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Assessment of mortality in older trauma patients sustaining injuries from falls or motor vehicle collisions treated in regional level I trauma centers.

https://arctichealth.org/en/permalink/ahliterature152378
Source
Ann Surg. 2009 Mar;249(3):488-95
Publication Type
Article
Date
Mar-2009
Author
John S Sampalis
Robin Nathanson
Julie Vaillancourt
Andreas Nikolis
Moishe Liberman
John Angelopoulos
Nickolaos Krassakopoulos
Nadia Longo
Eliofotisti Psaradellis
Author Affiliation
Department of Surgery, Surgical Research, McGill University, Montreal, Quebec, Canada. jsampalis@jssresearch.com
Source
Ann Surg. 2009 Mar;249(3):488-95
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Accidental Falls - statistics & numerical data
Accidents, Traffic - statistics & numerical data
Age Factors
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Male
Quebec - epidemiology
Retrospective Studies
Trauma Centers - statistics & numerical data
Wounds and Injuries - mortality
Abstract
To compare mortality in elderly trauma patients sustaining fall or motor vehicle collision (MVC) related injuries and who are subsequently treated at regional Level I (tertiary) trauma centers.
An increase in the mean age of the Canadian population is leading to a higher proportion of older patients injured in falls who are subsequently treated at Level 1 trauma centers in Quebec. The Level 1 centers were designed to treat younger patients injured in MVCs and violent acts. As a result, discordance may exist between the type of care supplied at these centers and the increased demand for care tailored to older trauma patients.
A retrospective cohort study comprised of 4,717 patients over the age of 65; 606 (12.8%) injured in MVCs and 4,111 (87.2%) in falls. The mean (SD) age was 79.6 (8.0) years and 67.9% were female. The mean (SD) Injury Severity Score (ISS) was 10.8 (7.4). Data were obtained from the Quebec Trauma Registry (QTR) for patients treated at 3 Level I trauma centers in the province of Quebec, Canada. The primary outcome measure in this study was mortality.
Being injured in a fall was a strong predictor for mortality, with an odds ratio of 5.11 (95% C.I. = 1.84-14.17, P = 0.002). Additionally, the adjusted mortality rate was 25.3% among fall victims, versus 7.8% for MVC patients. Female gender, older age, higher ISS and an increasing number of injuries were all associated with heightened mortality. In contrast, the number of body regions injured, experiencing complications, sustaining a hip fracture, the Revised Trauma Score, the Prehospital Index and the Charlson (comorbidity) Index had no association with mortality in the Level I centers.
Elderly patients sustaining fall-related injuries and treated at Level I trauma centers are at risk for excess mortality when compared with those injured in MVCs. Effective and efficient methods for treating this population must be determined.
PubMed ID
19247039 View in PubMed
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The association between trauma system and trauma center components and outcome in a mature regionalized trauma system.

https://arctichealth.org/en/permalink/ahliterature174450
Source
Surgery. 2005 Jun;137(6):647-58
Publication Type
Article
Date
Jun-2005
Author
Moishe Liberman
David S Mulder
Gregory J Jurkovich
John S Sampalis
Author Affiliation
Department of Surgery, Montreal General Hospital, McGill University Health Center, Quebec, Canada.
Source
Surgery. 2005 Jun;137(6):647-58
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Emergency Medical Service Communication Systems
Humans
Injury Severity Score
Outcome Assessment (Health Care)
Quality Assurance, Health Care
Quebec
Questionnaires
Risk Adjustment
Survival Rate
Trauma Centers - organization & administration
Wounds and Injuries - mortality - physiopathology - therapy
Abstract
Regionalized trauma systems have been shown repeatedly to improve the outcome of seriously injured patients. However, we do not have data regarding which components of these systems have the most impact on outcome and to what degree. The objective of this study was to understand the association between various components that make up a trauma system and outcome.
Surveys were administered to trauma directors at 59 hospitals in the province of Quebec, Canada. Data from the surveys were then linked with specific outcome variables obtained from a regionalized trauma database. Specific outcomes were assigned to trauma system- and in-hospital-based components after controlling for injury severity.
Over 4.8 years, 72,073 patients met inclusion criteria. Components found to affect survival after risk adjustment were prehospital notification (OR, 0.61; 95% CI, 0.39-0.94) and the presence of a performance improvement program in that hospital (OR, 0.44; 95% CI, 0.20-0.94). Increased patient volume was associated with a reduction in risk-adjusted mortality (OR, 0.98; 95% CI, 0.97-0.99). Tertiary trauma centers were also associated with a reduction in risk-adjusted mortality compared with both secondary and primary centers (OR, 0.68; 95% CI, 0.48-0.99).
Improvements in outcome in a regionalized trauma system are secondary to a combination of elements, as well as to the interplay of these elements on each other. Prehospital notification protocols and performance improvement programs appear to be most associated with decreased risk-adjusted odds of death.
PubMed ID
15933633 View in PubMed
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Bariatric surgery reduces cancer risk in morbidly obese patients.

https://arctichealth.org/en/permalink/ahliterature154091
Source
Surg Obes Relat Dis. 2008 Nov-Dec;4(6):691-5
Publication Type
Article
Author
Nicolas V Christou
Moishe Lieberman
Fotini Sampalis
John S Sampalis
Author Affiliation
McGill University Health Center, Montreal, Quebec, Canada. Nicolas.christou@muhc.mcgill.ca
Source
Surg Obes Relat Dis. 2008 Nov-Dec;4(6):691-5
Language
English
Publication Type
Article
Keywords
Adult
Bariatric Surgery
Cohort Studies
Female
Humans
Incidence
Male
Middle Aged
Neoplasms - epidemiology - etiology
Obesity, Morbid - complications - surgery
Quebec - epidemiology
Risk
Abstract
To assess the effect of bariatric surgery on the cancer risk of patients with morbid obesity because evidence is mounting of an association between obesity and cancer.
We performed an observational 2-cohort study. The treatment cohort (n = 1035) included patients who had undergone bariatric surgery from 1986 to 2002. The control group (n = 5746) included age- and gender-matched morbidly obese patients who had not undergone weight-reduction surgery and who were identified from a single-payor administrative database. The subjects with physician or hospital visits for a cancer-related diagnosis or treatment within the 6 months previous to the beginning of the study were excluded. The cohorts were followed up for a maximum of 5 years from study inception.
Bariatric surgery resulted in a significant reduction in the mean percentage of excess weight loss (67.1%, P
Notes
Comment In: Surg Obes Relat Dis. 2008 Nov-Dec;4(6):696-719026374
PubMed ID
19026373 View in PubMed
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Canadian variation by province in rheumatoid arthritis initiating anti-tumor necrosis factor therapy: results from the optimization of adalimumab trial.

https://arctichealth.org/en/permalink/ahliterature140779
Source
J Rheumatol. 2010 Dec;37(12):2469-74
Publication Type
Article
Date
Dec-2010
Author
Christopher Pease
Janet E Pope
Carter Thorne
Boulos Paul Haraoui
Don Truong
Claire Bombardier
Jessica Widdifield
Eliofotisti Psaradellis
John S Sampalis
Ashley Bonner
Author Affiliation
University of Western Ontario, London, Ontario, Canada.
Source
J Rheumatol. 2010 Dec;37(12):2469-74
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antibodies, Monoclonal - economics - therapeutic use
Antirheumatic Agents - economics - therapeutic use
Arthritis, Rheumatoid - drug therapy - pathology - physiopathology
Canada
Female
Humans
Insurance, Health, Reimbursement
Middle Aged
Multicenter Studies as Topic
Questionnaires
Randomized Controlled Trials as Topic
Registries
Treatment Outcome
Tumor Necrosis Factor-alpha - immunology
Abstract
We compared variations among Canadian provinces in rheumatoid arthritis (RA) initiating anti-tumor necrosis factor (TNF) therapy.
Data were obtained from the Optimization of Humira trial (OH) and from the Ontario Biologics Research Initiative (OBRI). Baseline characteristics were compared between regions: Ontario (ON), Quebec (QC), and other provinces (OTH). We compared Ontario OH to OBRI patients who were initiating anti-TNF therapy.
In 300 OH patients, mean age was 54.8 years (13.3). There were 151 (50.3%) ON patients, 57 from QC (19%), and 92 from OTH (30.7%). Regional differences were seen in the number of disease-modifying antirheumatic drugs (DMARD) ever taken (ON: 3.8 ± 1.4, QC: 3.1 ± 1.1, OTH: 3.3 ± 1.4; p
PubMed ID
20843910 View in PubMed
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A comparison of methods to obtain a composite performance indicator for evaluating clinical processes in trauma care.

https://arctichealth.org/en/permalink/ahliterature114539
Source
J Trauma Acute Care Surg. 2013 May;74(5):1344-50
Publication Type
Article
Date
May-2013
Author
Lynne Moore
André Lavoie
Marie-Josée Sirois
Amina Belcaid
Gilles Bourgeois
Jean Lapointe
John S Sampalis
Natalie Le Sage
Marcel Émond
Author Affiliation
Department of Social and Preventative Medicine, Centre de Recherche du CHU (Hôpital de l'Enfant- Jésus), Université Laval, Québec City, Québec, Canada. lynne.moore.cha@ssss.gouv.qc.ca
Source
J Trauma Acute Care Surg. 2013 May;74(5):1344-50
Date
May-2013
Language
English
Publication Type
Article
Keywords
Aged
Canada
Female
Hospital Mortality
Humans
Injury Severity Score
Male
Middle Aged
Quality Indicators, Health Care - statistics & numerical data
Quality of Health Care - standards
Registries
Reproducibility of Results
Retrospective Studies
Trauma Centers - standards
Traumatology - standards
Abstract
Process performance indicators that evaluate trauma centers in clinical case management provide information essential to the improvement of trauma care. However, multiple indicators are needed to adequately evaluate process performance, which renders comparisons cumbersome. Several methods are available for generating composite indicators that measure global performance. The goal of this study was to compare three composite methods that are widely used in other health care domains to identify the most appropriate for trauma care process performance evaluation.
In this retrospective, multicenter cohort study, 15 process performance indicators were implemented using data from a Canadian provincial trauma registry (19,853 patients; 59 centers) on patients with an Injury Severity Score (ISS) greater than 15. Composite scores were derived using three methods as follows: the indicator average, the opportunity model, and a latent variable model. Composite scores were evaluated in terms of discrimination, construct validity (association with an indicator of trauma center structural performance), criterion predictive validity (association with clinical outcomes), and forecasting (correlation over time).
All composite scores discriminated well between trauma centers. Only the average indicator score was correlated with improved structure (r = 0.29; 95% confidence interval [CI], 0.07-0.53), lower risk-adjusted mortality (r = -0.22; 95% CI, -0.46 to 0.04), and lower risk-adjusted complication rate (r = -0.48; 95% CI, -0.65 to -0.25). Composite scores calculated with 1999 to 2002 data all correlated with those calculated with 2003 to 2006 data (r = 0.49, 0.87, and 0.84 for the indicator average, the opportunity model, and the latent variable model, respectively).
Results suggest that of the three composite scores evaluated, only the indicator average demonstrates content and predictive criterion validity, discriminates between centers, and has good forecasting properties. In addition, this score is simple and intuitive and not subject to variation in weights over trauma systems and time. The observed association between higher indicator average scores and lower risk-adjusted mortality and complication rates suggests that improving process performance may improve patient outcome.
PubMed ID
23609288 View in PubMed
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Effectiveness and safety of dorzolamide-timolol alone or combined with latanoprost in open-angle glaucoma or ocular hypertension.

https://arctichealth.org/en/permalink/ahliterature158132
Source
Ann Pharmacother. 2008 Apr;42(4):498-504
Publication Type
Article
Date
Apr-2008
Author
Mark R Lesk
Theodoro Koulis
Fotini Sampalis
John S Sampalis
Natacha R Bastien
Author Affiliation
Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada.
Source
Ann Pharmacother. 2008 Apr;42(4):498-504
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antihypertensive Agents - adverse effects - therapeutic use
Canada
Drug Administration Schedule
Drug Combinations
Drug Therapy, Combination
Female
Glaucoma, Open-Angle - drug therapy
Humans
Male
Middle Aged
Ocular Hypertension - drug therapy
Ophthalmic Solutions
Prospective Studies
Prostaglandins F, Synthetic - adverse effects - therapeutic use
Sulfonamides - adverse effects - therapeutic use
Thiophenes - adverse effects - therapeutic use
Timolol - adverse effects - therapeutic use
Treatment Outcome
Abstract
Treatment of glaucoma is aimed at reducing intraocular pressure (IOP) to prevent further damage to the optic nerve. For patients who do not respond to monotherapy, combination treatment may be effective in achieving therapeutic reduction or target IOP.
To evaluate the effectiveness and safety of dorzolamide 2% with timolol 0.5% alone or combined with latanoprost in reducing IOP in a real-world setting.
A prospective, open-label, multicenter, nonrandomized interventional study was designed. Three hundred fifty patients with primary open-angle glaucoma or ocular hypertension and uncontrolled IOP after latanoprost monotherapy for 4 or more weeks were treated with combination dorzolamide-timolol twice daily added to their existing latanoprost therapy (D/T-Add-On; n = 280) or dorzolamide-timolol twice daily monotherapy (D/T-Switch; n = 70). The primary effectiveness outcome measure was the change in IOP after 6 and 12 weeks of treatment.
Of the total population, 313 patients completed this trial (248 D/T-Add-On; 65 D/T-Switch). After 12 weeks, the mean +/- SD IOP decrease was -6.3 +/- 3.6 mm Hg (-28.1%) and -5.8 +/- 4.9 mm Hg (-23.5%) in the D/T-Add-On and D/T-Switch groups, respectively (both p 20%) after 12 weeks of treatment for the D/T-Add-On and the D/T-Switch groups were 66.4% (186/280) and 52.9% (37/70), respectively. There were 116 predominantly mild, nonserious adverse events attributed to the study drugs, reported by 86 (24.6%) patients. The most frequent adverse events were eye irritation (n = 42; 12.0%) and taste perversion (n = 15; 4.3%). No serious adverse events related to the study medications were reported.
In patients with primary open-angle glaucoma or ocular hypertension and elevated IOP while on monotherapy with latanoprost, switching to dorzolamide-timolol or combining dorzolamide-timolol with latanoprost are effective and safe treatment options for reducing IOP and achieving therapeutic response.
PubMed ID
18364402 View in PubMed
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Effectiveness and safety of infliximab in rheumatoid arthritis: analysis from a Canadian multicenter prospective observational registry.

https://arctichealth.org/en/permalink/ahliterature256508
Source
Arthritis Care Res (Hoboken). 2014 Aug;66(8):1142-51
Publication Type
Article
Date
Aug-2014
Author
Carter Thorne
William G Bensen
Denis Choquette
Andrew Chow
Majed Khraishi
Christopher J Atkins
John T Kelsall
Allen J Lehman
May Shawi
Hayssam Khalil
Francois Nantel
Emmanouil Rampakakis
John S Sampalis
Susan Otawa
Author Affiliation
Southlake Regional Health Centre, Newmarket, and University of Toronto, Toronto, Ontario, Canada.
Source
Arthritis Care Res (Hoboken). 2014 Aug;66(8):1142-51
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antibodies, Monoclonal - adverse effects - therapeutic use
Antirheumatic Agents - adverse effects - therapeutic use
Arthritis, Rheumatoid - drug therapy
Canada
Female
Humans
Male
Middle Aged
Prospective Studies
Registries
Treatment Outcome
Abstract
To describe the profile of rheumatoid arthritis (RA) patients treated with infliximab in Canadian routine care and to assess the real-world effectiveness and safety of infliximab.
Biologics-naive RA patients from the Biologic Treatment Registry Across Canada were stratified based on their enrollment year. Effectiveness was assessed with the changes in clinical/laboratory parameters and patient-reported outcomes and the achievement of minimal disease activity and remission. Safety was assessed with the incidence of treatment-emergent adverse events (AEs).
Among 628 patients, 45.9%, 34.6%, and 19.6% were enrolled between 2002-2005, 2005-2008, and 2008-2011, respectively. Patients recruited in more recent years had significantly lower Disease Activity Score with a 28-joint count using the C-reactive protein level (DAS28-CRP), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), swollen joint count in 28 joints, tender joint count in 28 joints, physician's global assessment of disease activity, patient's global assessment of disease activity, Health Assessment Questionnaire disability index, pain, erythrocyte sedimentation rate, and CRP level (P
PubMed ID
24470077 View in PubMed
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Efficacy and tolerability of ezetimibe 10 mg/day coadministered with statins in patients with primary hypercholesterolemia who do not achieve target LDL-C while on statin monotherapy: A Canadian, multicentre, prospective study--the Ezetrol Add-On Study.

https://arctichealth.org/en/permalink/ahliterature167077
Source
Can J Cardiol. 2006 Oct;22(12):1035-44
Publication Type
Article
Date
Oct-2006
Author
Stéphane Bissonnette
Rafik Habib
Fotini Sampalis
Stella Boukas
John S Sampalis
Author Affiliation
Merck Frosst/Schering Pharmaceuticals, Kirkland, Canada.
Source
Can J Cardiol. 2006 Oct;22(12):1035-44
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anticholesteremic Agents - therapeutic use
Azetidines - therapeutic use
Canada
Cholesterol, LDL - blood
Drug Therapy, Combination
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hypercholesterolemia - blood - drug therapy
Male
Middle Aged
Prospective Studies
Safety
Treatment Outcome
Abstract
For patients who have above-target low-density lipoprotein cholesterol (LDL-C) levels while on statin monotherapy, coadministration of a cholesterol absorption inhibitor with the statin may decrease serum LDL-C levels and improve overall lipid profiles.
To assess the effectiveness and safety of ezetimibe 10 mg/day coadministered with a statin in patients with primary hypercholesterolemia who have higher than recommended LDL-C levels while on statin monotherapy.
A six-week, prospective, multicentre study of eligible patients who had above-target LDL-C levels while on monotherapy with any statin, regardless of dose, for a minimum of four weeks. All patients were treated for six weeks with 10 mg ezetimibe daily coadministered with their current statins.
A total of 1141 patients were screened, 953 (83.5%) fulfilled the study inclusion criteria and 837 (87.8%) completed the study. Reasons for withdrawal included: lost to follow-up (50 patients [5.2%]); protocol violations (45 patients [4.7%]); adverse events (19 patients [2.0%]); and withdrawal of consent (two patients [0.2%]). After six weeks of treatment, statistically significant (P = 0.001) mean reductions were observed in LDL-C (30.05%), total cholesterol (20.84%), triglycerides (10.16%), apolipoprotein B (19.84%) and the total cholesterol to high-density lipoprotein cholesterol ratio (19.88%). At six weeks, 674 patients (80.5%) achieved target LDL-C levels. Fifty predominantly mild, nonserious adverse events related to ezetimibe were reported by 32 patients (3.4%). Frequently reported adverse events included constipation (n = 7 [0.7% of patients]), diarrhea (n = 4 [0.4%]) and dizziness (n = 4 [0.4%]).
Ezetimibe coadministered with statins is effective in reducing LDL-C in patients who do not attain target LDL-C levels while on statin monotherapy.
Notes
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Erratum In: Can J Cardiol. 2007 Feb;23(2):159
PubMed ID
17036098 View in PubMed
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Field triage of trauma patients: improving on the Prehospital Index.

https://arctichealth.org/en/permalink/ahliterature190337
Source
Am J Emerg Med. 2002 May;20(3):170-6
Publication Type
Article
Date
May-2002
Author
Hala Tamim
Lawrence Joseph
David Mulder
Renaldo N Battista
Andre Lavoie
John S Sampalis
Author Affiliation
Faculty of Health Sciences, Department of Epidemiology and Biostatistics, American University of Beirut, Beirut, Lebanon. ht02@aub.edu.lb
Source
Am J Emerg Med. 2002 May;20(3):170-6
Date
May-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Area Under Curve
Clinical Protocols
Female
Humans
Logistic Models
Male
Middle Aged
Quebec
Reproducibility of Results
Sensitivity and specificity
Trauma Severity Indices
Triage - methods
Abstract
The purpose of the present study was to evaluate the predictive ability of the Prehospital Index (PHI) in identifying injury severity and to develop a trauma triage scale that incorporates, along with the PHI, a subset of time independent variables to improve the predictive ability of the PHI-based triage instrument. This study included 1,291 trauma patients treated in Montreal, Canada. The developed trauma triage protocol was based on logistic regression analysis, in which the model that predicts the data best was selected by using Bayesian information criterion. The selected regression model included the variables age, body region injured, mechanism of injury, comorbidity, and PHI. This algorithm was a substantial improvement in detecting major versus non-major injuries (major injury defined based on death, intensive care unit admission, and surgery intervention) over the PHI alone (area under the receiver operating characteristic curve: 0.76 v 0.66, P
PubMed ID
11992335 View in PubMed
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Functional status and quality of life in survivors of injury treated at tertiary trauma centers: what are we neglecting?

https://arctichealth.org/en/permalink/ahliterature169797
Source
J Trauma. 2006 Apr;60(4):806-13
Publication Type
Article
Date
Apr-2006
Author
John S Sampalis
Moishe Liberman
Laura Davis
John Angelopoulos
Nadia Longo
Monica Joch
Fotini Sampalis
Andreas Nikolis
Andre Lavoie
Ronald Denis
David S Mulder
Author Affiliation
Department of Surgery, McGill University Health Center, Montreal General Hospital, Quebec, Canada. jsampali@jssresearch.com
Source
J Trauma. 2006 Apr;60(4):806-13
Date
Apr-2006
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adult
Aged
Aged, 80 and over
Female
Humans
Length of Stay
Male
Middle Aged
Multicenter Studies as Topic
Quality of Life
Quebec
Questionnaires
Retrospective Studies
Sickness Impact Profile
Trauma Centers
Wounds and Injuries - classification
Abstract
The purpose of this study was to describe the functional status and quality of life (QOL) of patients at 12 months after injury.
Retrospective study consisting of patients treated at three tertiary trauma centers for injuries. Functional capacity (FC) was measured using the Sickness Impact Profile and QOL was measured using the Medical Outcomes Study Short Form (MOS SF-36) at approximately 12 months after the date of injury.
There were 144 patients that fulfilled the study inclusion and exclusion criteria. The mean duration of follow-up was 1.3 years, with a range of 0.8 to 1.5 years. Age and gender were not associated with the FC or QOL. The mean(standard deviation) Injury Severity Score (ISS) was 18.9(9.4), whereas ISS category distribution was 1 to 11 (22.9%), 12 to 24 (50.0%), and 25 to 49 (27.1%). Patients with an ISS of 25 to 49 had significantly worse physical (p = 0.008) and total (p = 0.023) Sickness Impact Profile scores and had more physical functioning (p = 0.096), emotional role functioning (p = 0.080), and energy (p = 0.017) impairments when compared with those with an ISS less than 24. Patients injured in motor vehicle collisions had significantly impaired psychosocial function (p = 0.031), whereas those injured in falls had reduced quality of life scores for physical function (p = 0.089), physical role (p = 0.066), and mental health (p = 0.081).
Patients who survive injuries experience residual impairments in FC and QOL for as long as 1 year after injury. Changes to the long-term management of these patients should be considered.
PubMed ID
16612301 View in PubMed
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