Quality of life in severely injured patients depends on psychosocial factors rather than on severity or type of injury

Abstract Purpose In hospitalized patients, malnutrition is associated with adverse outcomes. However, the consequences of malnutrition in trauma patients are still poorly understood. This study aims to review the current knowledge about the pathophysiology, prevalence, and effects of malnutrition in severely injured patients. Methods A systematic literature review in PubMed and Embase was conducted according to PRISMA-guidelines. Results Nine review articles discussed the hypermetabolic state in severely injured patients in relation to malnutrition. In these patients, malnutrition negatively influenced the metabolic response, and vice versa, thereby rendering them susceptible to adverse outcomes and further deterioration of nutritional status. Thirteen cohort studies reported on prevalences of malnutrition in severely injured patients; ten reported clinical outcomes. In severely injured patients, the prevalence of malnutrition ranged from 7 to 76%, depending upon setting, population, and nutritional assessment tool used. In the geriatric trauma population, 7–62.5% were malnourished at admission and 35.6–60% were at risk for malnutrition. Malnutrition was an independent risk factor for complications, mortality, prolonged hospital length of stay, and declined quality of life. Conclusions Despite widespread belief about the importance of nutrition in severely injured patients, the quantity and quality of available evidence is surprisingly sparse, frequently of low-quality, and outdated. Based on the malnutrition-associated adverse outcomes, the nutritional status of trauma patients should be routinely and carefully monitored. Trials are required to better define the optimal nutritional treatment of trauma patients, but a standardized data dictionary and reasonable outcome measures are required for meaningful interpretation and application of results.

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Outcome in 134 patients with prolonged posttraumatic unawareness

Journal of Neurosurgery ◽

10.3171/jns.1990.72.1.0081 ◽

1990 ◽

Vol 72 (1) ◽

pp. 81-84 ◽

Cited By ~ 35

Author(s):

Zeev Groswasser ◽

Leon Sazbon

Keyword(s):

Daily Living ◽

Severely Injured ◽

Job Market ◽

Severely Injured Patients ◽

Behavioral Deficits ◽

Content Type ◽

Rehabilitation Period ◽

The Mean ◽

Injured Patients

✓ Most publications regarding the outcome of traumatic brain injury include patients with periods of unconsciousness of varying durations. The aim of the present paper is to describe the outcome of 72 patients who suffered from prolonged unawareness for more than 30 days and subsequently recovered consciousness. Almost half of the patients were independent in activities of daily living and another 20% were only partially dependent. Cognitive and behavioral deficits were the most common central nervous system sequelae of injury. Eight patients (11.1%) were able to resume working in the open job market and 35 (48.6%) were engaged in sheltered workshops. Most of the patients (72%), including all those who were working, were living with their families. Although the mean rehabilitation period was about 15 months, over 70% of these severely injured patients are considered to be socially integrated, enabling them to enjoy a reasonable quality of life.

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Psychosocial Factors and Oral Health Related Quality of Life of Patients with Generalized Aggressive Periodontitis

10.26226/morressier.5ac383252afeeb00097a424a ◽

2018 ◽

Author(s):

Esra Guzeldemir-Akcakanat

Keyword(s):

Quality Of Life ◽

Oral Health ◽

Psychosocial Factors ◽

Aggressive Periodontitis ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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The evolution of trauma care in the Netherlands over 20 years

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-019-01273-4 ◽

2019 ◽

Vol 46 (2) ◽

pp. 329-335 ◽

Cited By ~ 1

Author(s):

Falco Hietbrink ◽

Roderick M. Houwert ◽

Karlijn J. P. van Wessem ◽

Rogier K. J. Simmermacher ◽

Geertje A. M. Govaert ◽

...

Keyword(s):

The Netherlands ◽

Trauma Care ◽

Trauma System ◽

Trauma Surgeon ◽

Severely Injured ◽

Severely Injured Patients ◽

The Past ◽

Level 1 ◽

Trauma Surgeons ◽

Injured Patients

Abstract Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a region-wide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

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The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01615-1 ◽

2021 ◽

Author(s):

Suzan Dijkink ◽

Erik W. van Zwet ◽

Pieta Krijnen ◽

Luke P. H. Leenen ◽

Frank W. Bloemers ◽

...

Keyword(s):

The Netherlands ◽

Trauma Care ◽

Trauma System ◽

Future Research ◽

Severely Injured ◽

Trauma Centers ◽

Severely Injured Patients ◽

The Right ◽

Injured Patients ◽

The Impact

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

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The (Absence of a) Role of Venous Duplex Scan in the Diagnosis of Pulmonary Embolism after Severe Trauma

The American Surgeon ◽

10.1177/000313480607200102 ◽

2006 ◽

Vol 72 (1) ◽

pp. 7-10

Author(s):

George C. Velmahos ◽

Carlos V. Brown ◽

Demetrios Demetriades

Keyword(s):

Intensive Care Unit ◽

Pulmonary Embolism ◽

Intensive Care ◽

Sensitivity And Specificity ◽

Clinical Suspicion ◽

Severely Injured ◽

Duplex Scan ◽

Severely Injured Patients ◽

High Level ◽

Injured Patients

Venous duplex scan (VDS) has been used for interim bedside diagnosis of pulmonary embolism (PE) in severely injured patients deemed to be at risk if transported out of the intensive care unit. In combination with the level of clinical suspicion for PE, VDS helps select patients for temporary treatment until definitive diagnosis is made. We evaluate the sensitivity and specificity of VDS in critically injured patients with a high level of clinical suspicion for PE. We performed a prospective observational cohort study at the surgical intensive care unit of an academic level 1 trauma center. Patients were 59 critically injured patients suspected to have PE over a 30-month period. The level of clinical suspicion for PE was classified as low or high according to preset criteria. Interventions were VDS and a PE outcome test (conventional or computed tomographic pulmonary angiography). The sensitivity and specificity of VDS to detect PE in all patients and in patients with high level of clinical suspicion was calculated against the results of the outcome test. PE was diagnosed in 21 patients (35.5%). The sensitivity and specificity of VDS was 33 per cent and 89 per cent, respectively. Among the 28 patients who had a high level of clinical suspicion for PE, the sensitivity of VDS was 23 per cent and the specificity 93 per cent. In this latter population, 1 of the 4 (25%) positive VDS was of a patient without PE and 10 of the 24 (42%) negative VDS were of patients who had PE. VDS does not accurately predict PE in severely injured patients, even in the presence of a high level of clinical suspicion.

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