Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA.
Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://www.twitter.com/Jefferson.
Surgery. 2023 Oct;174(4):1021-1025. doi: 10.1016/j.surg.2023.06.002. Epub 2023 Jul 28.
Patient-reported outcomes of postdischarge functional status can provide insight into patient recovery experiences not typically reflected in trauma registries. Injuries may be characterized by a long-term loss of independence. We sought to examine factors predictive of patient-reported, postdischarge loss of independence in trauma patients.
Trauma patients admitted to 1 of 3 level I trauma centers were contacted by phone between 6 to 12 months after hospital discharge to complete the Revised Trauma Quality of Life survey. Loss of independence was defined as a new need for assistance with at least one activity of daily living or transition to living in an institutional setting. Patients with severe traumatic brain injury or spinal cord injury were excluded. Multivariable logistic regression analyses were performed to identify predictors of loss of independence.
801 patients were included. The median age was 65 (interquartile range: 46-76) years, 46.1% were female, and the median Injury Severity Score was 9 (interquartile range: 9-13). Two hundred seventy-one patients (33.8%) experienced a loss of independence, most commonly requiring assistance walking up stairs. The main predictors of loss of independence were persistent daily pain (odds ratio: 3.83, 95% confidence interval: [2.90-5.04], P < .001), length of hospital stay (odds ratio: 1.04, 95% confidence interval: [1.01-1.09], P = .021) and income below the national median (odds ratio: 1.46, 95% confidence interval: [1.12-1.91], P = .006). Perceived social support (odds ratio: 0.75, 95% confidence interval: [0.66-0.85], P < .001) was protective against loss of independence.
Injury is associated with a relatively high rate of long-term loss of independence. Ensuring adequate social support systems for patients postdischarge may help them regain functional independence after injury.
出院后功能状态的患者报告结局可以提供患者康复体验的见解，而这些体验通常不会反映在创伤登记处。受伤可能会导致长期丧失独立性。我们试图研究预测创伤患者出院后报告的丧失独立性的因素。
在出院后 6 至 12 个月期间，通过电话联系入住 3 家 I 级创伤中心之一的创伤患者，以完成修订后的创伤生活质量调查。丧失独立性定义为至少需要他人帮助进行一项日常生活活动或需要转入机构居住。排除严重创伤性脑损伤或脊髓损伤患者。进行多变量逻辑回归分析以确定丧失独立性的预测因素。
共纳入 801 例患者。中位年龄为 65（四分位距：46-76）岁，46.1%为女性，损伤严重程度评分中位数为 9（四分位距：9-13）。271 例（33.8%）患者出现丧失独立性，最常见的是需要他人帮助上楼梯。丧失独立性的主要预测因素是持续性日常疼痛（优势比：3.83，95%置信区间：[2.90-5.04]，P <.001）、住院时间（优势比：1.04，95%置信区间：[1.01-1.09]，P =.021）和收入低于全国中位数（优势比：1.46，95%置信区间：[1.12-1.91]，P =.006）。感知到的社会支持（优势比：0.75，95%置信区间：[0.66-0.85]，P <.001）可预防丧失独立性。
受伤与长期丧失独立性的发生率相对较高有关。确保患者在出院后有足够的社会支持系统，可能有助于他们在受伤后恢复功能独立性。
