Ilkhani Saba, Naus Abbie E, Pinkes Nathaniel, Rafaqat Wardah, Grobman Ben, Valverde Madeline D, Sanchez Sabrina E, Hwabejire John O, Ranganathan Kavitha, Scott John W, Herrera-Escobar Juan P, Salim Ali, Anderson Geoffrey A
From the Center for Surgery and Public Health (S.I., N.P., M.D.V., K.R., J.P.H.-E., G.A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston; Beth Israel Lahey Health, Lahey Hospital and Medical Center (A.E.N.), Burlington; Division of Trauma, Emergency Surgery (W.R., JOH), and Surgical Critical Care, Massachusetts General Hospital, School of Medicine (B.G.), Harvard Medical School; Tufts University School of Medicine (M.D.V.), Boston; Division of Trauma, Acute Care Surgery & Surgical Critical Care (S.E.S.), Boston Medical Center, Boston University School of Medicine; Division of Plastic and Reconstructive Surgery (K.R.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, University of Washington (J.W.S.), Harborview Medical Center, Seattle, Washington; and Division of Trauma, Burn, and Surgical Critical Care (J.P.H.-E., A.S., G.A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Trauma Acute Care Surg. 2024 Jun 1;96(6):893-900. doi: 10.1097/TA.0000000000004247. Epub 2024 Jan 16.
Trauma survivors are susceptible to experiencing financial toxicity (FT). Studies have shown the negative impact of FT on chronic illness outcomes. However, there is a notable lack of data on FT in the context of trauma. We aimed to better understand prevalence, risk factors, and impact of FT on trauma long-term outcomes.
Adult trauma patients with an Injury Severity Score (ISS) ≥9 treated at Level I trauma centers were interviewed 6 months to 14 months after discharge. Financial toxicity was considered positive if patients reported any of the following due to the injury: income loss, lack of care, newly applied/qualified for governmental assistance, new financial problems, or work loss. The Impact of FT on Patient Reported Outcome Measure Index System (PROMIS) health domains was investigated.
Of 577 total patients, 44% (254/567) suffered some form of FT. In the adjusted model, older age (odds ratio [OR], 0.4; 95% confidence interval [95% CI], 0.2-0.81) and stronger social support networks (OR, 0.44; 95% CI, 0.26-0.74) were protective against FT. In contrast, having two or more comorbidities (OR, 1.81; 95% CI, 1.01-3.28), lower education levels (OR, 1.95; 95% CI, 95%, 1.26-3.03), and injury mechanisms, including road accidents (OR, 2.69; 95% CI, 1.51-4.77) and intentional injuries (OR, 4.31; 95% CI, 1.44-12.86) were associated with higher toxicity. No significant relationship was found with ISS, sex, or single-family household. Patients with FT had worse outcomes across all domains of health. There was a negative linear relationship between the severity of FT and worse mental and physical health scores.
Financial toxicity is associated with long-term outcomes. Incorporating FT risk assessment into recovery care planning may help to identify patients most in need of mitigative interventions across the trauma care continuum to improve trauma recovery. Further investigations to better understand, define, and address FT in trauma care are warranted.
Prognostic and Epidemiological; Level III.
创伤幸存者易遭受经济毒性（FT）。研究表明FT对慢性病结局有负面影响。然而，在创伤背景下，关于FT的数据明显不足。我们旨在更好地了解FT的患病率、风险因素及其对创伤长期结局的影响。
对在一级创伤中心接受治疗、损伤严重程度评分（ISS）≥9的成年创伤患者在出院后6个月至14个月进行访谈。如果患者因受伤报告以下任何一种情况，则认为存在经济毒性：收入损失、缺乏护理、新申请/符合政府援助条件、出现新的财务问题或工作损失。研究了FT对患者报告结局测量指标系统（PROMIS）健康领域的影响。
在577名患者中，44%（254/567）遭受了某种形式的FT。在调整模型中，年龄较大（优势比[OR]，0.4；95%置信区间[95%CI]：0.2 - 0.81）和更强大的社会支持网络（OR，0.44；95%CI，0.26 - 0.74）可预防FT。相比之下，患有两种或更多合并症（OR，1.81；95%CI，1.01 - 3.28）、教育水平较低（OR，1.95；95%CI，1.26 - 3.03）以及包括道路交通事故（OR，2.69；95%CI，1.51 - 4.77）和故意伤害（OR，4.31；95%CI，1.44 - 12.86）在内的损伤机制与更高的毒性相关。未发现与ISS、性别或单身家庭有显著关系。患有FT的患者在所有健康领域的结局更差。FT的严重程度与更差的心理和身体健康评分之间存在负线性关系。
经济毒性与长期结局相关。将FT风险评估纳入康复护理计划可能有助于识别在创伤护理连续过程中最需要缓解干预措施的患者，以改善创伤恢复。有必要进行进一步调查，以更好地理解、定义和解决创伤护理中的FT问题。
预后和流行病学；三级。
