Abstract
BACKGROUND
Upper extremity injuries often lead to long-term problems in function and quality of life in patients. However, not much is known about this effect in polytrauma patients. This study aimed to describe the upper extremity injuries in polytrauma patients and to compare self-reported disability and quality of life in polytrauma patients with versus without upper extremity injuries.
METHODS
A retrospective cohort study was performed in adult patients with an injury severity score (ISS) of 16 or higher, admitted to Erasmus MC between January 1, 2007 and December 31, 2016. Patients were asked to complete the Disabilities of the Arm, Shoulder and Hand (DASH), Short Form-36 (SF-36), and EuroQol-5D (EQ-5D) questionnaires. Details on injuries, treatment, and clinical outcome were collected from the national trauma registry and medical files. Characteristics and self-reported outcomes of polytrauma patients, with versus without upper extremity injuries, were compared.
RESULTS
In a cohort of 3,469 trauma patients 1,246 (36.5%) suffered upper extremity injuries. Of these, 278 (22.0%) suffered severe injuries (AIS≥3). Upper extremity injuries are associated with longer hospitalization (median 12 days versus 8 days, p<0.001), longer ICU stay (median 5 days versus 4 days, p=0.005), and lower mortality (14.6% versus 23.9%, p<0.001). In 598 patients who completed the questionnaires, no difference in physical component summary (47 versus 48, p=0.181) and mental component summary (54 versus 53, p=0.315) of the SF-36 and the Utility score (0.82 versus 0.85, p=0.101) and VAS score (80 versus 80, p=0.963) of the EQ-5D, was found. However, patients with upper extremity injuries showed a minor increase in disability in the DASH (9.2 versus 4.2, p=0.023).
CONCLUSION
Upper extremity injuries in polytrauma patients are associated with longer hospitalization, ICU stay, reduced mortality, and a minor increase in long-term disability.
Zeelenberg, Miliaan L