Follow-up and counseling service in trauma patients: needs and goals - a preliminary study

Introduction

Trauma is the most common cause of morbidity in young people. It has a high social impact both because of the high cost of the acute treatments and because of the physical and psychological consequences that it may cause. A prospective, observational, single-center study on quality of life 12 to 24 months after trauma was carried out. The aim of the study is to evaluate life quality after trauma and to identify the most important needs of the patients, in order to improve the level of care after an ICU stay and to implement a faster and more effective reintegration into the active and productive society.

Methods

All patients admitted to the 18-bed ICU of our university hospital between 5 May 2010 and 28 February 2011 because of a trauma who stayed in the ICU for at least 48 hours were eligible for the study. Patients were contacted and invited to attend a multidisciplinary interview. Data concerning family, working and economic status, main disabilities and medical needs were collected. The SF12 questionnaire was administered to define physical component summary (PCS) and mental component summary (MCS) scores. SPSS 20.0 was used to perform statistical analysis.

Results

Sixty-two patients matched inclusion criteria and were contacted. Thirty-three patients (90.9% males; age 38.7 ± 14.3 years; mean SAPS II 33.75 ± 11.79) were interviewed. Mean ICU stay was 25.7 ± 15.3 days. Fifteen patients (45.5%) had undergone temporary tracheostomy. Twenty-six patients were employed at the moment of trauma: of these, 11 (42.3%) stated to be jobless and one was pensioned at follow-up. In the whole cohort, the unemployment rate increased from 12.1 to 45.6%. Mean PCS was 43.59 ± 6.43, mean MCS was 41.04 ± 7.69. At follow-up, the 14 employed patients had a lower MCS versus the 19 jobless patients (37.94 ± 7.14 vs. 43.33 ± 7.44; P = 0.04), while no differences concerning PCS were found. The three patients that were living on their own when the trauma occurred showed, at follow-up, a lower mean MCS score towards the rest of the cohort (32.2 ± 0.47 vs. 41.93 ± 7.51; P 0.001).

Conclusion

Trauma is associated with an increase of the unemployment rate in young people. Patients that are employed at follow-up seemed to have a worse mental health status towards the unemployed ones. Conversely, the employed patients did not show any trend to a lower physical health status. Thus a counseling service that provides psychological care would be useful to implement more effective work reintegration for trauma patients.