A. Toppo6,7, J. P. Herrera-Escobar6, R. Manzano-Nunez6, J. B. Chang3, K. Brasel2, H. M. Kaafarani3, G. Velmahos3, G. Kasotakis5, A. Salim1, D. Nehra1, A. H. Haider1,6 1Brigham And Women’s Hospital,Division Of Trauma, Burn, & Surgical Critical Care,Boston, MA, USA 2Oregon Health And Science University,Department Of Surgery,Portland, OR, USA 3Massachusetts General Hospital,Division Of Trauma, Emergency Surgery, & Surgical Critical Care,Boston, MA, USA 5Boston University School Of Medicine,Division Of Acute Care, Trauma Surgery, & Surgical Critical Care,Boston, MA, USA 6Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 7Tufts University School Of Medicine,Boston, MA, USA
Introduction: We are increasingly aware of the fact that trauma patients that survive to hospital discharge often suffer from significant long-term consequences of their injury including physical disability, psychological disturbances, chronic pain and overall reduced quality of life. The recovery trajectory of traumatically injured patients is less well understood. In this study, we aim to describe the recovery trajectories of moderate-to-severely injured patients from 6 to 12 months after injury.
Methods: Adult trauma patients with moderate-to-severe injuries (ISS ≥ 9) admitted to one of three Level 1 Trauma Centers in Boston between 2016 and 2018 were contacted by phone at 6 and 12 months post-injury. Patients were asked to complete 12 item Short-Form Health (SF-12) survey to assess physical health, mental health, social functioning, and bodily pain, a validated Trauma Quality of Life (TQoL) questionnaire, and a screen for PTSD. This information was linked to the index hospitalization through the trauma registry. A longitudinal analysis was conducted to evaluate the change in outcomes between 6 and 12 months post-injury. Outcomes were also evaluated for gender and age (young < 65 years of age, old ≥ 65 years of age) subgroups.
Results: A total of 271 patients completed the phone screen at both 6 and 12 months post-injury. Overall, physical health improved significantly from six to twelve months post-injury (p < 0.001), but still remained well below the population norm (Figure 1A). Conversely, mental health was similar to the population norm at both 6 months and 12 months post-injury (Figure 1B). The elderly exhibited better social functioning than the young at both time points and remained within population norms. Young males experienced a significant improvement in social functioning over time, getting to the population norm by 12 months post-injury. Young females in contrast demonstrated no improvement in social functioning over time and remained well below population norms even 12 months post-injury (Figure 1C). Overall, 50% of patients reported having pain daily at 6 months post-injury and 75% of these patients continued to have daily pain 12 months post-injury. Looking at the SF-12 pain scores, only young females experienced significant improvement in bodily pain scores over time (Figure 1D). PTSD screens were positive for 20% of patients 6 months post-injury, and 76% still screened positive at 12 months.
Conclusion: The recovery trajectories of trauma patients between 6 and 12 months post-injury are not encouraging with minimal to no improvement in overall physical health, mental health, social functioning, and chronic pain. These recovery trajectories deserve further study so that appropriate post-discharge support services can be developed.
