Resiliency and quality of life trajectories after injury.
Resiliency and quality of life trajectories after injury.
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DOI：
10.1097/ta.0000000000001415
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发表时间：
2017-05
期刊：
影响因子：
--
通讯作者：
Zanskas SA
中科院分区：
文献类型：
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作者：
Zarzaur BL;Bell TM;Zanskas SA
损伤会严重影响患者的长期生活质量。复原力是指一个人在面对压力或创伤后积极适应的能力。本研究的目的是探讨受伤前的弹性分数和受伤后的生活质量之间的关系。纳入了225名受伤严重程度评分> 10但没有神经损伤的成年人。在入院时进行SF-36评估，并在伤后1、2、4和12个月进行重复评估。Connor-Davidson复原力量表在入院时完成，分数分为高复原力或不高复原力。使用基于组的轨迹建模（GBTM）来识别SF-36的身体成分评分（PCS）和心理成分评分（MCS）的不同恢复轨迹。使用多项逻辑回归来确定基线弹性评分是否可预测PCS和MCS恢复轨迹。年龄、种族、性别、损伤机制、Charlson合并症指数、损伤严重程度评分、入院时低血压的存在和保险状况与高弹性无关。与年收入低于1万美元的人相比，年收入超过5万美元的人进入高弹性组的几率更高（OR 10.92，95% CI 2.58-46.32）。确定了3个PCS和5个MCS轨迹。恢复力与PCS轨迹之间没有关系。然而，具有高弹性得分的患者属于轨迹1的可能性降低了85%，轨迹1是研究过程中心理健康得分最低的轨迹。研究的随访率为：第1个月93.8%，第2个月82.7%，第4个月69.4%，第12个月63.6%。患者弹性预测受伤后的生活质量与心理健康有关，超过25%的患者患有不良的心理健康结果轨迹。努力向受伤的病人教授恢复力技能可以改善受伤病人的长期心理健康。创伤中心完全有能力进行这种干预。三级
Injury can greatly impact patients’ long-term quality of life. Resilience refers to an individual’s ability to positively adapt after facing stress or trauma. The objective of this study was to examine the relationship between pre-injury resiliency scores and quality of life after injury. 225 adults admitted with an injury severity score > 10 but without neurological injury were included. The SF-36 was administered at the time of admission and repeated at 1, 2, 4 and 12 months after injury. The Connor-Davidson Resilience Scale was completed at admission and scores were categorized into high resiliency or not high resiliency. Group based trajectory modeling was used (GBTM) to identify distinct recovery trajectories for physical component scores (PCS) and mental component scores (MCS) of the SF-36. Multinomial logistic regression was used to determine whether baseline resiliency scores were predictive of PCS and MCS recovery trajectories. Age, race, gender, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, presence of hypotension on admission, and insurance status were not associated with High Resiliency. Compared to those who made <$10,000 per year, those who made more than $50,000 per year had higher odds of being in the High Resilience group (OR 10.92, 95% CI 2.58–46.32). Three PCS and 5 MCS trajectories were identified. There was no relationship between resilience and PCS trajectory. However, patients with high resiliency scores were 85% less likely to belong to trajectory 1, the trajectory that had the lowest mental health scores over the course of the study. Follow-up for the study was 93.8% for month 1, 82.7% for month 2, 69.4% for month 4 and 63.6% for month 12. Patient resiliency predicts quality of life after injury in regards to mental health with over 25% of patients suffering poor mental health outcome trajectories. Efforts to teach resiliency skills to injured patients could improve long-term mental health for injured patients. Trauma centers are well positioned to carry out such interventions. Level III