One-year functional outcomes following major trauma: experience of a UK level 1 major trauma centre

Ahmed, Wail; Alwe, Rupali; Wade, Derick T

doi:10.1177/0269215517712044

Cited by 14 publications

(15 citation statements)

References 21 publications

(31 reference statements)

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“…Our study also described the real-world functional outcome registry experience if majority of staff force made the calls during office hours. Our response rate at 12 months was lower than that of other countries (US 42%, UK 43%, Hong Kong 59%, and Australia 85.8%) [ 28 , 30 , 45 , 46 ]. Younger patients and foreign nationals were more likely to be non-responders [ 28 ].…”

Section: Discussioncontrasting

confidence: 75%

Predictors of Change in Functional Outcome at six months and twelve months after Severe Injury: A Retrospective Cohort Study

et al. 2018

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BackgroundThere is increasing focus on long-term survival, function and quality-of-life for trauma patients. There are few studies tracking longitudinal changes in functional outcome over time. The goal of our study was to compare the Glasgow Outcome Scale-Extended (GOSE) at 6 months and 12 months in blunt trauma survivors with an Injury Severity Score (ISS) of more than 15.MethodsUsing the Singapore National Trauma Registry 2011–2013, patients with 6-month GOSE and 12-month GOSE scores were analysed. Patients were grouped into three categories—those with the same score at 6 months and 12 months, an improvement in score, and a worse score at 12 months. Ordinal regression was used to identify risk factors for improved score. Patients with missing scores at either 6 months or 12 months were excluded.ResultsWe identified 478 patients: 174 had an improvement in score, 233 stayed the same, and 71 had worse scores at 12 months compared to 6 months. On univariate ordinal regression, the following variables were associated with same or better function at 12-months compared to 6-months: male gender, being employed pre-injury, thoracic Abbreviated Injury Scale (AIS) of 3 or more, anatomical polytrauma (AIS of 3 or more in 2 or more body regions), and road traffic injury mechanism. Older age, low fall, increasing Charlson comorbidity scores, new injury severity score, and head and neck AIS of 3 or more were associated with worse function at 12 months compared to 6 months. ISS and revised trauma score were not significant predictors on univariate or multivariable analysis.On multivariable ordinal regression, motor vehicle mechanism (OR 2.78, 1.51–5.12, p = 0.001) was associated with improved function, while male gender (OR 1.36, 95% CI 1.02–1.82, p = 0.039) predicted improved function at 12 months.ConclusionsFemales experience worse functional outcomes at 12 months, potentially due to majority of female injuries being low falls in the elderly. In contrast, motor vehicle injury patients had better functional outcomes at 12 months. Additional interventional strategies for high-risk groups should be explored.

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Section: Discussioncontrasting

confidence: 75%

Predictors of Change in Functional Outcome at six months and twelve months after Severe Injury: A Retrospective Cohort Study

et al. 2018

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“…Our utilities are from Ahmed et al, which is a survey in which 154 patients, whose ISS was 9 or more, completed the EQ-5D-5L questionnaire at an English MTC one year post-injury. [17] There was no evidence in this study that utility varied by ISS score. For patients with an ISS of 9 or more we applied these utilities multiplicatively to age-gender matched utilities for the UK general population.…”

Section: Utilitiesmentioning

confidence: 58%

“…A summary of the parameters used in the model. Mean age was 61 years and 59.1% of the analysis population was male in Ahmed et al[17] Utility multipliers, relative to the utility in the general population, for patients with: MTC admission, if ISS is less than 16 and over 8 £1,466Treatment of a patient with blunt trauma and an ISS in the range of:NB -distributions and the standard errors around each parameter are provided in the appendix local hospital -local hospital; MTC, major trauma centre; ISS, injury severity score…”

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confidence: 97%

An Economic Evaluation of Triage Tools For Patients With Suspected Severe Injuries In England

Pollard

Fuller

Goodacre

et al. 2021

Preprint

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BackgroundMany health care systems triage injured patients to major trauma centres (MTCs) or local hospitals by using triage tools and paramedic judgement. Triage tools are typically assessed by whether patients with an Injury Severity Score (ISS)≥16 go to an MTC and whether patients with an ISS<16 are sent to their local hospital. There is a trade‐off between sensitivity and specificity of triage tools, with the optimal balance being unknown. We conducted an economic evaluation of major trauma triage tools to identify which tool would be considered cost-effective by UK decision makers.MethodsA patient-level, probabilistic, mathematical model of a UK major trauma system was developed. Patients with an ISS≥16 who were only treated at local hospitals had worse outcomes compared to being treated in an MTC. Nine empirically derived triage tools, from a previous study, were examined so we assessed triage tools with realistic trade-offs between triage tool sensitivity and specificity. Lifetime costs, lifetime quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each tool and compared to maximum acceptable ICERs (MAICERs) in England. ResultsFour tools had ICERs within the normal range of MAICERs used by English decision makers (£20,000 to £30,000 per QALY gained). A low sensitivity (28.4%) and high specificity (88.6%) would be cost-effective at the lower end of this range while higher sensitivity (87.5%) and lower specificity (62.8%) was cost-effective towards the upper end of this range. These results were sensitive to the cost of MTC admissions and whether MTCs had a benefit for patients with an ISS between 9 and 15. ConclusionsThe cost-effective triage tool depends on the English decision maker’s MAICER for this health problem. In the usual range of MAICERs, cost-effective prehospital trauma triage involves clinically suboptimal sensitivity, with a proportion of seriously injured patients (at least 10%) being initially transported to local hospitals. High sensitivity trauma triage requires development of more accurate decision rules; research to establish if patients with an ISS between 9 and 15 benefit from MTCs; or, inefficient use of health care resources to manage patients with less serious injuries at MTCs.

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“…Besides potential reduction of physiological functions and psychological effects, trauma results in a spectrum of socioeconomic consequences on survivors. It can lead to the loss of employment, impede access to employment, and reduce job opportunities (6)(7)(8)(9). Trauma also affects social participation and having strong social support systems has shown to improve recovery (10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Measuring socioeconomic outcomes in trauma patients up to one year post-discharge: A systematic review and meta-analysis

David

Aroke

Roy

et al. 2022

Injury

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One-year functional outcomes following major trauma: experience of a UK level 1 major trauma centre

Abstract: A short simple questionnaire sent only once achieved a complete data set response rate of 43%. The outcome data are consistent with experience in other studies. Collection of data on specific functional outcomes might be most sensitive.

Cited by 14 publications

References 21 publications

Predictors of Change in Functional Outcome at six months and twelve months after Severe Injury: A Retrospective Cohort Study

Predictors of Change in Functional Outcome at six months and twelve months after Severe Injury: A Retrospective Cohort Study

An Economic Evaluation of Triage Tools For Patients With Suspected Severe Injuries In England

Measuring socioeconomic outcomes in trauma patients up to one year post-discharge: A systematic review and meta-analysis

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