Harris Ian A, Young Jane M, Rae Hamish, Jalaludin Bin B, Solomon Michael J
Orthopaedic Department, Liverpool Hospital, Liverpool, NSW, Australia.
J Trauma. 2008 Apr;64(4):969-74. doi: 10.1097/01.ta.0000245972.83948.1a.
Traumatic injury is a leading contributor to the global burden of disease, yet there has been little research on possible predictors of general health after major trauma. This study aims to explore possible predictors of general health after major physical trauma.
A survey was performed of 731 surviving consecutive adult patients presenting to a major trauma center with accidental major trauma, between 1 year and 5 years postinjury. Data pertaining to general patient factors, injury severity factors, socioeconomic factors, and claim-related factors were abstracted from the hospital trauma database and the questionnaire. Multiple linear regression was used to develop a predictive model for the main outcome, the physical and mental component summaries of the SF-36 General Health Survey.
One hundred and forty nine patients were excluded, 93 refused to participate, and 134 did not respond, leaving 355 participants. On multivariate analysis, better physical health was significantly associated with increasing time since the injury and lower Injury Severity Scores (p = 0.03 and 0.02, respectively). Having a settled compensation claim, having an unsettled compensation claim, and using a lawyer were independently associated with poor physical health (p = 0.02, 0.006, and <0.0001, respectively). Measures of injury severity or socioeconomic status were not associated with mental health. However, having an unsettled compensation claim was strongly associated with poor mental health (p < 0.0001).
General health after major physical trauma is more strongly associated with factors relating to compensation than with the severity of the injury. Processes involved with claiming compensation after major trauma may contribute to poor patient outcomes.
创伤性损伤是全球疾病负担的主要促成因素，但对于重大创伤后一般健康状况的可能预测因素的研究较少。本研究旨在探讨重大身体创伤后一般健康状况的可能预测因素。
对731名在受伤后1年至5年期间因意外重大创伤而入住一家主要创伤中心的成年幸存者进行了调查。与一般患者因素、损伤严重程度因素、社会经济因素和索赔相关因素有关的数据从医院创伤数据库和问卷中提取。采用多元线性回归建立预测模型，以预测主要结局，即SF-36一般健康调查的身体和心理成分总结。
149名患者被排除，93名拒绝参与，134名未回应，最终留下355名参与者。多变量分析显示，身体健康状况较好与受伤后时间增加以及较低的损伤严重程度评分显著相关（分别为p = 0.03和0.02）。获得已解决的赔偿索赔、未解决的赔偿索赔以及聘请律师均与身体健康状况不佳独立相关（分别为p = 0.02、0.006和<0.0001）。损伤严重程度或社会经济状况的指标与心理健康无关。然而，未解决的赔偿索赔与心理健康状况不佳密切相关（p < 0.0001）。
重大身体创伤后的一般健康状况与赔偿相关因素的关联比与损伤严重程度的关联更强。重大创伤后索赔赔偿的过程可能导致患者预后不良。
