Citation

Nehra D, Herrera-Escobar JP, Al Rafai SS, Havens J, Askari R, Nitzschke S, Velmahos G, Kasotakis G, Brasel KJ, Levy-Carrick N, Salim A, Haider A. J. Trauma Acute Care Surg. 2019; 87(4): 782-789.

Affiliation

From the Division of Trauma, Burn and Surgical Critical Care, Department of Surgery (D.N., J.H., R.A., S.N., A.S., A.H.), Center for Surgery and Public Health (J.P.H-E., S.S.A.R., J.H., A.H.), Brigham and Women's Hospital, Harvard Medical School; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), Massachusetts General Hospital, Harvard Medical School; Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery (G.K.), Boston University School of Medicine, Boston, Massachusetts; Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery (K.J.B.), Oregon Health and Science University. Portland, Oregon; and Department of Psychiatry (N.L-C.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002442

PMID

31589192

Abstract

BACKGROUND: Resilience, or the ability to cope with difficulties, influences an individual's response to life events including unexpected injury. We sought to assess the relationship between patient self-reported resilience traits and functional and psychosocial outcomes 6 months after traumatic injury.

METHODS: Adult trauma patients 18 years to 64 years of age with moderate to severe injuries (Injury Severity Score, ≥9) admitted to one of three Level I trauma centers between 2015 and 2017 were contacted by phone at 6 months postinjury and asked to complete a validated Trauma Quality of Life (T-QoL) survey and PTSD screen. Patients were classified into "low" and "high" resilience categories. Long-term outcomes were compared between groups. Adjusted logistic regression models were built to determine the association between resilience and each of the long-term outcomes.

RESULTS: A total of 305 patients completed the 6-month interview. Two hundred four (67%) of the 305 patients were classified as having low resilience. Mean age was 42 ± 14 years, 65% were male, 91% suffering a blunt injury, and average Injury Severity Score was 15.4 ± 7.9. Patients in the low-resilience group had significantly higher odds of functional limitations in activities of daily living (odds ratio [OR], 4.81; 95% confidence interval [CI], 2.48-9.34). In addition, patients in the lower resilience group were less likely to have returned to work/school (OR, 3.25; 95% CI, 1.71-6.19), more likely to report chronic pain (OR, 2.57; 95% CI, 1.54-4.30) and more likely to screen positive for PTSD (OR, 2.96; 95% CI, 1.58-5.54).

CONCLUSION: Patients with low resilience demonstrated worse functional and psychosocial outcomes 6 months after injury. These data suggest that screening for resilience and developing and deploying early interventions to improve resilience-associated traits as soon as possible after injury may hold promise for improving important long-term functional outcomes. LEVEL OF EVIDENCE: Prognostic, level II.

Language: en