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Outcome after severe trauma: implications for the clinical approach

  • Main research unit: CINTESIS, FMUP
  • Principal Investigator:  Este endereço de email está protegido contra piratas. Necessita ativar o JavaScript para o visualizar.
  • Team:
    • Armando Rogério Martins Teixeira-Pinto
    • Ernestina da Piedade Rodrigues Gomes
    • Cláudia Camila Rodrigues Pereira Dias
    • Jorge Abel Jácome Gomes
    • António Manuel Machado Henriques Carneiro
    • Maria de La Salete Pinheiro Alves
  • Start date: 19.03.2012   | End date: 18.03.2015
  • Financing: € 62.138,00 (FCT)

Project description: Trauma is a pandemic and a health care problem all over the world. It is the main cause of death in young adults. Portugal is the leader among European countries concerning mortality after trauma. The real dimension of the problem is not well known in Portugal because of scarce data.

The first and main objective of this study is to get new knowledge on the epidemiology and other characteristics of trauma in Portugal as well as about severity and consequences in terms of mortality and morbidity. If our knowledge on mortality is limited, data on morbidity are scare. Data from Portuguese trauma system might help in the understanding of mortality and morbidity after trauma.
The first important trauma registry was the Major Trauma Outcome Study (MTOS) that started in 1975 in the United States of America. The major Trauma Outcome Study cohort has been widely used as a benchmark for comparing outcomes in patients with trauma using the TRISS methodology. It can be used to identify unexpected outcomes in populations and in individual patients.

In Europe the trauma Audit & Research Network (TARN) is a group of hospitals from all over England, Wales and even other countries in Europe. The Trauma Network (previously known as European MTOS) has been operating for the past 14 years and is a located at the University of Manchester, United Kingdom (UK). In other words TARN is concentrating the trauma data collected from all hospitals in the UK, analyzing it and producing epidemiological, clinical and audit reports.

Using its vast experience in data collection and analysis, TARN took the initiative to start a European Registry (Euro TARN) initiative consists of a regular participation of a 14 countries and support from many others who have come together to develop an effective system to review the standards of trauma care across Europe and develop an effective method for future data collection. Portugal by the participation of some elements of this team takes part in this registry.

Mortality is the worst consequence of trauma but not the only problem for those injured people. As technology improves, more people who suffer severe injury can survive. And even the less severe forms of trauma can result in significant problems that may persist, or even arise only after the injury. These individuals are often young, and otherwise healthy. Apart from different types of physical disabilities persistent cognitive, behavioural or mood disturbances can significantly affect short and long term outcomes. Patients may appear physically recovered, but problems reintegrating into family, work, or school can quickly become apparent contributing to a decrease in the quality life.

Education and appropriate interventions and referrals must be initiated as early as possible. Too often, these patients receive excellent acute care and initial rehabilitation, but then are lost to follow-up- The loop of care must be closed. A significant number of these patients can achieve good function, but will require continuous and possibly lifelong access to various components of an interdisciplinary team. This ensures maximized quality of life, and is one of the most efficient and cost-effective solution in the long run. This process should start at the initial contact with the patient and family. It should involve close collaboration between the family, patient, emergency physician, intensivist, surgeons, psychiatrists, rehabilitation medicine and other therapists, rehabilitation facilities, the workplace and community groups.

The follow-up consultation developed for this project will do the clinic at 6 months after trauma. The main objectives will be to assess and diagnose problems in the patient as well as to serve as a base for data collection and research on late outcomes. Several tests will be done with that objective namely: Mini Mental State; PTSS14; Zung inventory; BDI; Glasgow Outcome Scale – Extended and EQ-5D

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