Trauma Service, Gold Coast University Hospital, Queensland, Australia.
Research, Gold Coast University Hospital, Queensland, Australia.
Injury. 2024 Dec;55(12):112012. doi: 10.1016/j.injury.2024.112012. Epub 2024 Nov 6.
The routine collection of long-term patient health outcomes after serious traumatic injury at the health service level is uncommon. In 2019, we implemented the longitudinal Trauma Service Follow Up (TSFU) program at a level I trauma centre. Delivered by the trauma service clinicians involved in inpatient care, it assesses quality of life and disability. This study reports the 6- and 12-month outcomes of the first two years of operation of the TSFU program.
This is a prospective cohort study of seriously injured adult trauma patients admitted to a level I trauma centre with 6- and 12-months post-discharge outcome assessments. Outcomes were quality of life and function/disability as measured using the EQ-5D-5L and WHODAS 2.0 validated instruments. Changes from 6 to 12 months were assessed using generalised estimating equations methods. Logistic regression models were used to identify factors associated with ongoing problems at each time point.
Five-hundred and eight seriously injured patients were eligible for the TSFU program with follow-up rates over 80 % at both 6- and 12-month timepoints. At six months, ongoing problems with pain (69.9 %), anxiety and depression (49 %) and carrying out usual activities (57.5 %) were highly prevalent; at 12 months problems with pain (61.4 %) and anxiety and depression (43.8 %) persisted. Lower extremity and/or pelvic surgery was associated with ongoing pain, odds ratio (OR) = 3.77 (95 % CI 1.54-9.21, p=0.01), anxiety and depression (OR 1.95, 95 % CI 1.09-3.48, p=0.02) and problems carrying out their usual activities (OR 3.19, 95 % CI 0.75-13.5, p=0.11) at six months. These patterns mostly persisted at 12 months. Similar associations between surgical intervention and high levels of disability were evident at both time points.
Persistent impairments in physical and emotional health continues to affect many people following serious traumatic injury. The collection of longitudinal health outcomes by trauma clinicians enables identification of factors that contribute to disability and a reduction in quality of life. This in turn can drive quality improvement initiatives within the hospital trauma system. Longitudinal follow-up programs may provide a platform to provide ongoing specialist trauma-informed care after hospital discharge.
在医疗服务层面上，常规收集严重创伤后患者的长期健康结果并不常见。2019 年，我们在一家一级创伤中心实施了纵向创伤服务随访（TSFU）计划。该计划由参与住院治疗的创伤服务临床医生提供，评估生活质量和残疾情况。本研究报告了 TSFU 计划实施头两年的 6 个月和 12 个月的结果。
这是一项对入住一级创伤中心的严重创伤成年患者的前瞻性队列研究，在出院后 6 个月和 12 个月进行了生活质量和功能/残疾评估。使用经过验证的 EQ-5D-5L 和 WHODAS 2.0 工具来衡量生活质量和功能/残疾。使用广义估计方程方法评估从 6 个月到 12 个月的变化。使用逻辑回归模型确定每个时间点与持续存在问题相关的因素。
有 508 名严重受伤的患者符合 TSFU 计划的条件，在 6 个月和 12 个月的时间点，随访率均超过 80%。6 个月时，疼痛（69.9%）、焦虑和抑郁（49%）以及进行日常活动（57.5%）持续存在问题的情况非常普遍；12 个月时，疼痛（61.4%）和焦虑和抑郁（43.8%）持续存在。下肢和/或骨盆手术与疼痛、焦虑和抑郁以及进行日常活动的问题持续存在相关，其比值比（OR）分别为 3.77（95%CI 1.54-9.21，p=0.01）、1.95（95%CI 1.09-3.48，p=0.02）和 3.19（95%CI 0.75-13.5，p=0.11）。这些模式在 12 个月时大多仍然存在。在两个时间点，手术干预与高水平残疾之间也存在类似的关联。
严重创伤后，许多人仍然存在身体和情绪健康方面的持续损伤。创伤临床医生收集纵向健康结果，可以确定导致残疾和生活质量下降的因素。这反过来又可以推动医院创伤系统内的质量改进计划。纵向随访计划可能为出院后提供一个持续提供专业创伤知情护理的平台。
