Outcome measurements in major trauma-Results of a consensus meeting
Outcome measurements in major trauma-Results of a consensus meeting
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DOI：
10.1016/j.injury.2012.05.008
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发表时间：
2012-10-01
影响因子：
2.5
通讯作者：
Willett, K.
中科院分区：
文献类型：
--
作者：
Ardolino, A.;Sleat, G.;Willett, K.
背景：英国国民健康保险制度结果框架已将重大损伤的康复确定为一个重要的临床领域。目前，没有既定的成果指标。随着越来越多的患者从重大创伤中幸存下来，结果将需要以发病率而不是死亡率来衡量。目的：为可纳入国家临床审计数据收集并成为地区创伤网络(RTN)临床治理要求的一部分以及政府追究RTN责任的措施的选择提出建议。重点放在成人和儿童的急性护理和康复上。方法：一个多专业、多学科的专家组在创伤审计和研究网络(TARN)和Cochrane损伤小组联合进行的系统审查的基础上，审查了目前关于成人和儿童人口中重大创伤结局衡量的证据。一项有组织的讨论涵盖了功能和生活质量结果指标，以及患者体验和指标，如重返工作岗位、教育和社会依赖。结果：对于成年人群，小组同意Tarn和Cochrane系统评估中建议的住院表现和出院措施。关于较长期的结果指标，该小组建议使用格拉斯哥结果扩展量表(GOS-E)和欧洲生活质量5D(EQ-5D)，并考虑世界卫生组织的生活质量调查(WHO-QOL)。对于有持续住院康复需求的患者，该组认为康复复杂性量表(RCS)和功能独立性测量(FIM)在全脑损伤中具有重要意义，美国脊髓损伤协会损伤量表(ASIA)和脊髓独立性测量(SCIM)在脊髓损伤中具有重要意义。对于儿童，该小组建议使用儿童头部损伤金氏结局量表(KOSCHI)和儿科生活质量量表(PEDS-QL)，最好在受伤后的多个时间间隔使用，以考虑对儿童发育的影响。结论：对成人和儿童严重创伤和创伤后有复杂康复需求的人使用结局测量提出了具体建议。需要在重大创伤的结果衡量方面开展更多工作，特别是对儿童而言。目前还没有用于重大创伤的患者体验的可靠衡量标准。该小组强调了数据联系的重要性，以便能够衡量非临床结果，如重返工作岗位、维持教育和社会依赖。记录结果的系统应该在受伤后以及6个月和12个月时试行，那些在这段时间后仍需要住院康复的人有更长的随访时间。(C)2012爱思唯尔有限公司。保留所有权利。
Background: The NHS Outcomes Framework for England has identified recovery from major injury as an important clinical area. At present, there are no established outcome indicators. As more patients survive major trauma, outcomes will need to be measured in terms of morbidity and not mortality alone.Objective: To make recommendations for a selection of outcome measures that could be integrated into National Clinical Audit data collection and form part of clinical governance requirements for Regional Trauma Networks (RTNs) and measures by which RTNs are held to account by government. Specific focus was given to acute care and rehabilitation for both adults and children.Method: A Multiprofessional, multidisciplinary expert group reviewed the current evidence on outcome measures for major trauma in the adult and children's populations, informed by a systematic review carried out jointly by the Trauma Audit and Research Network (TARN) and the Cochrane Injuries Group. A structured discussion covered functional and quality of life outcome measures as well as patient experience and indicators such as return to work, education and social dependency.Results: For the adult population the group agreed with the in-hospital performance and hospital discharge measures recommended in the TARN and Cochrane systematic review. Concerning longer-term outcome indicators, the group suggested the use of the Glasgow Outcome Scale - Extended (GOS-E) and European Quality of Life 5D (EQ-5D) with consideration to be given to the World Health Organisation Quality of Life survey (WHO-QoL). For patients who had ongoing inpatient rehabilitation needs the group thought the measurement of the Rehabilitation Complexity Scale (RCS) and Functional Independence Measure (FIM) were important in total brain injury and, the American Spinal Injury Association Impairment Scale (ASIA) and Spinal Cord Independence Measure (SCIM) in spinal cord injury. For children the group recommended the use of the King's Outcome Scale for Childhood Head Injury (KOSCHI) and Paediatric Quality of Life measure (Peds-QL) preferably at multiple intervals following injury to take into account effects on development.Conclusion: Specific recommendations were made for the use of outcome measures in adults and children with major trauma and those with complex rehabilitation needs following injury. More work on outcome measures in major trauma is needed especially for children. There are currently no robust measures of patient experience for use in major trauma. The importance of data linkage to allow measurement of non-clinical outcomes such as return to work, maintainence of education and societal dependency was emphasised by the group. A system for recording outcomes should be piloted post injury and at 6 and 12 months, with those still requiring inpatient rehabilitation after this time having longer follow up. (c) 2012 Elsevier Ltd. All rights reserved.