Quality of life in severely injured patients depends on psychosocial factors rather than on severity or type of injury

Background

Former studies have demonstrated that health-related quality of life is decreased in severely injured patients. However, in those studies patients were asked about their functioning and not about their (dis)contentment concerning their functioning. Little is known about how severely injured patients experience their quality of life (QOL). The objective of this cross-sectional study was to measure this subjective QOL of severely injured patients after their rehabilitation phase and to examine which accident- and patient-related factors affect the QOL of these patients.

Methods

Patients of 18 years or older with an injury severity score (ISS) above 15 were included 15–53 months after their accident. Comorbidity before the accident, accident and sociodemographic characteristics, and QOL were obtained from the trauma registry and questionnaires. The WHOQOL-BREF was used to measure QOL. A reference group of the Dutch general population was used for comparison.

Results

The participation rate was 61% (n = 173). Compared with the reference data, severely injured patients experienced a significantly worse QOL in all domains except social relations. The QOL scores were significantly decreased in all domains for patients with intracranial injury in combination with other injuries. Patients with a severe intracranial injury (AIS > 3) only reported significantly impaired QOL in the general and physical domains. Patients who resumed working or lived with others had significantly higher scores in all domains of QOL than patients who did not work anymore or were living alone. Significantly lower QOL scores were obtained from patients with comorbidity before the accident and from patients with longer durations of intensive care unit (ICU) treatment or hospitalisation. Gender, accident characteristics and time since the accident did not appear to be important for experienced QOL.

Conclusions

The experience of impaired QOL appears to depend on living alone, inability to return to work and pre-accidental comorbidity rather than on the injured body area or the severity of the injury. Duration of hospital or ICU stay is important to subsequent QOL, even if ISS or body region is not.     

Paediatric trauma systems and their impact on the health outcomes of severely injured children: An integrative review

BackgroundInjury is a leading cause of death and disability for children. Regionalised trauma systems have improved outcomes for severely injured adults, however the impact of adult orientated trauma systems on the outcomes of severely injured children remains unclear.AimsThis research aims to identify the impact of trauma systems on the health outcomes of children following severe injury.MethodsIntegrative review with data sourced from Medline, Embase, CINAHL, Scopus and hand searched references. Abstracts were screened for inclusion/exclusion criteria with fifty nine articles appraised for quality, analysed and synthesised into 3 main categories.ResultsThe key findings from this review include: (1) a lack of consistency of prehospital and inhospital triage criteria for severely injured children leading to missed injuries, secondary transfer and poor utilisation of finite resources; (2) severely injured children treated at paediatric trauma centres had improved outcomes when compared to those treated at adult trauma centres, particularly younger children; (3) major causes of delays to secondary transfer are unnecessary imaging and failure to recognise the need for transfer; (4) a lack of functional or long term outcomes measurements identified in the literature.ConclusionsResearch designed to identify the best processes of care and describe the impacts of trauma systems on the long term health outcomes of severely injured children is required. Ideally all phases of care including prehospital, paediatric triage trauma criteria, hospital type and interfacility transfer should be included, focusing on timeliness and appropriateness of care. Outcome measures should include long term functional outcomes in addition to mortality.     

The impact of diabetes on outcome in traumatically injured patients: an analysis of the National Trauma Data Bank

BACKGROUND: Studies on stress hyperglycemia in trauma patients have largely ignored diabetes, a potential confounder. The purpose of this study was to assess the relationship between diabetes and outcome in trauma patients. METHODS: Data were obtained from the National Trauma Data Bank (version 4.0). The primary outcome measures were mortality and infections. Age, injury severity, and comorbidities were analyzed as independent variables using logistic regression. RESULTS: A total of 343,250 patients were analyzed, of whom 2.7% were diabetic. On multivariate analysis, insulin-dependent diabetes was an independent although weak predictor of infectious morbidity and intensive care unit length of stay. However, diabetes was not associated with mortality or hospital length of stay. Age and injury severity were the main predictors for all outcome measures. CONCLUSIONS: Diabetes was an independent, although weak, risk factor for infectious complications in trauma patients. Age and injury severity were the most important predictors of outcome.     

The association of insurance status and race with the procedural volume of traumatic brain injury patients

IntroductionThe influence of non-medical factors on the volume of procedures undergone by TBI patients remains an issue of debate. We investigated the association of lack of insurance and African-American race with the procedural volume of TBI patients.MethodsWe performed a retrospective cohort study involving TBI patients, who were registered in the National Trauma Data Bank (NTDB) between 2009 and 2011. Multivariable logistic regression with mixed effects to control for clustering at the hospital level was used to investigate the association of insurance status and race with high volume of procedures for TBI patients.ResultsOf the 392,292 TBI patients, who were registered in NTDB and met the inclusion criteria, 9850 (3.8%) underwent high procedural volume, defined as 2 or more procedures during hospitalization (2 standard deviations over the mean). Multivariable logistic regression analysis demonstrated an association of uninsured patients with decreased possibility of high procedural volume (OR, 0.68; 95% CI, 0.63–0.73). This persisted after using a mixed effects model to control for clustering at the hospital level (OR, 0.66; 95% CI, 0.61–0.71). In stratified samples, uninsured patients demonstrated similar associations even for GCS below 8 (OR, 0.69; 95% CI, 0.64–0.75), or ISS above 15 (OR, 0.74; 95% CI, 0.69–0.79). Multivariable logistic regression analysis did not demonstrate an association of African Americans with procedural volume (OR, 0.93; 95% CI, 0.86–1.02).ConclusionsDuring the hospitalization of TBI patients, lack of insurance was associated with lower procedural volume. When controlling for insurance status, we did not observe any race associated disparities in procedural volume.