unfall gemessen und stieg danach wieder an [19].…”

Section: Outcome Und Traumafolgenunclassified

Rehabilitation nach Mehrfachverletzung

Simmel

2021

Orthopäde

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In diesem Beitrag-Outcome und Traumafolgen -Einflussfaktoren auf die Unfallfolgen -Das Phasenmodell der Traumarehabilitation QR-Code scannen & Beitrag online lesen Zusammenfassung Hintergrund: Die Wiedereingliederung ins soziale und berufliche Umfeld und das Erreichen einer bestmöglichen Lebensqualität ist nach Mehrfachverletzungen oft nur nach einem langwierigen Reha-Prozess zu erreichen und gehört in die Hände erfahrener Ärzte, Therapeuten und Reha-Manager. Rehabilitationsphasen: Die Rehabilitation nach schweren Unfällen ist von der "normalen" orthopädischen Rehabilitation nach elektiven Eingriffen abzugrenzen. Die Herausforderungen der Traumarehabilitation erfordern aufeinander abgestimmte Rehabilitationsphasen. Nur so kann das sog. Reha-Loch zwischen der Entlassung aus der Akutklinik und dem Beginn der postakuten Rehabilitation vermieden werden. Ein 6-Phasen-Modell wird beschrieben. Nach der Akutbehandlung (Phase A) und einer eventuell erforderlichen Frührehabilitation (Phase B) stellt die Phase C der postakuten Rehabilitation besondere Anforderungen an die Rehabilitationseinrichtung. Die Phase D der Anschlussrehabilitation ist etabliert. Die weiterführende Rehabilitation (Phase E) sieht speziell auf die Unfallfolgen abgestimmte Maßnahmen, wie die Schmerzrehabilitation oder tätigkeitsorientierte Verfahren vor. Eine langfristige Nachsorge ehemals schwerverletzter Patienten ist notwendig (Phase F). Ausblick: Eine Integration von Traumarehabilitationszentren in die bestehenden Traumanetzwerke bleibt das Ziel, um das Outcome zu verbessern. Schlüsselwörter Unfall • Nachsorge • Rehabilitationszentren • Return-to-work • Lebensqualität Keywords Accidents • After care • Rehabilitation centers • Return-to-work • Quality of life Der Orthopäde 11 • 2021 915

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Long-term changes of patient-reported quality of life after major trauma: The importance of the time elapsed after injury

Cited by 17 publications

References 38 publications

Health-related quality of life after severe trauma and available PROMS: an updated review (part I)

Health-related quality of life after severe trauma and available PROMS: an updated review (part I)

The Effect of Pre-Trauma Alcohol Use on Post-Traumatic Quality of Life in Severely Injured Trauma Patients

Rehabilitation nach Mehrfachverletzung

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