Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom; University of the Witwatersrand, Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa.
Injury. 2021 Feb;52(2):160-166. doi: 10.1016/j.injury.2020.11.009. Epub 2020 Nov 4.
Major trauma describes serious and often multiple injuries where there is a strong possibility of death or residual disability. There is little robust evidence on the effects of embedded rehabilitation within the trauma care pathway. Trauma rehabilitation services therefore remain fragmented and poorly integrated. This study aimed to determine changes in hospital length of stay (LoS), intensive care unit (ICU) LoS, 30-day mortality and Glasgow Outcome Scale following implementation of an embedded rehabilitation service into a Major Trauma Centre (MTC).
Retrospective pre-post observational study of a rehabilitation service introduced into an MTC, consisting of a dedicated 10-bedded inpatient unit, co-ordinating rehabilitation hub, and specialist multi-disciplinary outpatient clinic. Overall hospital LoS, ICU LoS, 30-day mortality and GOS were selected as outcome measures. Patient characteristics (age, sex, injury mechanism, injury severity score, Glasgow Coma Scale, and most injured body region) were compared and controlled for when analysing outcomes.
The study cohort included 6,484 patients, of which 4,298 were pre-intervention and 2,186 post-intervention. Patients in the post-intervention cohort were older than those in the pre-intervention cohort (58.3 compared to 56.6, p<0.001) and had higher injury severity scores (48.7% >15 compared to 43.9% >15). Moderate but significant changes to the most injured body region were also observed (p<0.001), with fewer injuries affecting the limbs (25.8% to 24.9%), spine (15.3% to 12.1%), multiple locations (11.3% to 10.7%), abdomen (2.7% to 2.4%) and face/other (1.9% to 1.5%) and more injuries affecting the head (27.5% to 31.5%) and chest (15.6% to 16.9%). Controlling for changes to patient characteristics between the two time periods, there was a reduction in overall hospital LoS of 2.56 days (b=-2.56, p<0.001) and ICU LoS of 0.94 days (b=-0.96, p<0.001). There was a 31% reduced chance of 30-day mortality in post-intervention patients (OR=0.69, 95%CI=0.54 to 0.88), and almost two times higher relative chance of GOS Good Recovery (RR=1.94, CI=1.51 to 2.49).
Embedded rehabilitation is an important and necessary component of an effective trauma system that is associated with improved service and patient outcomes. Future research should examine prospectively how a dedicated rehabilitation service affects medium- and long-term patient-centred outcomes.
严重创伤是指严重且常常多处受伤，极有可能导致死亡或残留残疾。关于在创伤救治途径中嵌入康复治疗的效果，目前几乎没有可靠的证据。因此，创伤康复服务仍然是碎片化和整合不良的。本研究旨在确定在一个主要创伤中心（MTC）实施嵌入式康复服务后，对医院住院时间（LoS）、重症监护病房（ICU）LoS、30 天死亡率和格拉斯哥结局量表（GOS）的影响。
对 MTC 中引入的康复服务进行回顾性前后观察性研究，该服务包括一个专门的 10 张病床的住院病房、协调康复中心和专门的多学科门诊诊所。整体医院 LOS、ICU LOS、30 天死亡率和 GOS 被选为结果衡量指标。在分析结果时，比较并控制了患者特征（年龄、性别、损伤机制、损伤严重程度评分、格拉斯哥昏迷量表和最受伤的身体部位）。
研究队列包括 6484 名患者，其中 4298 名是干预前患者，2186 名是干预后患者。与干预前队列相比，干预后队列的患者年龄更大（58.3 岁比 56.6 岁，p<0.001），损伤严重程度评分更高（48.7%>15 比 43.9%>15）。还观察到最受伤身体部位的中度但显著变化（p<0.001），影响四肢的损伤（25.8%至 24.9%）、脊柱（15.3%至 12.1%）、多处位置（11.3%至 10.7%）、腹部（2.7%至 2.4%）和面部/其他（1.9%至 1.5%）的损伤减少，影响头部（27.5%至 31.5%）和胸部（15.6%至 16.9%）的损伤增加。在控制两个时间段之间患者特征的变化后，整体医院 LOS 减少了 2.56 天（b=-2.56，p<0.001），ICU LOS 减少了 0.94 天（b=-0.96，p<0.001）。与干预前相比，干预后 30 天死亡率的风险降低了 31%（OR=0.69，95%CI=0.54 至 0.88），而 GOS 良好恢复的相对机会几乎增加了两倍（RR=1.94，CI=1.51 至 2.49）。
嵌入式康复是一个有效的创伤系统的重要和必要组成部分，它与改善服务和患者结果有关。未来的研究应前瞻性地研究专门的康复服务如何影响中、长期以患者为中心的结果。
