Melissa J. Hart

Population-based capture of long-term functional and quality of life outcomes after major trauma: the experiences of the Victorian State Trauma Registry.

Improved survival rates for trauma patients has placed a greater emphasis on determining the morbidity associated with injury, including the degree of functional loss, ongoing disability, and lost quality of life experienced by survivors.1–3 Improvements in trauma care in advanced trauma systems have the potential to influence morbidity rather than mortality; however, there is no systematic approach to measuring morbidity after injury and, therefore, no possibility of meaningfully benchmarking improvements. Anecdotally, a major impediment in measuring injury-related morbidity has been a belief that it is not feasible. Collection of long-term outcomes data are necessary to establish the impact of the injury problem, evaluate treatment approaches, inform injury prevention research, and improve public health program planning. Despite acknowledgment that the greatest cost burden of injury is related to morbidity, routine measurement of injury outcomes other than mortality is rare. Existing surveillance systems such as hospital admission datasets and trauma registries fail to include long-term outcome measures. Cost, institutional ethics approval, selection of instruments, and mode of administration are the barriers toward the collection of long-term outcomes data. These barriers are not insurmountable. This article outlines the approach taken by the Victorian State Trauma Registry (VSTR) in Australia to address these issues and implement routine, population-based follow-up of adult trauma survivors.

Patient perspectives of care in a regionalised trauma system: lessons from the Victorian State Trauma System.

Objectives: To explore injured patients’ experiences of trauma care to identify areas for improvement in service delivery.

Level of agreement between patient and proxy responses to the EQ-5D health questionnaire 12 months after injury

BACKGROUND: Health-related quality of life represents a patients experiences and expectations and should be collected from the patient. In trauma, collection of information from the patient can be challenging, particularly for subgroups where cognitive impairment is prevalent, increasing reliance on proxy reporting. This study assessed the agreement between patient and proxy reporting of health-related quality of life 12 months after injury. METHODS: The Victorian State Trauma Registry and Victorian Orthopaedic Trauma Outcomes Registry collect EQ-5D data at 12 months after injury. Cases where data were collected from the patient and proxy were extracted. Agreement between patient and proxy responses was compared using kappa (K) coefficients for the individual EQ-5D items, and Bland-Altman plots and Wilcoxon signed-rank tests for the EQ-5D summary score and visual analog scale (VAS). RESULTS: Agreement between patient and proxy respondents was substantial for the mobility (K = 0.61) and personal care items (K = 0.67) and moderate for the usual activities (K = 0.50), pain/discomfort (K = 0.42), and anxiety/depression items (K = 0.47). The mean difference between proxy and patient-reported scores for the VAS (0.74, 95% confidence interval: −2.73, 4.21) and the EQ-5D summary score (−0.02, 95% confidence interval: −0.07, 0.03) was small, but the limits of agreement were wide (−34.22 to 35.71 for VAS and −0.55 to 0.51 for summary score), suggesting no systematic bias. CONCLUSIONS: Although proxy and patient responses for the EQ-5D VAS may differ, the differences show random variability rather than systematic bias. Group comparisons using proxy responses are unlikely to be biased, but proxy responses should be used with caution when assessing individual patient recovery.

Does recall of preinjury disability change over time

Background Pre-injury disability must be determined when assessing whether treatment programs return people to pre-injury status, however there is little empirical evidence to support recommendations that this be done as soon as possible after injury to prevent recall bias. Objectives To determine disagreement between recall of pre-injury disability at different time points post-injury and bias towards under- or overestimating pre-injury disability. Methods Self-reported pre-injury global disability was assessed within days, 6 months and 12 months post-injury in patients admitted to two level 1 adult trauma centres. Kappa statistics and multiple logistic regression models identified predictors of disagreement between time-points. Results Pre-injury disability was measured at all time-points in 801 patients. Pre-injury disability at baseline was rated as none, mild, moderate, marked and severe in 80%, 12%, 5.1%, 1.9% and 1.0% respectively. Absolute agreement between baseline and 6 and 12 months respectively, was 79% and 80%. Corresponding kappa values (95% confidence intervals) were 0.33 (0.26−0.40) and 0.32 (0−25−0.38). Patients over 65 years or not completing high school were more likely to report less pre-injury disability at 6 and 12 months than at baseline with adjusted odds ratios (95% confidence intervals) for these groups being 8.24 (4.32−15.72) and 1.93 (1.03−3.64) respectively. Conclusions There was little evidence of recall bias in an adult trauma population if self-reported global pre-injury disability was assessed 6 months post-injury. The recall of pre-injury disability up to 6 months post-injury can be used to determine return to pre-injury status, if assessment is not feasible shortly after injury.

Interobserver agreement of Neer and AO classifications for proximal humeral fractures

The classification of proximal humeral fractures remains challenging. The two main classification systems used, the Neer and the AO classification, have both been shown to have less than ideal interobserver agreement. Agreement in classification is required, however, to guide fracture management.

Prevalence of non‐union and delayed union in proximal humeral fractures

Little is known about the prevalence of proximal humeral non‐union. There is disagreement on what constitutes union, delayed union and non‐union. Our aim was to determine the prevalence of these complications in proximal humeral fractures (PHFs) admitted to trauma hospitals.

Do non-steroidal anti-inflammatory drugs impair fracture healing? A survey of Australian orthopaedic surgeons

There is currently a lack of clear evidence on the impact of non‐steroidal anti‐inflammatory drugs (NSAIDs) on fracture healing post‐operatively. Australian orthopaedic surgeons were surveyed about their perceptions of the relationship between NSAIDs and fracture healing to determine whether equipoise exists within the profession. Results demonstrated divergence of opinion amongst Australian orthopaedic surgeons, lending support to the commencement of randomised controlled trials testing the influence of NSAIDs on fracture healing within Australia.