Return to Work and Functional Outcomes After Major Trauma: Who Recovers, When, and How Well?
Return to Work and Functional Outcomes After Major Trauma: Who Recovers, When, and How Well?
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DOI：
10.1097/sla.0000000000001564
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发表时间：
2016-04-01
影响因子：
9
通讯作者：
Cameron, Peter A.
中科院分区：
文献类型：
--
作者：
Gabbe, Belinda J.;Simpson, Pamela M.;Cameron, Peter A.
背景：随着创伤相关死亡率的降低，提高生存质量和减轻非致命性伤害负担日益受到重视。方法：对2007年7月至2012年6月在澳大利亚维多利亚州受伤的成年重大创伤幸存者出院后6个月、12个月和24个月进行随访，以测量功能(格拉斯哥结果量表扩展)和重返工作/学习。结果：在8844名幸存者中，有8128人(92%)获得了随访。此外，23%的患者功能恢复良好，70%的患者在24个月后重返工作/学习岗位。与6个月相比，12个月时功能改善的调整后优势比为27%(调整后优势比1.27，95%可信区间为1.19~1.36)；24个月时调整后优势比为9%(调整后优势比1.09，95%可信区间1.02~1.17)。12个月重返工作岗位的调整后相对危险度(RR)比6个月高14%(调整后RR为1.14，95%CI，1.12-1.16)，24个月时比12个月高8%(调整后RR为1.08，95%CI，1.06-1.10)。康复轨迹因患者特征不同而不同，为预测和服务规划提供有价值的信息，并提高我们对非致命性损伤负担的理解。
Objective:To describe the long-term outcomes of major trauma patients and factors associated with the rate of recovery.Background:As injury-related mortality decreases, there is increased focus on improving the quality of survival and reducing nonfatal injury burden.Methods:Adult major trauma survivors to discharge, injured between July 2007 and June 2012 in Victoria, Australia, were followed up at 6, 12, and 24 months after injury to measure function (Glasgow Outcome ScaleExtended) and return to work/study. Random-effects regression models were fitted to identify predictors of outcome and differences in the rate of change in each outcome between patient subgroups.Results:Among the 8844 survivors, 8128 (92%) were followed up. Also, 23% had achieved a good functional recovery, and 70% had returned to work/study at 24 months. The adjusted odds of reporting better function at 12 months was 27% (adjusted odds ratio 1.27, 95% confidence interval [CI] 1.19-1.36) higher compared with 6 months, and 9% (adjusted odds ratio 1.09, 95% CI, 1.02-1.17) higher at 24 months compared with 12 months. The adjusted relative risk (RR) of returning to work was 14% higher at 12 months compared with 6 months (adjusted RR 1.14, 95% CI, 1.12-1.16) and 8% (adjusted RR 1.08, 95% CI, 1.06-1.10) higher at 24 months compared with 12 months.Conclusions:Improvement in outcomes over the study period was observed, although ongoing disability was common at 24 months. Recovery trajectories differed by patient characteristics, providing valuable information for informing prognostication and service planning, and improving our understanding of the burden of nonfatal injury.