Outcome after major trauma: Discharge and 6-month follow-up results from the trauma recovery project
Outcome after major trauma: Discharge and 6-month follow-up results from the trauma recovery project
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DOI：
10.1097/00005373-199808000-00018
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发表时间：
1998-08-01
影响因子：
--
通讯作者：
Hoyt, DB
中科院分区：
文献类型：
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作者：
Holbrook, TL;Anderson, JP;Hoyt, DB
背景：由于复杂创伤护理系统的发展提高了患者的存活率，对重大创伤后短期和长期预后的研究已成为损伤研究的一个日益重要的焦点。创伤恢复项目（TRP）是一项大型前瞻性流行病学研究，旨在检查18岁及以上成人重大创伤后的多种结局，包括生活质量、功能结局和心理后遗症，如抑郁症和创伤后应激障碍（PTSD）。患者在出院时以及出院后6、12和18个月进行结局评估。本报告的具体目标是描述出院时的功能结果和TRP人群6个月的随访时间点，并检查假定的危险因素与功能结果的关系。方法：1993年12月1日至1996年9月1日，1048名符合条件的创伤患者被分为圣地亚哥区域化创伤系统的四家创伤中心医院纳入TRP研究。患者的入院标准为：(1)年龄≥18岁；(2)入院时格拉斯哥昏迷量表评分≥12分；(3)住院时间≥24小时。创伤后的功能结果使用健康质量（QWB）量表测量，这是一个对功能连续体的良好末端更敏感的指标（范围，0 =死亡至1.000 =最佳功能）。功能结果也使用标准日常生活活动（ADL）量表（范围，13 =完全功能至47 =最大功能障碍）进行测量，出院后6个月随访826例患者（79%）。结果：平均年龄36±14.8岁；70%的患者为男性；52%的患者是白人，30%是西班牙裔，18%是黑人或其他人种，不到40%的研究参与者已婚或与伴侣同居。平均损伤严重程度评分为13 +/- 8.5，其中85%为钝性损伤，平均住院时间为7 +/- 9.2天。损伤前的QWB评分反映了健康成年人的标准（平均值0.810±0.171）。严重创伤后，出院时的QWB评分显示出明显程度的功能限制（平均0.401 +/- 0.045）。在6个月的随访中，QWB评分继续显示高水平的功能限制（平均值0.633 +/- 0.122）。使用标准ADL量表测量的限制仅在出院时（平均30.0 +/- 7.7）和6个月随访时（平均15.0 +/- 4.2）发现中度功能障碍。伤后抑郁、创伤后应激障碍、严重肢体损伤和住院时间是6个月QWB结果的显著独立预测因素。结论：损伤后功能限制是创伤患者出院及随访6个月时的重要临床并发症。与传统的ADL仪器相比，QWB对功能状态的评估更为敏感。损伤后抑郁、创伤后应激障碍、严重肢体损伤和住院时间与6个月QWB结果显著相关。
Background: The study of both short-term and long-term outcomes after major trauma has become an increasingly important focus of injury research because of the improved survival rates attributable to the evolution of sophisticated trauma care systems. The Trauma Recovery Project (TRP) is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma in adults aged 18 years and older, including quality of life, functional outcome, and psychologic sequelae such as depression and posttraumatic stress disorder (PTSD), Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. The specific objectives of the present report are to describe functional outcomes at the discharge and 6-month follow-up time points in the TRP population and to examine the association of putative risk factors with functional outcome.Methods: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the TRP study. The admission criteria for patients were as follows: (1) age 18 years or older, (2) Glasgow Coma Scale score on admission of 12 or greater, and (3) length of stay greater than 24 hours. Functional outcome after trauma was measured before and after injury using the Quality of Well-Being (QWB) scale, a more sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Functional outcome was also measured using a standard activities of daily living (ADL) scale (range, 13 = full function to 47 = maximum dysfunction), Follow-up at 6 months after discharge was completed for 826 patients (79%).Results: The mean age was 36 +/- 14.8 years; 70% of the patients were male; 52% of the patients were white, 30% were Hispanic, and 18% were black or other, Less than 40% of study participants were married or living with a partner. The mean Injury Severity Score was 13 +/- 8.5, with 85% blunt injuries, and a mean length of stay of 7 +/- 9.2 days. QWB scores before injury reflected the norm for a healthy adult population (mean, 0.810 +/- 0.171). After major trauma, QWB scores at discharge showed a significant degree of functional limitation (mean, 0.401 +/- 0.045). At 6-month follow-up, QWB scores continued to show high levels of functional limitation (mean, 0.633 +/- 0.122). Limitation measured using the standard ADL scale found only moderate dysfunction at discharge (mean, 30.0 +/- 7.7) and at 6-month follow-up (mean, 15.0 +/- 4.2). Postinjury depression, PTSD, serious extremity injury, and length of stay were significant independent predictors of 6-month QWB outcome.Conclusion: Postinjury functional limitation is a clinically significant complication in trauma patients at discharge and a 6-month follow-up. The QWB yields a more sensitive assessment of functional status than traditional ADL instruments. Postinjury depression, PTSD, serious extremity injury, and length of stay are significantly associated with 6-month QWB outcome.