Patient reported outcomes 6 to 12 months after interpersonal violence: A multicenter cohort study

Abstract

Violence continues to be a significant public health burden, but little is known about the long-term outcomes of these patients. Our goal was to determine the impact of violence-related trauma on long-term functional and psychosocial outcomes. METHODS:We identified trauma patients with moderate to severe injuries (Injury Severity Score, ≥9) treated at one of three level 1 trauma centers. These patients were asked to complete a survey over the phone between 6 and 12 months after injury evaluating both functional and psychosocial outcomes (12-item Short Form Survey, Trauma Quality of Life, posttraumatic stress disorder [PTSD] screen, chronic pain, return to work). Patients were classified as having suffered a violent injury if the mechanism of injury was a stab, gunshot, or assault. Self-inflicted wounds were excluded. Adjusted logistic regression models were built to determine the association between a violent mechanism of injury and long-term outcomes. RESULTS:A total of 1,050 moderate to severely injured patients were successfully followed, of whom 176 (16.8%) were victims of violence.For the victims of violence, mean age was 34.4 years (SD, 12.5 years), 85% were male, and 57.5% were Black; 30.7% reported newly needing help with at least one activity of daily living after the violence-related event. Fifty-nine (49.2%) of 120 patients who were working before their injury had not yet returned to work; 47.1% screened positive for PTSD, and 52.3% reported chronic pain. On multivariate analysis, a violent mechanism was significantly associated with PTSD (odds ratio, 2.57; 95% confidence interval, 1.59-4.17; p < 0.001) but not associated with chronic pain, return to work, or functional outcomes. CONCLUSION:The physical and mental health burden after violence-related trauma is not insignificant. Further work is needed to identify intervention strategies and social support systems that may be beneficial to reduce this burden.

Parameters influencing health-related quality of life after severe trauma: a systematic review (part II)

“…The majority of studies were conducted prospectively ( n = 52) [ 2 , 29 – 40 , 50 – 52 , 54 , 56 – 59 , 61 – 72 , 77 , 78 , 80 , 86 , 130 , 133 , 136 , 137 , 139 , 142 , 146 – 148 , 150 – 154 , 157 ] and in Germany ( n = 23) [ 35 , 39 , 41 – 44 , 51 , 52 , 57 , 62 – 65 , 71 , 73 – 75 , 79 , 80 , 83 , 86 , 152 , 154 ]. The average ISS in studies ranged from 9 to 57.…”

“… Age : In 38 studies [ 2 , 29 – 49 , 133 , 134 , 136 , 138 , 140 , 144 – 151 , 153 , 154 , 157 ], the relationship between age and HRQoL was reported. The majority of those studies ( n = 24) found a significant correlation with age, mainly indicating that older age was an independent predictor of reduced HRQoL [ 2 , 29 , 31 , 33 , 35 – 37 , 41 , 42 , 44 , 133 , 134 , 136 , 138 , 145 – 147 , 149 , 153 , 154 , 157 ], disablement [ 46 , 152 ], and use of pain medication [ 149 ]. In some studies, the cut-off age for poor HRQoL was further specified: worse HRQoL was demonstrated in patients ≥ 55 [ 31 , 138 , 150 ], ≥ 60 [ 29 ], > 65 [ 139 , 148 , 154 ] and > 80 years [ 146 , 147 ].…”

“… Type of trauma and mechanism of injury : In one study, blunt trauma predicted poor HRQoL 90 days after injury [ 35 ]. Other mechanisms of injuries that were associated with HRQoL deficits included pedestrian struck mechanisms [ 133 , 142 ], self-inflicted injuries [ 137 ], violent mechanisms, such as assault [ 142 , 157 , 158 ], work-related injuries [ 149 ], falls [ 149 ], and firearm injuries in comparison to cutting or piercing penetrating traumas [ 158 ]. Characteristics of diagnoses and physiological parameters : The number of diagnoses had no significant effect on HRQoL or disablement [ 46 , 77 ].…”

Health-related quality of life after severe trauma and available PROMS: an updated review (part I)

“…Impairments in everyday daily living activities were found in approximately one third of patients with severe trauma; almost half did not return to work and was diagnosed with PTSD [197]. Up to 12 months post-injury approximately half of the patients reported daily pain [184,197].…”