Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, Seattle, Washington.
J Bone Joint Surg Am. 2021 Mar 17;103(6):469-476. doi: 10.2106/JBJS.20.00348.
Clinical follow-up in orthopaedic trauma is challenging, yet expectations exist that a 1-year follow-up is the minimum requirement for clinical trials and research publications. The primary purpose of our study was to evaluate the rate of follow-up after operative orthopaedic trauma care and the relationship to clinical care. Our secondary aim was to identify any independent risk factors regarding follow-up completion.
A chart review of patients operatively treated for a traumatic injury during the months of January and July 2016 was conducted. Patient demographic characteristics, injury type, severity, and patient distance from the hospital were collected. The final clinical instructions and whether a return visit was requested or as needed were recorded.
There were 293 patients in this study, of whom 84 (29%) had follow-up of at least 1 year and 52 (18%) were instructed to follow up only as needed at their last visit prior to the 1-year mark. When removing the latter 52 patients, the 1-year follow-up rate was 35% (84 of 241 patients). Of these 241 patients, 157 (65%) were requested to return for additional clinical care but failed to return prior to 1 year. Logistic regression identified tobacco use (odds ratio [OR], 0.34 [95% confidence interval (CI), 0.15 to 0.77]; p = 0.010), final appointment status (OR, 6.3 [95% CI, 3.4 to 11.6]; p < 0.001), isolated compared with multiple fractures (OR, 2.2 [95% CI, 1.2 to 4.1]; p = 0.013), and distance from the trauma center per mile as a continuous variable (OR, 0.999 [95% CI, 0.998 to 1.0]; p = 0.03) as significant predictors.
Our data suggest that a 1-year clinic follow-up requirement may not be feasible. We observed a low rate of patients with a minimum 1-year clinical follow-up. Clinical care had been completed in 18% of patients prior to 1 year. Journal and grant reviewers may need to consider the feasibility and clinical relevance of these follow-up expectations.
矫形创伤的临床随访具有挑战性，但人们期望临床试验和研究出版物的最低随访时间为 1 年。我们研究的主要目的是评估接受矫形创伤治疗后的随访率，并研究其与临床治疗的关系。我们的次要目的是确定任何与完成随访相关的独立风险因素。
对 2016 年 1 月和 7 月期间接受创伤性损伤手术治疗的患者进行病历回顾。收集患者的人口统计学特征、损伤类型、严重程度以及患者与医院的距离。记录最后的临床医嘱以及是否要求复诊或按需复诊。
本研究共纳入 293 例患者，其中 84 例（29%）至少随访 1 年，52 例（18%）在 1 年标记前的最后一次就诊时被指示仅按需复诊。在去除后 52 例患者后，1 年随访率为 35%（241 例患者中的 84 例）。在这 241 例患者中，157 例（65%）被要求进行额外的临床治疗，但在 1 年前未能返回。Logistic 回归分析确定吸烟（比值比 [OR]，0.34 [95%置信区间 [CI]，0.15 至 0.77]；p = 0.010）、最终预约状态（OR，6.3 [95%CI，3.4 至 11.6]；p < 0.001）、孤立性骨折与多发性骨折（OR，2.2 [95%CI，1.2 至 4.1]；p = 0.013）以及每英里距离创伤中心的英里数作为连续变量（OR，0.999 [95%CI，0.998 至 1.0]；p = 0.03）是显著的预测因素。
我们的数据表明，1 年的临床随访要求可能不可行。我们观察到有最低 1 年临床随访的患者比例较低。在 1 年前，18%的患者已经完成了临床治疗。期刊和资助评审人员可能需要考虑这些随访预期的可行性和临床相关性。
