No abstract

Objectives The purpose of this study was to determine whether pain at hospital discharge is associated with general health and depression and post-traumatic stress disorder (PTSD) at 1 year following traumatic orthopaedic injury. Methods This study prospectively enrolled 213 patients, 19 to 86 years of age, admitted to an Academic Level 1 trauma center for surgical treatment of a traumatic lower-extremity or upper-extremity orthopaedic injury. Pain at hospital discharge was measured with the Brief Pain Inventory. At 1 year follow-up, physical and mental health was assessed with the SF-12 and depressive and PTSD symptoms with the 9-item Patient Health Questionnaire (PHQ-9) and PTSD Checklist-Civilian Version (PCL-C), respectively. Cut-of scores of 10 on the PHQ-9 and 44 on the PCL-C classified patients as having depression or PTSD. Results 133 patients (62%) completed follow-up at 1 year. Responders and non responders did not differ significantly on baseline characteristics. Multivariable regression found that increased pain at discharge was significantly associated with depression (OR = 3.3; p < 0.001) and PTSD (OR = 1.4; p = 0.03) at 1 year, after controlling for age, education, injury severity score, and either depressive or PTSD symptoms at hospital discharge. Early postoperative pain was not a significant risk factor for long-term physical and mental health. Discussion Findings highlight the importance of early screening for uncontrolled postoperative pain to identify patients at high risk for poor psychological outcomes and who could benefit from more aggressive pain management. Results suggest early interventions are needed to address pain severity in patients with orthopaedic trauma.

No abstract

BACKGROUND:The Trauma Survivors Network (TSN), a program developed to help patients and families manage the psychosocial impact of their injuries, combines information access, self-management training, peer support, and online social networking. The purpose of this study was to evaluate the effectiveness of the TSN in improving patient reported outcomes among orthopedic trauma patients at a Level I trauma center. METHODS:We prospectively enrolled 251 patients with either severe lower-extremity injuries or polytrauma in two cohorts: one group (n = 125) before implementation of the TSN and one group (n = 126) after implementation. Participants were interviewed during their initial hospital stay and at 6 months. Outcomes evaluated at 6 months included depression, anxiety, self-efficacy, health status, and patient activation. RESULTS:Participation in the individual components of the TSN was low, ranging between 3% for the NextSteps self-management program and 27% for receipt of the Patient and Family Handbook. There were no statistically significant differences between treatment and control groups in self-efficacy, anxiety, health status, or activation. There were statistically significant differences in depression (24% of patients with probable depression in the TSN group vs. 40% in the control group, p = 0.02). However, the groups were not balanced with respect to sex, education, and baseline social support. After controlling for these differences, the TSN group still had 49% lower odds (95% confidence interval, 0% to 74%) of depression ( p = 0.05). CONCLUSION:The TSN represents a potentially important step toward the development of comprehensive psychosocial support programs for trauma survivors. Despite improvements in one important outcome, a key finding of this evaluation is the low rate of use of program components. This finding highlights the need for greater understanding of use barriers and efforts to increase adoption. (J Trauma Acute Care Surg. 2013;74: 1534Y1540.