Traumepatienten 1-2 år efter...

Transcription

1 Traumepatienten 1-2 år efter... Frederik Borup Danielsson, MD PhD-student University of Southern Denmark SDU Accident Analysis Group (UAG) Orthopaedic Research Unit, Dept. of Orthopaedic Surgery and Traumatology, Inst. of Clinical Institute Research of Clinical Research University University of Southern of Denmark

2 Background & Disclosures Accident Analysis Group (UAG) Department of Orthopaedic Surgery and Traumatology, Denmark University Of Southern Denmark SDU Odense, Denmark Department of Orthopaedic Surgery, SLB Kolding, a part of Hospital Lillebaelt, Denmark The danish foundation Tryg Fonden

3 Traumepatientens livskvalitet 1-2 år efter... Frederik Borup Danielsson, MD PhD-student University of Southern Denmark SDU Accident Analysis Group (UAG) Orthopaedic Research Unit, Dept. of Orthopaedic Surgery and Traumatology, Inst. of Clinical Institute Research of Clinical Research University University of Southern of Denmark

4 Considerations on importance in relation Outcome Frederik Borup Danielsson, MD PhD-student University of Southern Denmark SDU Accident Analysis Group (UAG) Orthopaedic Research Unit, Dept. of Orthopaedic Surgery and Traumatology, Inst. of Clinical Institute Research of Clinical Research University University of Southern of Denmark

5 Aspects of Severity

6 Aspects of Severity Jakola AS, Müller K, Larsen M, Waterloo K, Romner B, Ingebrigtsen T. Five-year outcome after mild head injury: a prospective controlled study. Acta Neurol. Scand Jun;115(6): Sluys K, Häggmark T, Iselius L. Outcome and quality of life 5 years after major trauma. J Trauma Jul;59(1): Gabbe BJ, Sutherland AM, Hart MJ, Cameron PA. Population-based capture of long-term functional and quality of life outcomes after major trauma: the experiences of the Victorian State Trauma Registry. J Trauma Sep;69(3): ; discussion 536. Haagsma JA, Polinder S, Olff M, Toet H, Bonsel GJ, Van Beeck EF. Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department. BMC Psychiatry. 2012;12:1. Ulvik A, Kvåle R, Wentzel-Larsen T, Flaatten H. Quality of life 2-7 years after major trauma. Acta Anaesthesiol Scand Feb;52(2):

7 Aspects of Severity What is Severely Injury? We as health professionals have one perception? A person not working in the health care system might have another perception? There is even a differences in perception in between health professionals!

8 Aspects of Severity Organ Destruction Mortality Yes No Survivor Time

9 Aspects of Severity Organ Destruction Mortality Yes No AIS- ISS- NISS- RISC- TRISS? Survivor Time

10 Grading TMPM trauma mortality prediction model 1. Association for the Advancement of Automotive Medicine. Abbreviated Injury Scale (AIS) 2005 Update Baker, S P, B O Neill, W Haddon Jr, and W B Long. The Injury Severity Score: a Method for Describing Patients with Multiple Injuries and Evaluating Emergency Care. The Journal of Trauma 14, no. 3 (March 1974): Osler, T, S P Baker, and W Long. A Modification of the Injury Severity Score That Both Improves Accuracy and Simplifies Scoring. The Journal of Trauma 43, no. 6 (December 1997): ; discussion Alan Cook, Jo Weddle, Susan Baker, David Hosmer, Laurent Glance, Lee Friedman, et al. A comparison of the Injury Severity Score and the Trauma Mortality Prediction Model. 2014;76(1):47 53.

11 Aspects of Outcome Primary outcome in most trauma registers still is mortality. Most will have a morbidity dimension GOS But what about the patient aspect of the outcome 1. Holbrook TL, Anderson JP, Sieber WJ, Browner D, Hoyt DB. Outcome after Major Trauma: Discharge and 6-Month Follow-Up Results from the Trauma Recovery Project. Journal of Trauma-Injury Infection. 1998;45(2):315 24

12 Assessment of Outcome Quality of life Quality of Well-being scale (QWB) Euro QOL SF12, SF 24 SF 36 Traume specifikt: Trauma Outcome Profile (TOP) Posttraumatic Stress Disorder (PTSD) Depression Occupation GOS 1. Holbrook TL, Anderson JP, Sieber WJ, Browner D, Hoyt DB. Outcome after Major Trauma: Discharge and 6-Month Follow-Up Results from the Trauma Recovery Project. Journal of Trauma-Injury Infection. 1998;45(2):315 24

13 Aspects of Outcome While the primary goal of trauma care continues to be the preservation of life, interest has begun to focus on disability and quality of life of those who survive. *. No consensus regarding which instruments to use. * Holbrook TL, Anderson JP, Sieber WJ, Browner D, Hoyt DB. Outcome after Major Trauma: Discharge and 6-Month Follow-Up Results from the Trauma Recovery Project. Journal of Trauma-Injury Infection. 1998;45(2):315 24

14 EQ-5D 1. EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy Amst Neth Dec;16(3): Brooks R. EuroQol: the current state of play. Health Policy Amst Neth Jul;37(1):53 72.

15 EQ-5D Ved en undersøgelse blandt en stor stikprøve af danskere efter standardiseret metode er det undersøgt, hvordan befolkningen ville vurdere livskvaliteten, hvis de selv var i de forskellige helbredstilstande EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy Amst Neth Dec;16(3): Brooks R. EuroQol: the current state of play. Health Policy Amst Neth Jul;37(1): Død: [0.000] Bevidstløs :[-0.293]

16 Case 1 20-årig mand indbragt med Falck efter solo TU : Basis skull fracture : Mandible fracture - body : Mandible fracture - angle : Pneumothorax : Lever laceration : Spleen laceration : Colon hematoma : Vertebral body burst fracture : Open distal radius fracture : Complex femur shaft fracture

17 Case 1 20-årig mand indbragt med Falck efter solo TU : Basis skull fracture : Mandible fracture - body : Mandible fracture - angle : Pneumothorax : Lever laceration : Spleen laceration : Colon hematoma : Vertebral body burst fracture : Open distal radius fracture : Complex femur shaft fracture Udskrives til Rehabilitering I regional regi. GOS: 3 ASA: 1 STATE: ISS: 22 NISS: 27

18 Case 1 20-årig mand indbragt med Falck efter solo TU : Basis skull fracture : Mandible fracture - body : Mandible fracture - angle : Pneumothorax : Lever laceration : Spleen laceration : Colon hematoma : Vertebral body burst fracture : Open distal radius fracture : Complex femur shaft fracture ISS: 22 NISS: 27 Udskrives til Rehabilitering I regional regi. GOS: 3 ASA: 1 STATE: Dk index EQ-5D = 1 Mean EQ-5D index score by gender, age group: SD EQ-VAS : 95

19 Case 1 20-årig mand indbragt med Falck efter solo TU : Basis skull fracture : Mandible fracture - body : Mandible fracture - angle : Pneumothorax : Lever laceration : Spleen laceration : Colon hematoma : Vertebral body burst fracture : Open distal radius fracture : Complex femur shaft fracture ISS: 22 NISS: 27 Udskrives til Rehabilitering I regional regi. GOS: 3 ASA: 1 Dk index EQ-5D = 1 Mean EQ-5D index score by gender, age group: SD EQ-VAS : 95 Efter 12 mdr.

20 Case 2 20-årig mand indbragt med Falck efter værtshus slagsmål. Stukket flere gange med kniv : Penetrating injury thorax, not involve internal structures : Pneumothorax : Penetrating injury below elbow ISS: 5 NISS: 6 Udskrives til Eget hjem. GOS: 5 ASA: 1 STATE: Dk index EQ-5D = Mean EQ-5D index score by gender, age group: SD EQ-VAS : 25

21 Case 2 20-årig mand indbragt med Falck efter værtshus slagsmål. Stukket flere gange med kniv : Penetrating injury thorax, not involve internal structures : Pneumothorax : Penetrating injury below elbow Udskrives til Eget hjem. GOS: 5 ASA: 1 Efter 12 mdr. ISS: 5 NISS: 6 Dk index EQ-5D = Mean EQ-5D index score by gender, age group: SD EQ-VAS : 25

22 QOL - in relation to Outcome measures

23 Measuring the Burden of Injuries Fatal Non-fatal Counts and rates Years of Potential Life Lost Health care use Hospitalization rates Functional limitations Severity AIS ICISS, etc Psychological limitation QoL - Qualy

24 HRQL What are we measuring? 34 studies from 755 studies were included 38 outcome measures were identified. only five were used in three or more studies Outcome measures used in major trauma capture only a small proportion of health impacts in relation to ICF. SF-36, EQ-5D, FIM, GOS, WHODAS-II, TOP Hoffman K, Cole E, Playford ED, Grill E, Soberg HL, Brohi K. Health Outcome after Major Trauma: What Are We Measuring? PLoS ONE Jul 22;9(7):e

25 Trauma patients QOL - in a danish setting Primary Aim: Measure the quality of life month after Multi Trauma. Measure symptoms of Posttraumatic Stress Disorder (PTSD) month after Multi Trauma. *Multi Trauma (MT): defined as received by trauma response team

26 Study Method A retrospective cohort study: Long-term follow-up (12-21 months) after Multi Trauma. Questionnaire package: EQ-5D-5L questionnaire. DSM-IV PCL-C questionnaire. Demographic Social and edcation (SUSY) *Multi Trauma (MT): defined as received by trauma response team

27 Follow Up

28 Data

29 Demographic

30 Results

31 Results

32 Results

33 Result s

34 Discussion Severity Grade principles ISS / AIS ICISS Looking at severity from an outcome perspective QOL - Considerations on importance in relation to Outcome measures Benefits Pittfalls Perspectives

35 Thank You!

36 Aspects of Outcome Mortality vs Morbidity 1. Holbrook TL, Anderson JP, Sieber WJ, Browner D, Hoyt DB. Outcome after Major Trauma: Discharge and 6-Month Follow-Up Results from the Trauma Recovery Project. Journal of Trauma-Injury Infection. 1998;45(2):315 24