J. P. Herrera-Escobar1, M. Apoj2, G. Kasotakis2,3, A. J. Rios-Diaz1, E. Lilley1, J. Appelson1, B. Gabbe4, K. Brasel5, E. Schneider1, H. Kaafarani6, G. Velmahos6, A. Salim1, A. H. Haider1 1Brigham And Women’s Hospital,Boston, MA, USA 2Boston University,Boston, MA, USA 3Boston Medical Center,Boston, MA, USA 4Monash University,Melbourne, VIC, Australia 5Oregon Health And Science University,Portland, OR, USA 6Massachusetts General Hospital,Boston, MA, USA
Introduction: The Institute of Medicine has recently called for incorporating long-term patient reported outcomes (PROs) to improve trauma care quality and increase patient-centeredness. In order to understand the value of collecting post-discharge PROs, we sought to describe the burden of self-reported pain at 6 and 12 months after injury, and determine its association with important PROs such as: Post-Traumatic Stress Disorder (PTSD), return to work, and new need of assistance at home.
Methods: Trauma patients with an ISS ≥9 were identified retrospectively using the institutional trauma registry of two Level I trauma centers and contacted 6 or 12 months post-injury to participate in a telephone interview evaluating PROs measures: Trauma and Health Related Quality of Life (T-QoL and Short Form-12 [SF-12]), PTSD screening (Breslau), return to work, and residential status. Multivariable logistic regression models clustered by facility and adjusting for confounders (age, sex, ISS, and length of stay) were used to obtain the odds of positive PTSD screening, not returning to work, and new need of assistance at home, in trauma patients who reported to have pain on a daily basis compared to those who did not.
Results: We conducted 305 interviews: 141 at 6 months and 164 at 12 months after injury. 48/52% (6/12 months) reported pain on a daily basis, 24/19% took pain medications daily, 47/48% were limited by pain in the things they are able to do, and 36/37% reported that pain moderately, quite a bit or extremely interfered with their normal work. There were no differences in age, gender, ISS, mechanism of injury, and length of stay between patients with and without pain on a daily basis at 6 and 12 months (all p>0.05). Compared to patients without pain, patients with pain at 6 months were more likely to screen positive for PTSD (OR: 1.92[1.28-2.88]), required assistance at home without prior need (OR: 2.86[1.82-4.48]), and did not return to work (OR: 2.85[2.46-3.30]). Similarly, at 12 months, patients with pain had higher odds of positive PTSD screening (OR: 5.95[3.87-9.15]) and requiring assistance at home without prior need (OR: 5.53[1.48-20.71]). However, we did not find a statistically significant difference in return to work compared to patients without pain (OR: 2.35[0.79-7.03])
Conclusion: There is an enormous amount of self-reported pain after trauma that is not being captured by current trauma registries that are limited to outcomes at discharge. Pain after trauma is associated with poor PROs such as positive PTSD screening, delayed return to work, and new need of assistance at home. Inclusion of long-term PROs in trauma registries will enable quality improvement that is more inclusive of all aspects of recovery after an injury.
