From the Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, (M.C.-A., J.P.H.-E., A.S., A.H.H., D.N.), Center for Surgery and Public Health, Department of Surgery (M.C.-A., J.P.H.-E., A.T., A.S., A.H.H.), Brigham and Women's Hospital, Harvard Medical School; Harvard T. H. Chan School of Public Health (M.C.-A., J.P.H.-E., A.T., A.S., A.H.H.); Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery (S.E.S.), Boston University School of Medicine; and Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (H.M.K.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Trauma Acute Care Surg. 2021 Aug 1;91(2):260-264. doi: 10.1097/TA.0000000000003272.
Violence continues to be a significant public health burden, but little is known about the long-term outcomes of these patients. Our goal was to determine the impact of violence-related trauma on long-term functional and psychosocial outcomes.
We identified trauma patients with moderate to severe injuries (Injury Severity Score, ≥9) treated at one of three level 1 trauma centers. These patients were asked to complete a survey over the phone between 6 and 12 months after injury evaluating both functional and psychosocial outcomes (12-item Short Form Survey, Trauma Quality of Life, posttraumatic stress disorder [PTSD] screen, chronic pain, return to work). Patients were classified as having suffered a violent injury if the mechanism of injury was a stab, gunshot, or assault. Self-inflicted wounds were excluded. Adjusted logistic regression models were built to determine the association between a violent mechanism of injury and long-term outcomes.
A total of 1,050 moderate to severely injured patients were successfully followed, of whom 176 (16.8%) were victims of violence. For the victims of violence, mean age was 34.4 years (SD, 12.5 years), 85% were male, and 57.5% were Black; 30.7% reported newly needing help with at least one activity of daily living after the violence-related event. Fifty-nine (49.2%) of 120 patients who were working before their injury had not yet returned to work; 47.1% screened positive for PTSD, and 52.3% reported chronic pain. On multivariate analysis, a violent mechanism was significantly associated with PTSD (odds ratio, 2.57; 95% confidence interval, 1.59-4.17; p < 0.001) but not associated with chronic pain, return to work, or functional outcomes.
The physical and mental health burden after violence-related trauma is not insignificant. Further work is needed to identify intervention strategies and social support systems that may be beneficial to reduce this burden.
Prognostic and epidemiological, level III.
暴力仍然是一个严重的公共卫生负担，但人们对这些患者的长期后果知之甚少。我们的目标是确定与暴力相关的创伤对长期功能和心理社会结果的影响。
我们确定了在三个一级创伤中心之一接受中度至重度损伤（损伤严重程度评分≥9）治疗的创伤患者。在受伤后 6 至 12 个月，这些患者通过电话完成了一项评估功能和心理社会结果的调查（12 项简短表格调查、创伤生活质量、创伤后应激障碍（PTSD）筛查、慢性疼痛、重返工作岗位）。如果损伤机制是刺伤、枪击或袭击，则将患者归类为遭受暴力损伤。排除自残伤口。建立调整后的逻辑回归模型，以确定暴力损伤机制与长期结果之间的关联。
共成功随访了 1050 名中度至重度受伤患者，其中 176 名（16.8%）是暴力受害者。对于暴力受害者，平均年龄为 34.4 岁（标准差为 12.5 岁），85%为男性，57.5%为黑人；30.7%报告在与暴力相关事件后至少有一项日常生活活动需要新的帮助。在受伤前工作的 120 名患者中，有 59 名（49.2%）尚未重返工作岗位；47.1%的患者 PTSD 筛查呈阳性，52.3%的患者报告慢性疼痛。多变量分析显示，暴力机制与 PTSD 显著相关（优势比，2.57；95%置信区间，1.59-4.17；p <0.001），但与慢性疼痛、重返工作岗位或功能结果无关。
与暴力相关创伤后的身心健康负担不小。需要进一步努力确定干预策略和社会支持系统，以减轻这一负担。
预后和流行病学，III 级。
