Polinder Suzanne, van Beeck Ed F, Essink-Bot Marie Louise, Toet Hidde, Looman Caspar W N, Mulder Saakje, Meerding Willem Jan
Department of Public Health, ErasmusMC/University Medical Center Rotterdam, The Netherlands.
J Trauma. 2007 Jan;62(1):133-41. doi: 10.1097/TA.0b013e31802b71c9.
The collection of empirical data on the frequency, severity, and duration of functioning is a prerequisite to identify patient groups with long term or permanent disability.
We fielded postal questionnaires in a stratified sample of 8,564 injury patients aged 15 years and older, who had visited an emergency department in the Netherlands. Measurements were at 2.5, 5, 9, and 24 months after the injury and included a generic health status classification (EQ-5D), socio-demographic, and medical information. We analyzed determinants of long-term functional outcome by multivariate regression analysis.
Five months after the injury health status of nonhospitalized injury patients was comparable to the general population's health (EQ-5D summary measure 0.87). Health status of patients admitted for 3 days or less improved until 9 months (0.82). For those admitted more than 3 days health status improved until 24 months (0.48 toward 0.67), but remained below population norms. Hospitalization, age and sex (females), type of injury (spinal cord injury, hip fracture, and lower extremity injury), and comorbidity were significant predictors of poor functioning in the long term.
Recovery patterns vary widely between nonhospitalized, shortly, and long hospitalized injury patients. Nonhospitalized injury patients recover within 5 months from an injury whereas a considerable group of hospitalized injury patients suffer from persistent health problems. Our study indicates the importance of health monitoring with an adapted longitudinal design for injury patients. The time intervals used should match the various stages of the recovery process, which depends on the severity of the injury studied.
收集关于功能频率、严重程度和持续时间的实证数据是识别长期或永久性残疾患者群体的先决条件。
我们对8564名15岁及以上在荷兰急诊科就诊的受伤患者进行分层抽样，通过邮寄问卷进行调查。在受伤后的2.5个月、5个月、9个月和24个月进行测量，包括一般健康状况分类（EQ-5D）、社会人口统计学和医疗信息。我们通过多元回归分析来分析长期功能结局的决定因素。
受伤5个月后，非住院受伤患者的健康状况与一般人群相当（EQ-5D综合测量值为0.87）。住院3天或以下的患者健康状况在9个月前有所改善（0.82）。对于住院超过3天的患者，健康状况在24个月前有所改善（从0.48提高到0.67），但仍低于人群标准。住院、年龄和性别（女性）、损伤类型（脊髓损伤、髋部骨折和下肢损伤）以及合并症是长期功能不佳的重要预测因素。
非住院、短期住院和长期住院的受伤患者的恢复模式差异很大。非住院受伤患者在受伤后5个月内恢复，而相当一部分住院受伤患者存在持续的健康问题。我们的研究表明，采用适应性纵向设计对受伤患者进行健康监测很重要。所使用的时间间隔应与恢复过程的各个阶段相匹配，这取决于所研究损伤的严重程度。
