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Predictors of Late Clinical Outcome Following Orthopedic Injuries After Multiple Trauma

Pape, Hans-Christoph MD; Probst, Christian MD; Lohse, Ralf PhD; Zelle, Boris A. MD; Panzica, Martin MD; Stalp, Michael MD; Steel, Jennifer L. MD; Duhme, Heinrich M. MD; Pfeifer, Roman MD; Krettek, Christian MD; Sittaro, Nicola-Alexander MD

The Journal of Trauma: Injury, Infection, and Critical Care: November 2010 - Volume 69 - Issue 5 - p 1243-1251
doi: 10.1097/TA.0b013e3181ce1fa1
Original Article
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Background: The long-term clinical status of surviving patients with multiple injuries has not been well described. The aim of this study was to evaluate whether certain injury patterns predispose a patient to a poor clinical outcome 10 or more years after multiple injuries.

Methods: Patients who were treated at a level I trauma center at least 10 years before participation in this study were reinvited for a follow-up physical examination. Clinical outcome included the assessment of pain, gait, and various outcome scores (Short-Form [SF]-12, Lysholm, Merle D'Aubigne) were also used to measure outcome.

Statistics: Binary logistic regression was used to test predictors of physical and psychosocial outcomes 10 years or longer after trauma. Differences between the types of injury and outcomes were assessed using Mann-Whitney and Kruskal Wallis tests.

Results: Of 1,034, 637 patients (62%) participated in this study. Predictors of poor physical and psychosocial functioning using a clinical outcome score at 10 or more years follow-up included lower extremity amputation (odds ratio = 15.08; 95% confidence interval = 1.87–121.61) and a higher Abbreviated Injury Scale (AIS) spine score (SF-12 Mental subscale [odds ratio = 0.78; 95% confidence interval = 0.64–0.96]). Other factors associated with worse outcome scores were presence of two or more articular injuries, lower extremity injuries, and a combination of shaft and articular injuries.

Conclusion: If patients survived, traumatic lower extremity amputation and a high initial maximum AIS (MAIS) spine score was the only predictive parameter for an increased odds of adverse clinical outcomes late after trauma. Injuries associated with these outcomes should be the focus of attention regarding injury prevention and priority in care.

From the Department of Orthopaedic Trauma (H.-C.P.), University of Aachen Medical Center, Aachen, Germany; Department of Orthopaedic Trauma (C.P., M.P., C.K.), Hannover Medical School, Hannover, Germany; Medical Division (R.L., H.M.D., N.-A.S.), Hannover Life RE-Insurance, Hannover, Germany; Department of Orthopaedic Surgery (B.A.Z., R.P.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Trauma (M.S.), Sande General Hospital, Sande, Germany; and Division of Transplantation (J.L.S.), Department of Surgery and Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Submitted for publication June 14, 2009.

Accepted for publication December 4, 2009.

Supported by Hannover Life RE-Insurance, Medical Division, Hannover, Germany.

None of the authors has another conflict of interest with any other company or organization.

Address for reprints: Hans-Christoph Pape, MD, Orthopaedic Trauma, University of Aachen Medical Center, 30 Pauwels Street, Aachen, Germany; email: papehc@aol.com.

© 2010 Lippincott Williams & Wilkins, Inc.