Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Ann Surg. 2022 Jul 1;276(1):22-29. doi: 10.1097/SLA.0000000000005471. Epub 2022 May 12.
The aim of this study was to evaluate the Social Vulnerability Index (SVI) as a predictor of long-term outcomes after injury.
The SVI is a measure used in emergency preparedness to identify need for resources in the event of a disaster or hazardous event, ranking each census tract on 15 demographic/social factors.
Moderate-severely injured adult patients treated at 1 of 3 level-1 trauma centers were prospectively followed 6 to 14 months post-injury. These data were matched at the census tract level with overall SVI percentile rankings. Patients were stratified based on SVI quartiles, with the lowest quartile designated as low SVI, the middle 2 quartiles as average SVI, and the highest quartile as high SVI. Multivariable adjusted regression models were used to assess whether SVI was associated with long-term outcomes after injury.
A total of 3153 patients were included [54% male, mean age 61.6 (SD = 21.6)]. The median overall SVI percentile rank was 35th (IQR: 16th-65th). compared to low SVI patients, high SVI patients were more likely to have new functional limitations [odds ratio (OR), 1.51; 95% confidence interval (CI), 1.19-1.92), to not have returned to work (OR, 2.01; 95% CI, 1.40-2.89), and to screen positive for post-traumatic stress disorder (OR, 1.56; 95% CI, 1.12-2.17). Similar results were obtained when comparing average with low SVI patients, with average SVI patients having significantly worse outcomes.
The SVI has potential utility in predicting individuals at higher risk for adverse long-term outcomes after injury. This measure may be a useful needs assessment tool for clinicians and researchers in identifying communities that may benefit most from targeted prevention and intervention efforts.
本研究旨在评估社会脆弱性指数（SVI）作为预测伤后长期结局的指标。
SVI 是一种在应急准备中使用的衡量标准，用于在发生灾害或危险事件时确定资源需求，根据 15 个人口统计学/社会因素对每个普查区进行排名。
对在 3 个 1 级创伤中心之一接受治疗的中度至重度受伤成年患者进行前瞻性随访，随访时间为受伤后 6 至 14 个月。这些数据在普查区层面上与总体 SVI 百分位数排名相匹配。根据 SVI 四分位数对患者进行分层，最低四分位数指定为低 SVI，中间两个四分位数指定为平均 SVI，最高四分位数指定为高 SVI。使用多变量调整回归模型评估 SVI 是否与伤后长期结局相关。
共纳入 3153 名患者[54%为男性，平均年龄 61.6（SD=21.6）岁]。总体 SVI 百分位数中位数为第 35 位（IQR：第 16 位至第 65 位）。与低 SVI 患者相比，高 SVI 患者更有可能出现新的功能障碍[比值比（OR），1.51；95%置信区间（CI），1.19-1.92）、未恢复工作（OR，2.01；95%CI，1.40-2.89）和创伤后应激障碍筛查阳性（OR，1.56；95%CI，1.12-2.17）。将平均 SVI 与低 SVI 患者进行比较时，也得到了类似的结果，平均 SVI 患者的结局明显更差。
SVI 在预测伤后不良长期结局风险较高的个体方面具有潜在的应用价值。该指标可能是临床医生和研究人员在确定最有可能受益于针对性预防和干预措施的社区时的一种有用的需求评估工具。
