Patterson Joseph T, Albright Patrick D, Jackson J Hunter, Eliezer Edmund N, Haonga Billy T, Morshed Saam, Shearer David W
Institute for Global Orthopaedic Trauma, University of California San Francisco, San Francisco, CA.
Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
OTA Int. 2020 Mar 3;3(1):e061. doi: 10.1097/OI9.0000000000000061. eCollection 2020 Mar.
Predict loss to follow-up in prospective clinical investigations of lower extremity fracture surgery.
Secondary analysis of 2 prospective clinical trials.
National public orthopaedic and neurologic trauma tertiary referral hospital in Dar es Salaam, Tanzania, a low-income country in sub-Saharan Africa.
PATIENTS/PARTICIPANTS: Three hundred twenty-nine femoral shaft and 240 open tibial shaft fracture patients prospectively enrolled in prospective controlled trials of surgical fracture management by external fixation, plating, or intramedullary nailing between June 2015 and March 2017.
Telephone contact for failure to attend scheduled 1-year clinic visit.
Ascertainment of primary trial outcome at 1-year from surgery; post-hoc telephone questionnaire for reasons patient did not attend the 1-year clinic visit.
One hundred twenty-seven femur fracture (39%) and 68 open tibia fracture (28%) patients did not attend the 1-year clinic visit. Telephone contact significantly improved ascertainment of the primary study outcome by 20% between 6-month and 1-year clinic visits to 82% and 92% respectively at study completion. Multivariable analysis associated unemployment (OR = 2.5 [1.7-3.9], < .001), treatment with an external fixator (OR = 1.7 [1.0-2.8], = .033), and each additional 20 km between residence and clinic (OR = 1.03 [1.00-1.06], = .047] with clinic nonattendance. One hundred eight (55%) nonattending patients completed the telephone questionnaire, reporting travel distance to the hospital (49%), and travel costs to the hospital (46%) as the most prevalent reasons for nonattendance. Sixty-five percent of patients with open tibia fractures cited relocation after surgery as a contributing factor.
Relocation during recovery, travel distance, travel cost, unemployment, and use of an external fixator are associated with loss to clinical follow-up in prospective investigations of femur and open tibia fracture surgery in this population. Telephone contact is an effective means to assess outcome.
预测下肢骨折手术前瞻性临床研究中的失访情况。
对两项前瞻性临床试验进行二次分析。
坦桑尼亚达累斯萨拉姆的一家国家级公立骨科和神经创伤三级转诊医院，该国是撒哈拉以南非洲的一个低收入国家。
患者/参与者：2015年6月至2017年3月期间，329例股骨干骨折患者和240例开放性胫骨干骨折患者前瞻性纳入了关于手术骨折治疗的前瞻性对照试验，治疗方式包括外固定、钢板固定或髓内钉固定。
对于未按计划参加1年门诊随访的患者进行电话联系。
确定术后1年的主要试验结果；通过事后电话问卷调查患者未参加1年门诊随访的原因。
127例股骨干骨折患者（39%）和68例开放性胫骨干骨折患者（28%）未参加1年门诊随访。电话联系显著提高了主要研究结果的确定率，在6个月至1年的门诊随访期间，确定率分别从6个月时的20%提高到研究结束时的82%和92%。多变量分析显示，失业（比值比[OR]=2.5[1.7 - 3.9]，P<0.001）、采用外固定器治疗（OR=1.7[1.0 - 2.8]，P=0.033）以及居住地与诊所之间每增加20公里（OR=1.03[1.00 - 1.06]，P=0.047）与未参加门诊随访有关。108例（55%）未参加随访的患者完成了电话问卷调查，报告前往医院的距离（49%）和前往医院的交通费用（46%）是未参加随访最常见的原因。65%的开放性胫骨干骨折患者将术后搬迁作为一个促成因素。
在该人群中，股骨和开放性胫骨骨折手术的前瞻性研究中，恢复期间的搬迁、出行距离、交通费用、失业以及使用外固定器与临床随访失访有关。电话联系是评估结果的有效手段。
