Psychological distress and quality of life after orthopedic trauma: an observational study

Although trauma remains the leading cause of mortality in the first 4 decades of life, most people with traumatic injuries will survive their accident.1 Management of such patients focuses on patient medical resuscitation, stabilization of injuries and restoration of function.2 Costs related to trauma care in the United States have been estimated to exceed US$400 billion annually.3 Research is needed to identify factors associated with patient outcomes. Several studies of patients with orthopedic trauma have focused on measures of functional recovery, complications, mortality and costs.4–7 Less attention has been focused on patient psychological status following orthopedic trauma — a common source of patient complaints and a clinically relevant outcome.8 The prevalence of psychological illness following traumatic injuries varies according to the diagnostic criteria used in studies, the timing of the assessment and definitions of trauma. Estimates of psychological symptoms following musculoskeletal trauma have ranged from 6.5% to 51.0%.8–14 Despite mounting evidence that non-injury–related factors have an important role in recovery from trauma, specific variables associated with clinical outcomes are poorly understood.15–17 This lack of knowledge complicates efforts to improve the care of orthopedic trauma patients. We report the findings of an observational study of patients attending 10 orthopedic fracture clinics that was designed to investigate the prevalence of psychological symptoms and their association with health-related quality of life.