Sorensen Mathew D, Wessells Hunter, Rivara Frederick P, Zonies David H, Jurkovich Gregory J, Wang Jin, Mackenzie Ellen J
Departments of Urology, Surgery, Pediatrics and Epidemiology, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA.
J Trauma. 2008 Nov;65(5):1045-52; discussion 1052-3. doi: 10.1097/TA.0b013e3181896192.
To determine the prevalence and predictors of sexual dysfunction (SDF) after moderate-to-severe trauma in a large multicenter study.
The National Study on the Costs and Outcomes of Trauma was a prospective cohort study involving 69 hospitals from 15 regions in 14 states. Men and women aged 18 to 84 years with moderate-to-severe injures participated in 3 and 12 month postinjury interviews. At 12 months, sexual function was assessed using the Functional Capacity Index. Predictors of SDF were determined using adjusted multivariate Poisson regression. Sensitivity analyses were conducted on patients aged 18 to 30 years.
Of 10,122 weighted subjects, 3,087 (30.5%) reported some degree of SDF, with the majority reporting severe SDF. On multivariate analysis, independent predictors of SDF included increasing age (aRR 1.02 per year age), decreasing household income category (aRR 1.12-1.60), lower baseline global health status (aRR 1.27-3.54), preexisting diabetes (aRR 1.34) increasing Injury Severity Score (aRR 1.02 per point increase), pelvic fracture (aRR 1.45), lower extremity fracture (aRR 1.48), and spinal cord injury (aRR 3.73).
SDF is common and usually severe after major trauma. Injury severity is a significant independent predictor of SDF. This may be due to persistent physical, psychologic, or social limitations from injury. Given the effect on quality of life, these data support the need in the clinical setting to identify and address SDF after trauma. Further investigation is necessary to determine the mechanism by which injury severity mediates SDF and whether earlier interventions can decrease the later risk of SDF.
在一项大型多中心研究中，确定中重度创伤后性功能障碍（SDF）的患病率及预测因素。
创伤成本与结局全国性研究是一项前瞻性队列研究，涉及来自14个州15个地区的69家医院。年龄在18至84岁之间的中重度受伤的男性和女性参与了受伤后3个月和12个月的访谈。在12个月时，使用功能能力指数评估性功能。使用校正后的多变量泊松回归确定SDF的预测因素。对18至30岁的患者进行了敏感性分析。
在10,122名加权受试者中，3,087名（30.5%）报告有某种程度的SDF，大多数报告为严重SDF。多变量分析显示，SDF的独立预测因素包括年龄增长（每年年龄校正风险比为1.02）、家庭收入类别降低（校正风险比为1.12 - 1.60）、基线总体健康状况较差（校正风险比为1.27 - 3.54）、既往糖尿病（校正风险比为1.34）、损伤严重程度评分增加（每增加1分校正风险比为1.02）、骨盆骨折（校正风险比为1.45）、下肢骨折（校正风险比为1.48）和脊髓损伤（校正风险比为3.73）。
SDF在重大创伤后很常见且通常较为严重。损伤严重程度是SDF的一个重要独立预测因素。这可能是由于损伤导致的持续身体、心理或社会限制。鉴于对生活质量的影响，这些数据支持在临床环境中识别和处理创伤后SDF的必要性。有必要进一步研究以确定损伤严重程度介导SDF的机制，以及早期干预是否可以降低后期SDF的风险。
