59th Clinical Research Division, Lackland Air Force Base, San Antonio, Tex; U.S. Army Institute of Surgical Research, Chambers Pass, Fort Sam Houston, Tex.
U.S. Army Institute of Surgical Research, Chambers Pass, Fort Sam Houston, Tex.
J Vasc Surg. 2014 Jan;59(1):173-9.e1. doi: 10.1016/j.jvs.2013.07.103. Epub 2013 Sep 13.
To date, contemporary studies on wartime vascular trauma have focused on acute management strategies and early results, with no characterization of enduring functional limb salvage or its relation to quality of life. The objective of this study was to describe long-term, patient-based quality of life and function after extremity vascular injury (EVI).
The Joint Theater Trauma Registry was queried for U.S. troops with EVI. Injury and management data was obtained and the Medical Outcomes Study Short Form 36 (SF-36) Health Survey administered after patient contact and consent. Demographic, injury, and management variables were analyzed and examined for correlation with the primary end points of favorable or unfavorable outcome defined by SF-36 Mental (MCS) or Physical Component Summary (PCS) scores of >42 or <42 (effect size ≥ 0.8).
Surveys were completed by 214 patients, who were a median age of 25 years (range, 19-52 years). The Injury Severity Score was 15.3 ± 8.6 and the Mangled Extremity Severity Score was 5.65 ± 1.4. Amputation-free survival was 84% at mean follow-up of 61 ± 24 months. Overall SF-36 PCS and MCS scores were 43.0 ± 9.2 and 46.6 ± 12.4, respectively, with 92 respondents (43%) reporting favorable outcomes on both MCS and PCS. On multivariate analysis, older age, severe extremity injury (Mangled Extremity Severity Scores ≥ 7), and chronic pain were predictive of unfavorable physical outcomes (P < .05). Presence of pain, nerve injury, and junior rank (<E7) were predictive of unfavorable MCS scores (P < .05). Higher educational background (baccalaureate or above) was associated with favorable outcome (P < .05).
This study reports the first long-term patient-centered outcomes data after wartime EVI. At 5 years after injury, quality-of-life measures are reduced compared with national norms. Understanding high-risk characteristics, both demographic- and injury-specific, that are associated with unfavorable outcomes will help guide future acute management and long-term recovery strategies.
迄今为止，有关战时血管创伤的当代研究集中在急性处理策略和早期结果上，而没有对持久的肢体功能保存进行特征描述，也没有将其与生活质量联系起来。本研究的目的是描述四肢血管损伤（EVI）后长期的、以患者为基础的生活质量和功能。
查询美国联合战区创伤登记处的 EVI 美军士兵数据。获取损伤和处理数据，并在与患者取得联系并获得同意后，采用医疗结局研究 36 项简短健康调查（SF-36）进行调查。分析人口统计学、损伤和处理变量，并检查其与主要结局指标（SF-36 精神健康评分（MCS）或生理健康评分（PCS）>42 或<42 定义的有利或不利结局）的相关性，其效应量为 0.8。
214 名患者完成了调查，平均年龄为 25 岁（19-52 岁）。损伤严重程度评分（ISS）为 15.3±8.6，四肢损伤严重程度评分（MEFS）为 5.65±1.4。平均随访 61±24 个月时，无截肢生存率为 84%。SF-36 PCS 和 MCS 评分的总体平均值分别为 43.0±9.2 和 46.6±12.4，92 名患者（43%）在 MCS 和 PCS 两项上报告了有利结局。多变量分析显示，年龄较大、严重肢体损伤（MEFS≥7）和慢性疼痛是物理结局不良的预测因素（P<0.05）。存在疼痛、神经损伤和初级军衔（<E7）是 MCS 评分不良的预测因素（P<0.05）。较高的教育背景（学士或以上）与有利结局相关（P<0.05）。
本研究报告了首次关于战时 EVI 后的长期以患者为中心的结局数据。在损伤后 5 年，生活质量测量结果低于全国标准。了解与不良结局相关的人口统计学和损伤特异性的高危特征，将有助于指导未来的急性处理和长期康复策略。
