肋骨骨折后患者报告的疼痛及心理健康症状的风险因素与解决方法。
Risk factors and resolution of patient-reported pain and mental health symptoms following rib fracture(s).
作者信息
Sundlof Madison, Switalla Kayla, Jones Emma K, Bahr Matthew, Doering Michael, Martin David, McCormick-Deaton John, Melton-Meaux Genevieve B, Tignanelli Christopher J
机构信息
From the Department of Surgery, University of Minnesota Medical School (M.S., K.S.); Department of Surgery (E.K.J., D.M., J.M.-D.), University of Minnesota; Fairview Health Services, Trauma Services, (M.B., M.D.); and Department of Surgery (G.B.M.-M., C.J.T.), Institute for Health Informatics (G.B.M.-M., C.T.), and Center for Learning Health System Sciences (G.B.M.-M., C.T.), University of Minnesota, Minneapolis, Minnesota.
出版信息
J Trauma Acute Care Surg. 2025 May 1;98(5):769-775. doi: 10.1097/TA.0000000000004529. Epub 2025 Jan 6.
BACKGROUND
Rib fractures, constituting 10% to 15% of trauma admissions, contribute significantly to morbidity and mortality. Effective postdischarge patient care remains a challenge. Our system has operationalized patient-reported outcome measures (PROMs) via a mobile platform into routine postdischarge monitoring for rib fracture patients. This study aimed to use PROMs to investigate the association between patient factors and postdischarge pain and mental health.
METHODS
We collected PROMs from nine Midwest trauma hospitals (2021-2022) using a mobile platform. The platform provided automated check-ins, education, health reminders, and 24/7 monitored interventions based on PROM responses. Multivariate logistic regression was used to investigate the association of patient factors for the primary outcome. The primary outcome was pain 2 weeks postdischarge (days 4-14). Secondary outcomes were mental health at 1 week, with long-term assessments at one and 3 months.
RESULTS
Of 72 patients, 55.6% reported moderate to severe pain at 2 weeks, with higher admission pain scores associated with increased pain (odds ratio, 1.69; 95% confidence interval, 1.15-2.5; p < 0.01). By 4 weeks, 29.4% of responding patients reported persistent moderate-to-severe pain, decreasing to 4.0% by 12 weeks. Patients with moderate-to-severe pain within the first 2 weeks also reported significantly higher rates of mental health symptoms at (44.8% vs. 16.7%) compared with mild pain. By weeks 4 and 12, mental health differences between pain groups were insignificant.
CONCLUSION
This study suggests a potential link between early pain and mental health symptoms. In addition, higher pain at admission may predict worse pain outcomes 2 weeks postdischarge. Patients in our cohort showed improvement in both pain and mental health symptoms within 4 to 12 weeks. These findings highlight the opportunity for PROMs and mobile apps to support optimal postdischarge follow-up and help minimize persistent pain, particularly for rib fracture patients with identifiable risk factors.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
背景
肋骨骨折占创伤入院病例的10%至15%，对发病率和死亡率有重大影响。出院后有效的患者护理仍然是一项挑战。我们的系统已通过移动平台将患者报告的结局指标（PROMs）应用于肋骨骨折患者的常规出院后监测。本研究旨在使用PROMs来调查患者因素与出院后疼痛和心理健康之间的关联。
方法
我们在2021年至2022年期间使用移动平台从九家美国中西部创伤医院收集了PROMs。该平台提供自动签到、教育、健康提醒以及基于PROMs回复的全天候监测干预措施。使用多变量逻辑回归来研究患者因素与主要结局之间的关联。主要结局是出院后2周（第4至14天）的疼痛情况。次要结局是1周时的心理健康状况，以及在1个月和3个月时的长期评估。
结果
在72名患者中，55.6%报告在2周时存在中度至重度疼痛，入院时疼痛评分较高与疼痛加剧相关（优势比为1.69；95%置信区间为1.15至2.5；p<0.01）。到4周时，29.4%的有回应患者报告持续存在中度至重度疼痛，到12周时降至4.0%。与轻度疼痛患者相比，在最初2周内有中度至重度疼痛的患者报告心理健康症状的比例也显著更高（44.8%对16.7%）。到第4周和第12周时，疼痛组之间的心理健康差异不显著。
结论
本研究表明早期疼痛与心理健康症状之间可能存在联系。此外，入院时疼痛程度较高可能预示出院后2周疼痛结局更差。我们队列中的患者在4至12周内疼痛和心理健康症状均有所改善。这些发现凸显了PROMs和移动应用程序在支持最佳出院后随访以及帮助将持续性疼痛降至最低方面的机会，特别是对于具有可识别风险因素的肋骨骨折患者。
证据级别
治疗/护理管理；三级。
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