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Do foot injuries significantly affect the functional outcome of multiply injured patients?
D C Turchin1, E H Schemitsch, M D McKee
1Department of Surgery, St. Michael's Hospital, and the University of Toronto, Ontario, Canada.
Objective:
To assess the functional outcome of multiply injured trauma patients with foot injuries and to determine which outcome measures are most appropriate for this assessment.
Design:
Prospective, matched pair analysis.
Setting:
University-affiliated Level I trauma center with a prospectively entered trauma database.
Patients:
Twenty-eight multiply injured patients with foot injuries were randomly identified in our prospective trauma database (Group 1). The patients in Group 1 were randomly matched in a blinded fashion to twenty-eight multiply injured patients without foot injuries who were selected from the entire group of patients in our trauma database (Group 2). The patients were matched by age, sex, length of follow-up, and Injury Severity Score.
Main Outcome Measures:
Three outcome tools were used: the Short Form 36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the modified Boston Children's Hospital Grading System.
Results:
The outcome of multiply injured patients with foot injuries was significantly worse than that of patients without foot injuries when using any of the three outcome measures (SF-36, p = 0.008; WOMAC, p = 0.00007; modified Boston Children's score, p = 0.001). The outcome of patients with foot injuries was worse than that of those without foot injuries in five of the eight components of the SF-36 score (physical functioning, p = 0.0004; role physical, p = 0.01; bodily pain, p = 0.01; social functioning, p = 0.01; role emotional, p = 0.006). The outcome of patients with foot injuries was worse than that of patients without foot injuries in all three components of the WOMAC (pain score, p = 0.0004; stiffness score, p = 0.007; physical function score, p = 0.00006). For the patients with foot injuries, there was strong correlation across all three scales (SF-36 vs. WOMAC, r = 0.84; SF-36 vs. modified Boston Children's Hospital, r = 0.88; WOMAC vs. modified Boston Children's Hospital, r = 0.78).
Conclusions:
The SF-36, WOMAC, and modified Boston Children's Hospital Grading System are all useful in assessing the outcome of multiply injured patients with foot injuries. The outcome of these patients is poor when using any of these measures. Foot injuries cause significant disability to multiply injured patients. More attention should be given to these injuries, and more aggressive management should be considered to improve the outcome of this group of multiply injured patients.