OTA 2006 Posters
Scientific Poster #5 Polytrauma
Long-Term Outcome in 338 Polytrauma Patients: Are Trauma Factors Associated
with Mental Well-Being?
Christian Probst, MD1 (n); Lisa Haurisa, MD1
(n);
Hans W. Kuensebeck, MD2 (n); Christian Krettek, MD1
(n); Friedhelm Lamprecht, MD2 (n); Hans C. Pape, MD3
(n);
1Department of Traumatology, Hannover Medical School,
Hannover, Germany;
2Department of Psychiatry, Hannover Medical School, Hannover,
Germany;
3Department of Orthopaedic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania, USA
Purpose: Several short-term effects of multiple injuries on psychological
health including posttraumatic stress disorder (PTSD) are well known. However,
whether multiple trauma and its squeals attenuate the patients' mental well-being
in the long term is poorly described. We therefore investigated the long-term
outcome of multiple trauma patients in terms of psychological health.
Methods: We assessed 637 polytrauma patients (3-60 years) of our
level I trauma center with more than 10 years follow-up after trauma for
their rehabilitation status with the Hannover Score for Polytrauma Outcome
(HASPOC) and Short Form 12 (SF-12), and for mental disorders such as PTSD
or depression with the impact of event scale and the hospital anxiety and
depression scale.
Results: 338 questionnaires (53%) were included in the analysis.
Patients were re-assessed at 19 ± 5 years after polytrauma. The average
SF-12 psychological/physical was 50.8 ± 9.1/43.2 ± 10.2 points;
the average HASPOC was 50.5 ± 31.0 points. 154 patients showed symptoms
of PTSD or depression and 184 patients were mentally healthy, with significantly
more female (27.9% vs. 23.9%) and older patients (30.0 ± 12.2 vs.
26.9 ± 10.5 years) in the PTSD/depression group. We found a significantly
more severe head injury on the abbreviated injury scale (AIS; 2.9 ±
0.9 vs. 2.6 ± 0.8) in PTSD/depression vs. normal patients. PTSD/depression
patients had more secondary surgery (15.4% ± 26.8%), more psychological
counseling (25.5% vs. 10.9%), took more regular medication (30.2% vs. 9.8%),
and had more in-hospital rehabilitation therapies (66.4% vs. 51.4%). PTSD/
depression patients showed significant unsatisfactory rehabilitation (33.6%
vs. 11.4%), loss of friends (10.6% vs. 5.1%), prolonged time off the job
(16.1% vs. 9.7%), more early retirement (33.6% vs. 13.1%), and more financial
problems (54.4% vs. 36.6%).
Conclusion: A high percentage of patients remain psychologically
impaired for more than 10 years after polytrauma. Females and severe head
injuries may indicate an increased risk for mental impairment. The rate
of patients with socioeconomic and job-related problems associated to the
mental impairment is higher than reported by previous studies. This finding
suggests that patient care should not focus only on physical rehabilitation
but also on mental well-being.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.