Abstract | March 15, 2024

Patient-Reported Outcomes Provide Qualitative Insight into Patient Conditions in Trauma Patients

Caroline H. Clutton, BA, Medical Student, 2nd Year, University of South Alabama College of Medicine, Mobile, AL

Ashley Williams Hogue, MD, Assistant Professor of Surgery, Trauma & Acute Care Surgery and Burns, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL

Learning Objectives

  1. Be better prepared to examine factors that impact patient quality of life post traumatic injury and discuss possible opportunities for equity

Introduction: There is a wealth of medical literature examining quantitative outcomes like mortality and procedural success for traumatic injuries; however, there is not sufficient research investigating subjective outcomes like quality of life, including physical, social, and psychological factors that contribute to patient satisfaction after injury. This information is valuable to completely understand health outcomes. We hypothesize that there will be a difference in cumulative quality of life scores for trauma patients of different age, race, mechanism of trauma, insurance status, and length of stay in the hospital.

Methods: The study was conducted among adult trauma patients admitted to a level 1 trauma center from December 2022 to February 2023. Inclusion criteria included: 18 years of age or older, Glasgow Coma Score of 15 on arrival, English-speaking, discharged to home. Each patient who met inclusion criteria was administered a 12-question phone survey compiling questions from EuroQol-5-Dimension (EQ-5D), Three-Item Care Transition Measure (CTM-3), and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires. The responses were analyzed for correlation with age, race, mechanism of trauma, hospital length of stay, and insurance status. IRB approval was obtained.

Results: 302 patients were admitted for traumatic injuries during the date range studied. 180 of these patients met inclusion criteria. Of those, 12 refused participation, 2 were deceased, 3 were incarcerated. 24 had disconnected phone numbers. 105 were unable to be reached after 2 attempts. 34 surveys were completed. Of the factors analyzed, median cumulative CTM-3 scores were different by race (White 3[3-6] vs Black 6[5-6], p=0.010). EQ-5D and PROMIS were not significantly different. There was also a significant difference in median cumulative EQ-5D scores by insurance (BCBS 13[6-14.5] vs Medicare 6[5-11] vs Medicaid 7[7-11.5] vs Self Pay 16[13-19] vs Other 6[6-17], p=0.030). We calculated a p-value of 0.013 with Dunn’s posttest for Medicare vs Self Pay. Median cumulative CTM-3 and PROMIS scores were not significantly different. No other comparisons yielded statistically significant differences.

Conclusion: The data suggests that discharge readiness after traumatic injury differs based on race. This could be due to several factors including: cultural competency of provider, healthy literacy, education level, provider bias, or lack of patient-centered discharge. The results also suggest that insurance status may predict patient-reported physical ability after trauma.

References and Resources

  1. Sigune Kaske, Rolf Lefering, Heiko Trentzsch, Arne Driessen, Bertil Bouillon, Marc Maegele, Christian Probst, Quality of life two years after severe trauma: A single centre evaluation, Injury, Volume 45, Supplement 3, 2014, Pages S100-S105, ISSN 0020-1383, https://doi.org/10.1016/j.injury.2014.08.028. (https://www.sciencedirect.com/science/article/pii/S002013831400388X)
  2. Lavallee DC, Chenok KE, Love RM, Petersen C, Holve E, Segal CD, Franklin PD. Incorporating Patient-Reported Outcomes Into Health Care To Engage Patients And Enhance Care. Health Aff (Millwood).2016 Apr;35(4):575-82. doi: 10.1377/hlthaff.2015.1362. PMID: 27044954.
  3. Sakran JV, Ezzeddine H, Schwab CW, Bonne S, Brasel KJ, Burd RS, Cuschieri J, Ficke J, Gaines BA, Giacino JT, Gibran NS, Haider A, Hall EC, Herrera-Escobar JP, Joseph B, Kao L, Kurowski BG, Livingston D, Mandell SP, Nehra D, Sarani B, Seamon M, Yonclas P, Zarzaur B, Stewart R, Bulger E, Nathens AB; Patient Reported Outcome Consortium. Proceedings from the Consensus Conference on Trauma Patient- Reported Outcome Measures. J Am Coll Surg. 2020 May;230(5):819-835. doi: 10.1016/j.jamcollsurg.2020.01.032. Epub 2020 Mar 19. PMID: 32201197.
  4. Wihlke, Gunilla et al. “Long-Term Follow-up of Patients Treated for Traumatic Injury Regarding Physical and Psychological Function and Health-Related Quality of Life.” European Journal of Trauma and Emergency Surgery 47.1 (2021): 129–135. European Journal of Trauma and Emergency Surgery. Web.
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