James Arthur, Ravaud Philippe, Riveros Carolina, Raux Mathieu, Tran Viet-Thi
Centre d'Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France.
Département d'Anesthésie Réanimation, Sorbonne Université, GRC 29, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.
Ann Surg Open. 2022 Nov 7;3(4):e211. doi: 10.1097/AS9.0000000000000211. eCollection 2022 Dec.
To assess the completeness of the collection of patient-important outcomes and the mismatch between outcomes measured in research and patients' important issues after trauma.
To date, severe trauma has mainly been assessed using in-hospital mortality. Yet, with 80 to 90% survivors discharged from hospital, it is critical to assess the collection of patient important long-term outcomes of trauma.
Mixed methods study combining a systematic review of outcomes and their comparison with domains elicited by patients during a qualitative study. We searched Medline, EMBASE and clinicaltrials.gov from January 1, 2014 to September 30, 2019 and extracted all outcomes from reports including severe trauma. We compared these outcomes with 97 domains that matter to trauma survivors identified in a previous qualitative study. We defined as patient-important outcome as the 10 most frequently elicited domains in the qualitative study. We assessed the number of domains captured in each report to illustrate the completeness of the collection of patient-important outcomes. We also assessed the mismatch between outcomes collected and what matters to patients.
Among the 116 reports included in the systematic review, we identified 403 outcomes collected with 154 unique measurements tools. Beside mortality, measurement tools most frequently used were the Glasgow Outcome Scale (31.0%, n=36), questions on patients' return to work (20,7%, n=24) and the EQ-5D (19.0%, n=22). The comparison between the outcomes identified in the systematic review and the domains from the qualitative study found that 10.3% (n=12) reports did not collect any patient-important domains and one collected all 10 patient-important domains. By examining each of the 10 patient-important domains, none was collected in more than 72% of reports and only five were among the ten most frequently measured domains in studies.
The completeness of the collection of the long-term patient-important outcomes after trauma can be improved. There was a mismatch between the domains used in the literature and those considered important by patients during a qualitative study.
评估创伤后患者重要结局的收集完整性以及研究中测量的结局与患者重要问题之间的不匹配情况。
迄今为止，严重创伤主要通过院内死亡率进行评估。然而，由于80%至90%的幸存者出院，评估创伤患者重要的长期结局的收集情况至关重要。
采用混合方法研究，将结局的系统评价与定性研究中患者提出的领域进行比较。我们检索了2014年1月1日至2019年9月30日期间的Medline、EMBASE和clinicaltrials.gov，并从包括严重创伤的报告中提取所有结局。我们将这些结局与先前定性研究中确定的对创伤幸存者重要的97个领域进行了比较。我们将定性研究中最常出现的10个领域定义为患者重要结局。我们评估了每份报告中涵盖的领域数量，以说明患者重要结局收集的完整性。我们还评估了收集的结局与患者所关注问题之间的不匹配情况。
在系统评价纳入的116份报告中，我们确定了403个结局，使用了154种独特的测量工具。除死亡率外，最常用的测量工具是格拉斯哥预后量表（31.0%，n = 36）、关于患者重返工作的问题（20.7%，n = 24）和EQ - 5D（19.0%，n = 22）。系统评价中确定的结局与定性研究中的领域之间的比较发现，10.3%（n = 12）的报告未收集任何患者重要领域，一份报告收集了所有10个患者重要领域。通过检查10个患者重要领域中的每一个，没有一个领域在超过72%的报告中被收集，并且只有五个领域是研究中测量最频繁的十个领域之一。
创伤后长期患者重要结局的收集完整性可以得到改善。文献中使用的领域与定性研究中患者认为重要的领域之间存在不匹配。
