Deepika Nehra1, Juan P Herrera-Escobar, Syeda S Al Rafai, Joaquim Havens, Reza Askari, Stephanie Nitzschke, George Velmahos, George Kasotakis, Karen J Brasel, Nomi Levy-Carrick, Ali Salim, Adil Haider. 1. From the Division of Trauma, Burn and Surgical Critical Care, Department of Surgery (D.N., J.H., R.A., S.N., A.S., A.H.), Center for Surgery and Public Health (J.P.H-E., S.S.A.R., J.H., A.H.), Brigham and Women's Hospital, Harvard Medical School; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), Massachusetts General Hospital, Harvard Medical School; Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery (G.K.), Boston University School of Medicine, Boston, Massachusetts; Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery (K.J.B.), Oregon Health and Science University. Portland, Oregon; and Department of Psychiatry (N.L-C.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: Resilience, or the ability to cope with difficulties, influences an individual's response to life events including unexpected injury. We sought to assess the relationship between patient self-reported resilience traits and functional and psychosocial outcomes 6 months after traumatic injury. METHODS: Adult trauma patients 18 years to 64 years of age with moderate to severe injuries (Injury Severity Score, ≥9) admitted to one of three Level I trauma centers between 2015 and 2017 were contacted by phone at 6 months postinjury and asked to complete a validated Trauma Quality of Life (T-QoL) survey and PTSD screen. Patients were classified into "low" and "high" resilience categories. Long-term outcomes were compared between groups. Adjusted logistic regression models were built to determine the association between resilience and each of the long-term outcomes. RESULTS: A total of 305 patients completed the 6-month interview. Two hundred four (67%) of the 305 patients were classified as having low resilience. Mean age was 42 ± 14 years, 65% were male, 91% suffering a blunt injury, and average Injury Severity Score was 15.4 ± 7.9. Patients in the low-resilience group had significantly higher odds of functional limitations in activities of daily living (odds ratio [OR], 4.81; 95% confidence interval [CI], 2.48-9.34). In addition, patients in the lower resilience group were less likely to have returned to work/school (OR, 3.25; 95% CI, 1.71-6.19), more likely to report chronic pain (OR, 2.57; 95% CI, 1.54-4.30) and more likely to screen positive for PTSD (OR, 2.96; 95% CI, 1.58-5.54). CONCLUSION: Patients with low resilience demonstrated worse functional and psychosocial outcomes 6 months after injury. These data suggest that screening for resilience and developing and deploying early interventions to improve resilience-associated traits as soon as possible after injury may hold promise for improving important long-term functional outcomes. LEVEL OF EVIDENCE: Prognostic, level II.
BACKGROUND: Resilience, or the ability to cope with difficulties, influences an individual's response to life events including unexpected injury. We sought to assess the relationship between patient self-reported resilience traits and functional and psychosocial outcomes 6 months after traumatic injury. METHODS: Adult traumapatients 18 years to 64 years of age with moderate to severe injuries (Injury Severity Score, ≥9) admitted to one of three Level I trauma centers between 2015 and 2017 were contacted by phone at 6 months postinjury and asked to complete a validated Trauma Quality of Life (T-QoL) survey and PTSD screen. Patients were classified into "low" and "high" resilience categories. Long-term outcomes were compared between groups. Adjusted logistic regression models were built to determine the association between resilience and each of the long-term outcomes. RESULTS: A total of 305 patients completed the 6-month interview. Two hundred four (67%) of the 305 patients were classified as having low resilience. Mean age was 42 ± 14 years, 65% were male, 91% suffering a blunt injury, and average Injury Severity Score was 15.4 ± 7.9. Patients in the low-resilience group had significantly higher odds of functional limitations in activities of daily living (odds ratio [OR], 4.81; 95% confidence interval [CI], 2.48-9.34). In addition, patients in the lower resilience group were less likely to have returned to work/school (OR, 3.25; 95% CI, 1.71-6.19), more likely to report chronic pain (OR, 2.57; 95% CI, 1.54-4.30) and more likely to screen positive for PTSD (OR, 2.96; 95% CI, 1.58-5.54). CONCLUSION:Patients with low resilience demonstrated worse functional and psychosocial outcomes 6 months after injury. These data suggest that screening for resilience and developing and deploying early interventions to improve resilience-associated traits as soon as possible after injury may hold promise for improving important long-term functional outcomes. LEVEL OF EVIDENCE: Prognostic, level II.
Authors: Emily K Lenart; Tiffany K Bee; Catherine P Seger; Richard H Lewis; Dina M Filiberto; Dih-Dih Huang; Peter E Fischer; Martin A Croce; Timothy C Fabian; Louis J Magnotti Journal: Trauma Surg Acute Care Open Date: 2021-04-13