Nemunaitis Gregory, Roach Mary Joan, Claridge Jeffrey, Mejia Melvin
MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH(∗).
MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH; Center for Health Research and Policy, MetroHealth Medical Center, Cleveland, OH; Department of PM&R, MetroHealth Medical Center, Rammelkamp R222A, 2500 MetroHealth Dr, Cleveland, OH 44109(†).
PM R. 2016 Apr;8(4):314-320. doi: 10.1016/j.pmrj.2015.08.007. Epub 2015 Aug 24.
Despite the availability of routinely collected trauma data, researchers who investigate rehabilitation outcomes, functional evaluation, and comparative effectiveness have not incorporated this potentially clinically meaningful information in their modeling as predictors or adjustors.
The purpose of this study was to identify variables from the scene of a traumatic accident and from the emergency department that can be used in assessing functional outcomes of persons who survive trauma.
Prospective study.
Level I academic trauma center.
Persons who sustained and survived a spinal cord injury, a traumatic brain injury, or polytrauma.
Trauma and rehabilitation registries were merged by matching the 2 data files for each patient by medical record number, and the files were verified by gender and date of birth. Analysis consisted of standard descriptive statistics (frequencies and averages). A 2-staged linear regression was used to investigate the relationship between the demographic, scene, and ED data elements and discharge functional outcome.
Discharge Functional Independence Measure (FIM).
Older patients with government insurance had poorer discharge FIM scores compared with patients who had commercial insurance. The Injury Severity Score (ISS) and Glasgow Coma Scale score from the scene of the accident were significantly associated with the discharge FIM. Persons with a lower ISS had significantly higher discharge FIM scores than did persons with a higher ISS (P < .001). For every unit change in Glasgow Coma Scale score, FIM scores increased by 0.488 points (P = .030).
The use of routinely collected trauma data elements can be useful in assessing the continuum of patient care. Incorporating trauma data into research has the potential to improve our models of functional outcomes and provide meaningful risk adjustors when comparing and evaluating rehabilitation care systems and treatments.
尽管有常规收集的创伤数据，但研究康复结局、功能评估和比较效果的研究人员在其模型中并未将这些可能具有临床意义的信息作为预测因素或调整因素纳入。
本研究的目的是确定创伤事故现场和急诊科的变量，这些变量可用于评估创伤幸存者的功能结局。
前瞻性研究。
一级学术创伤中心。
遭受脊髓损伤、创伤性脑损伤或多发伤并存活的患者。
通过病历号将每个患者的创伤和康复登记数据文件进行匹配合并，并通过性别和出生日期对文件进行验证。分析包括标准描述性统计（频率和平均值）。采用两阶段线性回归研究人口统计学、事故现场和急诊科数据元素与出院时功能结局之间的关系。
出院时功能独立性测量（FIM）。
与拥有商业保险的患者相比，拥有政府保险的老年患者出院时的FIM评分更低。事故现场的损伤严重程度评分（ISS）和格拉斯哥昏迷量表评分与出院时的FIM显著相关。ISS较低的患者出院时的FIM评分显著高于ISS较高的患者（P <.001）。格拉斯哥昏迷量表评分每变化一个单位，FIM评分增加0.488分（P =.030）。
使用常规收集的创伤数据元素有助于评估患者护理的连续性。将创伤数据纳入研究有可能改进我们的功能结局模型，并在比较和评估康复护理系统及治疗方法时提供有意义的风险调整因素。
