Holbrook Troy Lisa, Hoyt David B, Coimbra Raul, Potenza Bruce, Sise Michael J, Sack Dan I, Anderson John P
Division of Trauma, Department of Surgery, University of California, CA, USA.
J Trauma. 2007 Mar;62(3):577-83; discussion 583. doi: 10.1097/TA.0b013e318031aa97.
Injury is a leading cause of death and preventable morbidity in adolescents. Little is known about long-term quality of life (QoL) outcomes in injured adolescents. The objectives of the present report are to describe long-term QoL outcomes and compare posttrauma QoL to national norms for QoL in uninjured adolescents from the National Health Interview Survey (NHIS).
In all, 401 trauma patients aged 12 to 19 years were enrolled in the study. Enrollment criteria excluded spinal cord injury. QoL after trauma was measured using the Quality of Well-being (QWB) scale, a sensitive and well-validated functional index (range: 0 = death to 1.000 = optimum functioning). Patient outcomes were assessed at discharge, and 3, 6, 12, 18, and 24 months after discharge. NHIS data were based on 3 survey years and represent a population-based U.S. national random sample of uninjured adolescents.
Major trauma in adolescents was associated with significant and marked deficits in QoL throughout the 24-month follow-up period, compared with NHIS norms for this age group. Compared with NHIS norms for QoL in uninjured adolescents aged 12 to 19 years (N = 81,216,835; QWB mean = 0.876), injured adolescents after major trauma had striking and significant QoL deficits beginning at 3-month follow-up (QWB mean = 0.694, p < 0.0001), that continued throughout the long-term follow-up 24 months after discharge (6-month follow-up QWB mean = 0.726, p < 0.0001; 12-month follow-up QWB mean = 0.747, p < 0.0001; 18-month follow-up QWB mean = 0.758, p < 0.0001; 24-month follow-up QWB mean = 0.766, p < 0.0001). QoL deficits were also strongly associated with age (>or=15 years) and female sex. Other significant risk factors for poor QoL outcomes were perceived threat to life, pedestrian struck mechanism, and Injury Severity Scores >16.
Major trauma in adolescents is associated with significant and marked deficits in long-term QoL outcomes, compared with U.S. norms for healthy adolescents. Early identification and treatment of risk factors for poor long-term QoL outcomes must become an integral component of trauma care in mature trauma care systems.
损伤是青少年死亡和可预防发病的主要原因。对于受伤青少年的长期生活质量（QoL）结果知之甚少。本报告的目的是描述长期QoL结果，并将创伤后QoL与来自国家健康访谈调查（NHIS）的未受伤青少年的全国QoL规范进行比较。
总共401名年龄在12至19岁的创伤患者被纳入研究。纳入标准排除了脊髓损伤。创伤后的QoL使用幸福感质量（QWB）量表进行测量，这是一个敏感且经过充分验证的功能指标（范围：0 = 死亡至1.000 = 最佳功能）。在出院时以及出院后3、6、12、18和24个月对患者结果进行评估。NHIS数据基于3个调查年份，代表了美国未受伤青少年的基于人群的全国随机样本。
与该年龄组的NHIS规范相比，青少年的重大创伤在整个24个月的随访期内与QoL的显著和明显缺陷相关。与12至19岁未受伤青少年的NHIS QoL规范（N = 81,216,835；QWB平均值 = 0.876）相比，重大创伤后的受伤青少年在3个月随访时就开始出现显著的QoL缺陷（QWB平均值 = 0.694，p < 0.0001），并且在出院后长达24个月的长期随访中持续存在（6个月随访QWB平均值 = 0.726，p < 0.0001；12个月随访QWB平均值 = 0.747，p < 0.0001；18个月随访QWB平均值 = 0.758，p < 0.0001；24个月随访QWB平均值 = 0.766，p < 0.0001）。QoL缺陷也与年龄（≥15岁）和女性性别密切相关。QoL结果不佳的其他重要风险因素包括对生命的感知威胁、行人被撞机制以及损伤严重程度评分>16。
与美国健康青少年的规范相比，青少年的重大创伤与长期QoL结果的显著和明显缺陷相关。在成熟的创伤护理系统中，早期识别和治疗长期QoL结果不佳的风险因素必须成为创伤护理的一个组成部分。
