Road traffic accidents (RTA) contribute significantly to the global burden of trauma. The World Health Organization indicates that approximately 1.3 million people die each year on the world's... Show moreRoad traffic accidents (RTA) contribute significantly to the global burden of trauma. The World Health Organization indicates that approximately 1.3 million people die each year on the world's roads and between 20 and 50 million sustain non-fatal injuries. The introduction of extensive traffic safety laws, preventive governmental programs and substantial changes in (the organisation of) pre- and in-hospital trauma care have resulted in a gradual decrease in road traffic injuries and fatalities in the 1990s and onward in the Netherlands. Since 2006, however, the number of seriously injured road traffic participants has been increasing despite these government measures to improve road safety. In 2018, an estimated 21,700 people were seriously injured in traffic in the Netherlands, approximately 1,000 more than in 2017.The primary aim of this thesis was to analyse injury patterns, injury severity and mortality for different types of road traffic participants involved in accidents in the Netherlands. Secondly, the association between blood alcohol concentrations, TBI patterns and patient outcome was analysed. Finally, patient and injury characteristics associated with HRQoL, fatigue and societal participation in polytrauma patients were identified. Show less
Purpose In hospitalized patients, malnutrition is associated with adverse outcomes. However, the consequences of malnutrition in trauma patients are still poorly understood. This study aims to... Show morePurpose In hospitalized patients, malnutrition is associated with adverse outcomes. However, the consequences of malnutrition in trauma patients are still poorly understood. This study aims to review the current knowledge about the pathophysiology, prevalence, and effects of malnutrition in severely injured patients. Methods A systematic literature review in PubMed and Embase was conducted according to PRISMA-guidelines. Results Nine review articles discussed the hypermetabolic state in severely injured patients in relation to malnutrition. In these patients, malnutrition negatively influenced the metabolic response, and vice versa, thereby rendering them susceptible to adverse outcomes and further deterioration of nutritional status. Thirteen cohort studies reported on prevalences of malnutrition in severely injured patients; ten reported clinical outcomes. In severely injured patients, the prevalence of malnutrition ranged from 7 to 76%, depending upon setting, population, and nutritional assessment tool used. In the geriatric trauma population, 7-62.5% were malnourished at admission and 35.6-60% were at risk for malnutrition. Malnutrition was an independent risk factor for complications, mortality, prolonged hospital length of stay, and declined quality of life. Conclusions Despite widespread belief about the importance of nutrition in severely injured patients, the quantity and quality of available evidence is surprisingly sparse, frequently of low-quality, and outdated. Based on the malnutrition-associated adverse outcomes, the nutritional status of trauma patients should be routinely and carefully monitored. Trials are required to better define the optimal nutritional treatment of trauma patients, but a standardized data dictionary and reasonable outcome measures are required for meaningful interpretation and application of results. Show less
Leijdesdorff, H.A.; Krijnen, P.; Rooyen, L. van; Marang-van de Mheen, P.; Rhemrev, S.; Schipper, I.B. 2018
Objective: This cross-sectional study analyzed associations between and determinants for health-related quality of life (HRQoL), fatigue, and societal participation in polytrauma patients.Summary... Show moreObjective: This cross-sectional study analyzed associations between and determinants for health-related quality of life (HRQoL), fatigue, and societal participation in polytrauma patients.Summary of background data: More polytrauma patients survive their injuries, often resulting in long-term disabilities. HRQoL is therefore an important outcome of trauma care. Fatigue and societal participation may be related to HRQoL. Also, their relation to severe injuries has not been studied to date.Methods: A total of 283 polytrauma patients (injury severity score >= 16) admitted to the Dutch level 1 Trauma Centre West were analyzed. HRQoL was measured by the physical component summary (PCS) and mental component summary (MCS) scores of the SF-36, fatigue by the multidimensional fatigue inventory, and societal participation by the Utrecht scale for evaluation of rehabilitation-participation. Age, sex, comorbidity, injury pattern, injury severity, and time since trauma were analyzed as potential determinants.Results: A total of 122 patients (43%) responded after a median follow-up of 15 (range, 10-23) months after polytrauma; 44% reported reduced physical health (PCS < 45) and 47% reported reduced mental health (MCS < 45). HRQoL was highly correlated with all fatigue and participation subscales. Severe head injury was associated with worse mental health. Female patients reported more general and mental fatigue and were less satisfied with their ability to perform daily activities. Patients with pre-existing comorbidity experienced worse physical health, more fatigue, and reduced societal participation.Conclusions: One to 2 years after trauma, polytrauma patients report reduced HRQoL, which is associated with more fatigue and reduced societal participation. Trauma rehabilitation strategies should focus on early recognition of reduced HRQoL, fatigue, and societal participation and facilitate early intervention to improve these outcomes. Show less
