Resilience and long-term outcomes after trauma: An opportunity for early intervention?

Deepika Nehra, Juan P. Herrera-Escobar, Syeda S. Al Rafai, Joaquim Havens, Reza Askari, Stephanie Nitzschke, George Velmahos, George Kasotakis, Karen J. Brasel, Nomi Levy-Carrick, Ali Salim, Adil Haider

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)782-789
Number of pages8
JournalThe journal of trauma and acute care surgery
Volume87
Issue number4
DOIs
StatePublished - Oct 1 2019

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Wounds and Injuries
Odds Ratio
Confidence Intervals
Injury Severity Score
Post-Traumatic Stress Disorders
Logistic Models
Nonpenetrating Wounds
Aptitude
Trauma Centers
Activities of Daily Living
Chronic Pain
Quality of Life
Interviews

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Nehra, D., Herrera-Escobar, J. P., Al Rafai, S. S., Havens, J., Askari, R., Nitzschke, S., ... Haider, A. (2019). Resilience and long-term outcomes after trauma: An opportunity for early intervention? The journal of trauma and acute care surgery, 87(4), 782-789. https://doi.org/10.1097/TA.0000000000002442

Resilience and long-term outcomes after trauma : An opportunity for early intervention? / Nehra, Deepika; Herrera-Escobar, Juan P.; Al Rafai, Syeda S.; Havens, Joaquim; Askari, Reza; Nitzschke, Stephanie; Velmahos, George; Kasotakis, George; Brasel, Karen J.; Levy-Carrick, Nomi; Salim, Ali; Haider, Adil.

In: The journal of trauma and acute care surgery, Vol. 87, No. 4, 01.10.2019, p. 782-789.

Research output: Contribution to journalArticle

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 2019, 'Resilience and long-term outcomes after trauma: An opportunity for early intervention?', The journal of trauma and acute care surgery, vol. 87, no. 4, pp. 782-789. https://doi.org/10.1097/TA.0000000000002442
Nehra, Deepika ; Herrera-Escobar, Juan P. ; Al Rafai, Syeda S. ; Havens, Joaquim ; Askari, Reza ; Nitzschke, Stephanie ; Velmahos, George ; Kasotakis, George ; Brasel, Karen J. ; Levy-Carrick, Nomi ; Salim, Ali ; Haider, Adil. / Resilience and long-term outcomes after trauma : An opportunity for early intervention?. In: The journal of trauma and acute care surgery. 2019 ; Vol. 87, No. 4. pp. 782-789.
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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.",
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AU - Al Rafai, Syeda S.

AU - Havens, Joaquim

AU - Askari, Reza

AU - Nitzschke, Stephanie

AU - Velmahos, George

AU - Kasotakis, George

AU - Brasel, Karen J.

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N2 - 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.

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