Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia.
Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia.
Eur J Trauma Emerg Surg. 2024 Aug;50(4):1439-1452. doi: 10.1007/s00068-023-02430-6. Epub 2024 Feb 15.
Modern trauma care has reduced mortality but poor long-term outcomes with low follow-up rates are common with limited recommendations for improvements. The aim of this study was to describe the impact of severe injury on the health-related quality of life, specifically characterise the non-responder population and to identify modifiable predictors of poorer outcomes.
Five-year (2012-2016) prospective cohort study was performed at a level 1 trauma centre. Baseline Short-Form Health Survey (SF36) was collected at admission, and at 6 and 12 months postinjury together with demographics, injury mechanism and severity, psychosocial wellbeing, and return to work capacity.
Of the 306 consecutive patients [age 52 ± 17 years, male 72%, ISS 21 (17, 29), mortality 5%], 195 (64%) completed questionnaires at baseline, and at 12 months. Preinjury physical health scores were above the general population (53.1 vs. 50.3, p < 0.001) and mental health component was consistent with the population norms (51.7 vs. 52.9, p = 0.065). One year following injury, both physical health (13.2, 95% CI 14.8, 11.6) and mental health scores (6.0, 95% CI 8.1, 3.8) were significantly below age- and sex-adjusted preinjury baselines. Non-responders had similar ISS but with a lower admission GCS, and were more likely to be younger, and without comorbidities, employment, or university education.
Contrary to their better than population norm preinjury health status, polytrauma patients remain functionally impaired at least 1 year after injury. The identified high risk for non-responding group needs more focused efforts for follow-up. A fundamentally different approach is required in polytrauma research which identify modifiable predictors of poor long-term outcomes.
现代创伤救治降低了死亡率，但低随访率导致长期预后较差的情况较为常见，改善方法的建议也很有限。本研究旨在描述严重损伤对健康相关生活质量的影响，具体描述无应答人群，并确定预后较差的可修正预测因素。
这是一项在一级创伤中心进行的为期 5 年（2012-2016 年）的前瞻性队列研究。在入院时、受伤后 6 个月和 12 个月采集简明健康调查量表（SF36）短表，并收集人口统计学、损伤机制和严重程度、社会心理健康和重返工作能力的数据。
在连续的 306 例患者中[年龄 52±17 岁，男性 72%，ISS 21（17，29），死亡率 5%]，195 例（64%）完成了基线和 12 个月时的问卷调查。受伤前的生理健康评分高于一般人群（53.1 比 50.3，p<0.001），心理健康评分与人群正常值一致（51.7 比 52.9，p=0.065）。受伤 1 年后，生理健康（13.2，95%CI 14.8，11.6）和心理健康评分（6.0，95%CI 8.1，3.8）均显著低于年龄和性别调整后的基线。无应答者的 ISS 相似，但入院时格拉斯哥昏迷评分较低，且更年轻，无合并症，就业或接受过大学教育。
与受伤前好于人群正常值的健康状况相反，多发伤患者在受伤至少 1 年后仍存在功能障碍。确定的无应答高风险人群需要更有针对性的随访努力。多发伤研究需要一种截然不同的方法，以确定预后较差的可修正预测因素。
