The impact of upper-extremity injuries on polytrauma patients at a level 1 trauma center

Miliaan L Zeelenberg; Dennis Den Hartog; Sascha Halvachizadeh; Hans-Christian Pape; Michael H J Verhofstad; Esther M M Van Lieshout

doi:10.1016/j.jse.2021.10.005

The impact of upper-extremity injuries on polytrauma patients at a level 1 trauma center

J Shoulder Elbow Surg. 2022 May;31(5):914-922. doi: 10.1016/j.jse.2021.10.005. Epub 2021 Oct 20.

Authors

Miliaan L Zeelenberg¹, Dennis Den Hartog¹, Sascha Halvachizadeh², Hans-Christian Pape², Michael H J Verhofstad¹, Esther M M Van Lieshout³

Affiliations

¹ Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
² Trauma Department, University Hospital Zürich, Zürich, Switzerland.
³ Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Electronic address: e.vanlieshout@erasmusmc.nl.

PMID: 34687916
DOI: 10.1016/j.jse.2021.10.005

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 the effects 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 vs. without upper-extremity injuries.

Methods: We performed a retrospective cohort study of adult patients with an Injury Severity Score ≥ 16 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, Short Form 36, and EuroQol-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 vs. without upper-extremity injuries were compared.

Results: In a cohort of 3469 trauma patients, 1246 (36.5%) had upper-extremity injuries. Of these, 278 (22.0%) had severe injuries (Abbreviated Injury Scale score ≥ 3). Upper-extremity injuries were associated with a longer hospitalization (median, 12 days vs. 8 days; P < .001), longer intensive care unit stay (median, 5 days vs. 4 days; P = .005), and lower mortality rate (14.6% vs. 23.9%, P < .001). Among the 598 patients who completed the questionnaires, no differences in the physical component summary score (47 vs. 48, P = .181) and mental component summary score (54 vs. 53, P = .315) of the Short Form 36 questionnaire, as well as the utility score (0.82 vs. 0.85, P = .101) and visual analog scale score (80 vs. 80, P = .963) of the EuroQol-5D questionnaire, were found. However, patients with upper-extremity injuries showed a minor increase in disability in the Disabilities of the Arm, Shoulder and Hand score (9.2 vs. 4.2, P = .023).

Conclusion: Upper-extremity injuries in polytrauma patients are associated with a longer hospitalization, longer intensive care unit stay, and reduced mortality rate, as well as a minor increase in long-term disability.

Keywords: DASH; Polytrauma; disability; epidemiology; fracture; quality of life; upper extremity.

MeSH terms

Adult
Arm Injuries* / complications
Humans
Multiple Trauma*
Quality of Life
Retrospective Studies
Trauma Centers
Upper Extremity