H. J. ten Duis

Long-term outcome of equestrian injuries in children

Purpose:u2002To investigate the possible development of long-term disabilities arising from paediatric equestrian injuries. Method:u2002All patients, aged 17 years or younger, treated in a hospital setting because of an equestrian injury during a five-year period received a questionnaire. A reference population and healthy friends served as controls. Results:u2002Four years post-injury, 41 of the 100 respondents still experienced disabilities following the injury. The median Injury Severity Score was 4. Absenteeism from school lasted 2 weeks, and from horse riding, 4 months. Compared to the reference population, the results of the Child Health Questionnaire were poorer considering most of its subscales. In comparison with the friends, the patients only scored lower on ‘physical functioning’. The risk factors concerning poor long-term outcomes were being an advanced rider, sustaining injuries other than fractures of the extremities or sustaining subsequent injuries following the riding accident. Conclusions:u2002Although equestrian injuries in children are minor to moderate in their severity, these injuries are significant considering that a large proportion of patients experience long-term disabilities.

Long-term outcome of sports injuries: results after inpatient treatment

Objective: To investigate whether sports injuries result in long-term disabilities and handicaps and to establish variables with a prognostic value for the occurrence of these long-term consequences. Materials and methods: All patients older than 17 years of age and admitted to the University Hospital Groningen because of a sports injury were entered in the study. By filling in a questionnaire 1–4 years after the injury an inventory was made of the long-term consequences. Main outcome measures: Absenteeism from work and sports, experienced disabilities or handicaps and the Sickness Impact Profile 68 (SIP68). Results: Out of 306 patients 229 (75%) returned a completed questionnaire. Sixty-seven per cent of the working population had been unfit for work up to one year, whereas 4% still had not resumed work. Absenteeism from sports was also considerable; nearly half of the population did not participate in sports for more than a year. Furthermore, 32% of the patients still experienced disability or handicap following the injury. This finding is in agreement with the results of the SIP68 (odds ratio 6.8; confidence interval (95% CI): 3.51–13.08). Two prognostic variables could be distinguished: ‘gender’ and ‘type of sport’. Long-term consequences occur more often in women (p < 0.03) and with playing outdoor soccer, horse riding or skiing (p < 0.01). Conclusions: Sports injuries can lead to long-term disabilities and handicaps. The variables ‘gender’ and ‘type of sport’ were of prognostic significance.

Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment

SummaryTo improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care.IntroductionThe study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors.MethodsThis study included patients, aged 70xa0years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008.ResultsThe analysis demonstrated that the 1-year mortality rate was 23.2xa0% (nu2009=u2009197) in the CvGT group compared to 35.1xa0% (nu2009=u2009188) in the historical control group (pu2009<u20090.001). Independent risk factors for 1-year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4–5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1–2 OR 1.46, CCI 3–4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96).ConclusionAfter integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail elderly patients with a hip fracture compared to the historical control patients who were treated with standard care. The most important risk factors for 1-year mortality were male gender, increasing age, malnutrition, physical limitations, increasing BI, and medical conditions. Awareness of risk factors that affect the 1-year mortality can be useful in optimizing care and outcomes. Orthogeriatric treatment should be standard for elderly patients with hip fractures due to the multidimensional needs of these patients.

Long-term disabilities and handicaps following sports injuries : outcome after outpatient treatment

Purpose : The aim was to investigate whether long-term disabilities and handicaps arise from a sports injury requiring outpatient treatment and to identify the potential risk factors. Method : A representative sample was taken from a population of patients treated as outpatients due to a sports injury. The selected patients were sent a questionnaire, 2 - 5 years after the injury. Result : Thirty-nine percent of the patients studied were unable to work for up to 1 month after the injury, 19% were not able to work for up to 3 months and another 5% could not work for a maximum of 8 months. Participation in sporting activities was hampered for up to 1 year in 76% of the patients and 11% had not resumed sports participation at all. In addition, 20% of the population stated that they still suffered from disabilities and handicaps following the sports injury. The outcome of the SIP68 underlines these results. Nine percent of the patients had a sumscore larger than 0. The variables which could be identified as risk factors were the body region: knee and sex: female. Conclusions : Sports injuries requiring outpatient treatment can lead to long-term disabilities and handicaps, especially in patients with knee injuries and injuries in women. On average these consequences are less severe than those associated with inpatients; however, this finding is of great value since the number of outpatients is much higher than in patients admitted to a hospital.PURPOSEnThe aim was to investigate whether long-term disabilities and handicaps arise from a sports injury requiring outpatient treatment and to identify the potential risk factors.nnnMETHODnA representative sample was taken from a population of patients treated as outpatients due to a sports injury. The selected patients were sent a questionnaire, 2-5 years after the injury.nnnRESULTnThirty-nine percent of the patients studied were unable to work for up to 1 month after the injury, 19% were not able to work for up to 3 months and another 5% could not work for a maximum of 8 months. Participation in sporting activities was hampered for up to 1 year in 76% of the patients and 11% had not resumed sports participation at all. In addition, 20% of the population stated that they still suffered from disabilities and handicaps following the sports injury. The outcome of the SIP68 underlines these results. Nine percent of the patients had a sumscore larger than 0. The variables which could be identified as risk factors were the body region: knee and sex: female.nnnCONCLUSIONSnSports injuries requiring outpatient treatment can lead to long-term disabilities and handicaps, especially in patients with knee injuries and injuries in women. On average these consequences are less severe than those associated with inpatients; however, this finding is of great value since the number of outpatients is much higher than in patients admitted to a hospital.

Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment

IntroductionThis study aimed to evaluate the incidence of complications in elderly patients with a hip fracture following integrated orthogeriatric treatment. To discover factors that might be adjusted, in order to improve outcome in those patients, we examined the association between baseline patient characteristics and a complicated course.MethodsWe included patients aged 70xa0years and older with a hip fracture, who were treated at the Centre for Geriatric Traumatology (CvGT) at Ziekenhuisgroep Twente (ZGT) Almelo, the Netherlands between April 2011 and October 2013. Data registration was carried out using the clinical pathways of the CvGT database. Based on the American Society of Anesthesiologists (ASA) score, patients were divided into high-risk (HR, ASA 3 ≥, nu2009=u2009341) and low-risk (LR, ASA 1–2, nu2009=u2009111) groups and compared on their recovery. Multivariate logistic regression was used to identify risk factors for a complicated course.ResultsThe analysis demonstrated that 49.6% (nu2009=u2009224) of the patients experienced a complicated course with an in-hospital mortality rate of 3.8% (nu2009=u200917). In 57.5% (nu2009=u2009196) of the HR patients, a complicated course was seen compared to 25.2% (nu2009=u200928) of the LR patients. The most common complications in both groups were the occurrence of delirium (HR 25.8% vs. LR 8.1%, p ≤ 0.001), anemia (HR 19.4% vs. LR 6.3%, pu2009=u20090.001), catheter-associated urinary tract infections (CAUTIs) (HR 10.6% vs. LR 7.2%, pu2009=u20090.301) and pneumonia (HR 10.9% vs. LR 5.4%, pu2009=u20090.089). Independent risk factors for a complicated course were increasing age (OR 1.04, 95% CI 1.01–1.07, pu2009=u20090.023), delirium risk VMS Frailty score (OR 1.57, 95% CI 1.04–2.37, pu2009=u20090.031) and ASA score ≥3 (OR 3.62, 95% CI 2.22–5.91, p ≤ 0.001).ConclusionsAfter integrated orthogeriatric treatment, a complicated course was seen in 49.6% of the patients with a hip fracture. The in-hospital mortality rate was 3.8%. Important risk factors for a complicated course were increasing age, poor medical condition and delirium risk VMS Frailty score. Awareness of risk factors that affect the course during admission can be useful in optimizing care and outcomes. In the search for possible areas for improvement in care, targeted preventive measures to mitigate delirium, and healthcare-associated infections (HAIs), such as CAUTIs and pneumonia are important.

Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: A systematic review

IntroductionThe objective of this systematic review was to analyze (1) prevalence of radiological posttraumatic arthritisxa0(PA), (2) associations of PA with outcome measures and (3) predictors of PA following distal radius fractures in non-osteoporotic patients.Materials and methodsNineteen studies were included (10 open source data).ResultsIn total, 733 patients were described with a weighted mean age of 37xa0years (range 25–54) at the time of the injury. Follow-up ranged from 13xa0months to 38xa0years. Overall prevalence of PA was 50% and 37% in the open source data. Radial deviation was significantly worse in patients with PA (Nxa0=xa049, mean 14°, SD 6° versus Nxa0=xa055, mean 17°, SD 6°, pxa0=xa00.037). No analysis could be performed regarding patient reported outcome measures, because of limited data. Articular incongruence was a significant predictor for PA.ConclusionsA high prevalence of PA was found in non-osteoporotic patients following a distal radius fracture. PA following a distal radial fracture was associated with a limited radial deviation and flexion, but not with grip strength. Articular incongruence predicted PA. Patient reported outcome measures should be investigated more thoroughly to be able to understand the value of using these instruments in interpreting outcome in follow-up of non-osteoporotic patients following a distal radius fracture.Level of evidenceLevel of evidence 3 (Phillips et al. Levels of Evidence—Oxford Centre for Evidence-based Medicine, 1)