From the Department of Surgery, Rutgers New Jersey Medical School; and Eric Munoz Trauma Center, University Hospital, Newark, New Jersey.
J Trauma Acute Care Surg. 2022 Jul 1;93(1):118-123. doi: 10.1097/TA.0000000000003634. Epub 2022 Apr 8.
Although the need for high-level care persists postdischarge, severely injured trauma survivors have historically poor adherence to follow-up. We hypothesized that a dedicated Center for Trauma Survivorship (CTS) improves follow-up and facilitates postdischarge specialty care.
A retrospective study of "CTS eligible" trauma patients before (January to December 2017) and after (January to December 2019) creation of the CTS was performed. Patients with an intensive care unit stay ≥2 days or a New Injury Severity Score of ≥16 are CTS eligible. The before (PRE) cohort was followed through December 2018 and the after (CTS) cohort through December 2020. Primary outcome was follow-up within the hospital system exclusive of mental health and rehabilitative therapy appointments. Secondary outcomes include postdischarge surgical procedures and specialty-specific follow-up.
There were no significant differences in demographics or hospital duration in the PRE (n = 177) and CTS (n = 119) cohorts. Of the CTS group, 91% presented for outpatient follow-up within the hospital system, compared with 73% in the PRE group (p < 0.001). In the PRE cohort, only 39% were seen by the trauma service compared with 62% in the CTS cohort (p < 0.001). Center for Trauma Survivorship patients also had increased follow-up with other providers (80% vs. 65%; p = 0.006). Notably, 33% of CTS patients had additional surgery compared with only 20% in the PRE group (p = 0.011). Center for Trauma Survivorship patients had more than 20% more outpatient visits (1,280 vs. 1,006 visits).
Despite the follow-up period for the CTS cohort occurring during the peak of the COVID-19 pandemic, limiting availability of outpatient services, our CTS significantly improved follow-up with trauma providers, as well as with other specialties. The CTS patients also underwent significantly more secondary operations. These data demonstrate that creation of a CTS can improve the postdischarge care of severely injured trauma survivors, allowing for care coordination within the health care system, retaining patients, generating revenue, and providing needed follow-up care.
Therapeutic/Care Management; Level IV.
尽管出院后仍需要高水平的护理，但严重创伤幸存者在随访方面的依从性历来较差。我们假设专门的创伤幸存者中心（CTS）可以改善随访并促进出院后的专科护理。
对创建 CTS 之前（2017 年 1 月至 12 月）和之后（2019 年 1 月至 12 月）的“CTS 符合条件”创伤患者进行了回顾性研究。入住重症监护病房≥2 天或新损伤严重程度评分≥16 的患者为 CTS 符合条件。PRE 队列随访至 2018 年 12 月，CTS 队列随访至 2020 年 12 月。主要结局是排除心理健康和康复治疗预约的院内系统随访。次要结局包括出院后的手术和专科随访。
PRE（n=177）和 CTS（n=119）队列在人口统计学和住院时间方面无显著差异。CTS 组中有 91%的人在院内系统接受了门诊随访，而 PRE 组中这一比例为 73%（p<0.001）。在 PRE 队列中，只有 39%的患者接受了创伤服务，而 CTS 队列中有 62%（p<0.001）。CTS 患者还增加了与其他提供者的随访（80%对 65%；p=0.006）。值得注意的是，CTS 组中有 33%的患者进行了额外的手术，而 PRE 组中这一比例仅为 20%（p=0.011）。CTS 患者的门诊就诊次数比 PRE 组多 20%以上（1280 次比 1006 次）。
尽管 CTS 队列的随访期正值 COVID-19 大流行高峰期，限制了门诊服务的可用性，但我们的 CTS 显著改善了创伤提供者以及其他专科医生的随访情况。CTS 患者还进行了更多的二次手术。这些数据表明，创建 CTS 可以改善严重创伤幸存者的出院后护理，在医疗保健系统内进行护理协调，留住患者，产生收入，并提供所需的随访护理。
治疗/护理管理；IV 级。
