To Örebro University

Trauma-informed interventions have been implemented in various settings, but trauma-informed care (TIC) has not been widely incorporated into the treatment of adult patients with traumatic injuries. The purpose of this study was to examine health care provider knowledge, attitudes, practices, competence, and perceived barriers to implementation of TIC. This cross-sectional study used an anonymous web-based survey to assess attitudes, knowledge, perceived competence, and practice of TIC among trauma providers from an urban academic medical center with a regional resource trauma center. Providers (nurses, physicians, therapists [physical, occupational, respiratory]) working in trauma resuscitation, trauma critical care, and trauma care units were recruited. Descriptive statistics summarized knowledge, attitudes, practice, competence, and perceived barriers to TIC and logistic regression analyses examined factors predicting the use of TIC in practice. Of 147 participants, the majority were nurses (65%), followed by therapists (18%) and physicians (17%), with a median 3 years of experience; 75% answered the knowledge items correctly and 89% held favorable opinions about TIC. Nineteen percent rated themselves as less than "somewhat competent." All participants rated the following as significant barriers to providing basic TIC: time constraints, need of training, confusing information about TIC, and worry about retraumatizing patients. Self-rated competence was the most consistent predictor of providers' reported use of specific TIC practices. Despite some variability, providers were generally knowledgeable and held favorable views toward incorporating TIC into their practice. TIC training for trauma providers is needed and should aim to build providers' perceived competence in providing TIC.

Background

Family involvement in in-patient care enhances patient safety and quality of care by reducing complications and hospital length of stay. A valid measurement of family involvement in care is needed when implementing and evaluating family involvement-promoting activities. 

Methods

The design of this study was inspired by the guidelines for best practices for developing and validating measurement scales. The steps used were: identifying domains and generating items, assessing content validity, and pre-testing items with the target population. An expert group rated item relevance and the content validity index was calculated. Nineteen online Think-aloud interviews were conducted with family members of former in-patient surgical patients.

Results 

The domains of family involvement and item selection from two preexisting questionnaires were grounded in scholarly literature. Items were adapted for family members in the in-patient care setting. Item content validity varied between 0.71–1.00, scale content validity/averaging was 0.90. After adjustments, the items were pretested through on-line cognitive interviews with family members. Three main problem areas were found: defining family involvement, misinterpretation of different terms, and underuse of one response option. These problems were adjusted for. The Family Involvement in Care Questionnaire consists of 16 items with a four-point Likert scale and two open-ended items.

Conclusion

On-line think aloud interviews are a feasible method when evaluating new questionnaires. Problems experienced by the target population were identified prior to a large quantitative psychometric evaluation of the questionnaire. 

BACKGROUND: Family involvement in care can be seen as a prerequisite for high-quality family-centered care. It has been identified to improve both patient safety and the quality of care by reducing patient complications and hospital length of stay.

OBJECTIVE: To develop and evaluate the content validity of a questionnaire measuring family involvement in inpatient care.

METHODS: The study followed a systematic approach in building a rigorous questionnaire: identification of domain, item generation, and assessment of content validity. The content validity index was calculated based on ratings of item relevance by an expert group consisting of seven senior nurses. Subsequently, 19 online cognitive interviews using the Think-aloud method were conducted with family members of former patients who had undergone open-heart surgery.

RESULTS: Five aspects of family involvement were identified, and the initial pool of items were selected from two preexisting questionnaires. The experts' ratings resulted in item content validity of 0.71-1.00, and the scale content validity/averaging was 0.90, leading to rewording, exclusion, and addition of items. The pretesting of items through two rounds of cognitive interviews with family members resulted in the identification of three main problem areas: defining family involvement, misinterpretation of different terms, and underuse of the not relevant response option. The problems were adjusted in the final version of the questionnaire, which consists of 16 items with a four-point Likert scale and two open-ended items.

CONCLUSIONS: The Family Involvement in Care Questionnaire has demonstrated potential in evaluating family involvement in inpatient care. Further psychometric properties regarding reliability and validity need to be established.

Purpose

To examine the relationship between child self-report and parent proxy report of health-related quality of life (HRQL) and how parents’ mental health status relates to the HRQL ratings 6 years after minor to severe injury of the child.

Materials and methods

This cross-sectional cohort study was performed at a regional pediatric trauma center in Stockholm, Sweden. The PedsQL 4.0 versions for ages 5–7, 8–12, and 13–18 years were completed by 177 child–parent dyads 6 years after injury to the child. The parents also rated their own mental health through the mental health domain (MH) in the SF-36 Health Survey.

Results

The children’s median age was 13 years (IQR 10–16 years), 54 % were males, and the median ISS was 5 (IQR 2–9). Most of the parents were female (77 %), born in Sweden (79 %), and half had university degrees. There was no statistically significant difference between child self-report and parent proxy report in any of the PedsQL 4.0 scales or summary scales. The levels of agreement between child self-report and parent proxy reports were excellent (ICC ≥ 0.80) for all scales with the exception of emotional functioning (ICC 0.53) which also was the scale with the lowest internal consistency in child self-report (α 0.60). Multiple regression analyses showed that worse parental mental health status correlated with worse child self-report and parent proxy report of children’s HRQL.

Conclusions

Children and their parents’ reports on child’s HRQL were in agreement. Decreased mental health in parents was associated with lower scores on parent proxy reports and child self-reports of HRQL after injury. The current investigation highlights the possible relationship between parent’s mental health status and children’s HRQL long after an injury, which should be considered in future investigations and in clinical care.

PURPOSE: To investigate the impact on health related quality of life (HRQL) during the first year after minor extremity injury and to determine whether there is a difference in recovery patterns and return to work between upper extremity injuries (UEI) and lower extremity injuries (LEI).

METHOD: A total of 181 adults' age 18 years or older randomly selected from patients admitted to an emergency department with minor injuries were studied. HRQL was measured using the Functional Status Questionnaire (FSQ) at 1-2 weeks, 3, 6, and 12-months post-injury. Pre-injury FSQ scores were measured retrospectively at admission. A quasi-least square (QLS) model was constructed to examine differences of FSQ scores at each measuring point for UEI and LEI.

RESULTS: Fractures of the knee/lower leg (25%) were the most frequently injured body area. Slips or falls (57%) and traffic-related events (22%) were the most common injury causes. The mean ISS was 4.2 (SD 0.86). Both groups had significant declines in the FSQ scores physical and social functioning at 1-2 weeks after injury. Patients with UEI made larger improvements in the first 3 months post-injury versus patients with LEI whose improvements extended over the first 6 months. None of the groups reached the pre-injury FSQ scores during the first post-injury year except in the subscale work performance where UEI exceeded the pre-injury scores. At 12 months post-injury, significant lower FSQ scores remained in the LEI group compared to the UEI group in intermediate activities of daily living (p=0.036, d 0.4) and work performance (p=0.004, d 0.7). The return to work at 3 months and 12 months were 76% and 88% for UEI and 58% and 77% for LEI. No significant differences were found between groups in the FSQ scale mental health and social interaction.

CONCLUSIONS: LEI had the highest impact on HRQL and return to work during the first year which exceeded the consequences of UEI. These findings contribute to the information about the consequences of injury in order to give sufficient prognostic information to patients and different stakeholders. Future investigations should aim to investigate specific minor extremity injuries and identify factors that facilitate recovery and return to work.

Background: Trauma is the number one killer of children and young adults and the  most common cause for hospital admissions for these age-groups in Sweden. Trauma is  also one of the most common causes for hospital care and early death for older people.  In the last decades trauma care has advanced and improved short-term survival of  injured but knowledge of the long-term outcome is limited.

The overall aim of this thesis is to investigate long-term outcome and health-related  quality of life after injuries in different age groups and to identify factors associated  with outcome.

Methods: The thesis is based on four studies. In the first study patients with major  trauma were contacted 5 years after injury and HRQL was measures using the SF-36  questionnaire and compared to an age and sex-matched reference group. In the second  study data was collected on children with injuries to describe demographic and injury  characteristics and outcome. The sample in the second study was the source for the  third and fourth study. The third study measured HRQL using the PedsQL 4.0 in a  cohort of children 6 years after injury and determined the relationship within subgroups  in the cohort. The fourth study measured child HRQL in a sample of children after  injury and their parent´s and determined the relationship within scoring results and the impact of parents reported mental health status.

Results: The adult major trauma patients (n=205) reported significantly lower HRQL  scores in all eight domains compared to the reference group. A large number of patients  suffered from physical (68%) and psychological disabilities (41%) and nearly half reported the need for better follow-up after discharge from hospital. The severity of the injury did not anticipate a lower health-related quality of life. In the pediatric group  (n=432) the median injury severity score was 4 (IQR 1-9), 50% sustained head injuries  and the most severe head injuries were seen in the youngest age group. Mortality rate  was low (1%), 19% stayed in a PICU and the median length of hospital stay was two  days. In the follow-up study (n=204) the youngest children had the lowest PedsQL  scores. Children who suffered from extremity injuries had lower scores in the school  functioning compared to children with head injuries. The levels of agreement between  child self-report and parent proxy report of PedsQL 4.0 scales were excellent  (ICC≥0.80) for all scales with the exception of children´s self-reported emotional  functioning. Multiple regression analyses showed that poor parental mental health  status contributed to worse child self-report and parent proxy report of children´s  HRQL.

Conclusion: Adult major trauma patients have significant disabilities 5 years after  injury. Improved follow-up by trauma specialist teams are needed. Children´s HRQL 6  years after trauma seems to in parity or better than healthy peers. Parent´s mental health  status can possibly impact on children´s HRQL long after an injury. Further studies are  recommended to evaluate the PedsQL 4.0versions for self-report in pediatric trauma  population.

BACKGROUND: This study aimed to determine quality of life after injury and identify factors potentially associated with outcome.

METHODS: Five years after injury from blunt or penetrating trauma, patients received a questionnaire based on the SF-36 Health Survey.

RESULTS: Two hundred five patients (83%) replied. Most were men, median age 39 years, 93% injured by blunt energy, median Injury Severity Score 14 (range 9-57). Mean SF-36 scores were significantly lower than in a matched reference group. Poor outcome was associated with: in-hospital days, intensive care days, surgical procedures, in-hospital major complications, age, recurrent injury, and inadequate information. Subjects reported considerable physical (68%) and psychologic (41%) disabilities. Near half reported need of improved follow-up care. Injury severity did not predict poor health-related quality of life 5 years later.

CONCLUSION: Adequate information, sufficient pain management and follow-up by trauma specialist teams are needed. Certain factors can help identify patients in need of additional help and support.

Background:

Although trauma is a leading cause of pediatric mortality and morbidity in Sweden, few studies have examined the outcome of pediatric trauma.

Objective:

Here, we describe the age and gender distribution, injury mechanisms, injury severity, and outcome of pediatric trauma in the Stockholm region.

Methods:

This retrospective study comprises all trauma patients (age ≤ 15 years) admitted to a regional pediatric trauma center and all pediatric deaths due to trauma in Stockholm in 2002. Data from the trauma registry database were verified by comparison with medical records and autopsy reports. Outcome was measured by mortality and length of stay in a pediatric intensive care unit (PICU) and acute care hospital.

Results:

In all, 432 injured children were included. The median age was 10 years and 59% were males. The median injury severity score was 4 (interquartile range [IQR] 1–9) and 50% sustained head injuries. Mortality was low (1%) and the median length of hospital stay was 2 days (IQR 1–3); 19% stayed in a PICU and, of those, 89% stayed for one day. Comparison with medical records showed that much information in the trauma registry database was either incorrect or missing.

Conclusions:

Many injuries were minor and half of the children were discharged home from the emergency department. Head injuries were the most common injury in all age groups. The most severe head injuries were seen in the youngest group and were caused by falls. Trauma team activation criteria should be improved to avoid overutilization. The quality and completeness of data in the trauma registry must be enhanced.