Skip to main content
Erschienen in: European Journal of Trauma and Emergency Surgery 3/2022

15.11.2021 | Original Article

Prediction of recovery in trauma patients using Latent Markov models

verfasst von: Roos Johanna Maria Havermans, Felix Johannes Clouth, Koen Willem Wouter Lansink, Jeroen Kornelis Vermunt, Mariska Adriana Cornelia de Jongh, Leonie de Munter

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 3/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Patients’ expectations during recovery after a trauma can affect the recovery. The aim of the present study was to identify different physical recovery trajectories based on Latent Markov Models (LMMs) and predict these recovery states based on individual patient characteristics.

Methods

The data of a cohort of adult trauma patients until the age of 75 years with a length of hospital stay of 3 days and more were derived from the Brabant Injury Outcome Surveillance (BIOS) study. The EuroQol-5D 3-level version and the Health Utilities Index were used 1 week, and 1, 3, 6, 12, and 24 months after injury. Four prediction models, for mobility, pain, self-care, and daily activity, were developed using LMMs with ordinal latent states and patient characteristics as predictors for the latent states.

Results

In total, 1107 patients were included. Four models with three ordinal latent states were developed, with different covariates in each model. The prediction of the (ordinal) latent states in the LMMs yielded pseudo-R2 values between 40 and 53% and between 21 and 41% (depending of the type R2 used) and classification errors between 24 and 40%. Most patients seem to recover fast as only about a quarter of the patients remain with severe problems after 1 month.

Conclusion

The use of LMMs to model the development of physical function post-injury is a promising way to obtain a prediction of the physical recovery. The step-by-step prediction fits well with the outpatient follow-up and it can be used to inform the patients more tailor-made to manage the expectations.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Havermans RJM, de Jongh MAC, Bemelman M, van Driel APG, Noordergraaf GJ, Lansink KWW. Trauma care before and after optimisation in a level I trauma Centre: life-saving changes. Injury. 2019;50(10):1678–83.CrossRef Havermans RJM, de Jongh MAC, Bemelman M, van Driel APG, Noordergraaf GJ, Lansink KWW. Trauma care before and after optimisation in a level I trauma Centre: life-saving changes. Injury. 2019;50(10):1678–83.CrossRef
4.
Zurück zum Zitat Lansink KWW, Gunning AC, Spijkers ATE, Leenen LPH. Evaluation of trauma care in a mature level I trauma center in the Netherlands: outcomes in a Dutch mature level I trauma center. World J Surg. 2013;37(10):2353–9.CrossRef Lansink KWW, Gunning AC, Spijkers ATE, Leenen LPH. Evaluation of trauma care in a mature level I trauma center in the Netherlands: outcomes in a Dutch mature level I trauma center. World J Surg. 2013;37(10):2353–9.CrossRef
5.
Zurück zum Zitat Twijnstra MJ, Moons KGM, Simmermacher RKJ, Leenen LPH. Regional trauma system reduces mortality and changes admission rates: a before and after study. Ann Surg. 2010;251(2):339–43.CrossRef Twijnstra MJ, Moons KGM, Simmermacher RKJ, Leenen LPH. Regional trauma system reduces mortality and changes admission rates: a before and after study. Ann Surg. 2010;251(2):339–43.CrossRef
6.
Zurück zum Zitat Ringburg AN, Polinder S, van Ierland MCP, et al. Prevalence and prognostic factors of disability after major trauma. J Trauma Acute Care Surg. 2011;70(4):916–22.CrossRef Ringburg AN, Polinder S, van Ierland MCP, et al. Prevalence and prognostic factors of disability after major trauma. J Trauma Acute Care Surg. 2011;70(4):916–22.CrossRef
7.
Zurück zum Zitat Holtslag HR, van Beeck EF, Lindeman E, Leenen LPH. Determinants of long-term functional consequences after major trauma. J Trauma Acute Care Surg. 2007;62(4):919–27.CrossRef Holtslag HR, van Beeck EF, Lindeman E, Leenen LPH. Determinants of long-term functional consequences after major trauma. J Trauma Acute Care Surg. 2007;62(4):919–27.CrossRef
8.
Zurück zum Zitat Dinh MM, Cornwall K, Bein KJ, Gabbe BJ, Tomes BA, Ivers R. Health status and return to work in trauma patients at 3 and 6 months post-discharge: an Australian major trauma centre study. Eur J Trauma Emerg Surg. 2016;42(4):483–90.CrossRef Dinh MM, Cornwall K, Bein KJ, Gabbe BJ, Tomes BA, Ivers R. Health status and return to work in trauma patients at 3 and 6 months post-discharge: an Australian major trauma centre study. Eur J Trauma Emerg Surg. 2016;42(4):483–90.CrossRef
9.
Zurück zum Zitat Gabbe BJ, Simpson PM, Harrison JE, et al. Return to work and functional outcomes after major trauma. Ann Surg. 2016;263(4):623–32.CrossRef Gabbe BJ, Simpson PM, Harrison JE, et al. Return to work and functional outcomes after major trauma. Ann Surg. 2016;263(4):623–32.CrossRef
10.
Zurück zum Zitat van Delft-Schreurs C, van Bergen JJM, de Jongh MAC, van de Sande P, Verhofstad MHJ, de Vries J. Quality of life in severely injured patients depends on psychosocial factors rather than on severity or type of injury. Injury. 2014;45(1):320–6.CrossRef van Delft-Schreurs C, van Bergen JJM, de Jongh MAC, van de Sande P, Verhofstad MHJ, de Vries J. Quality of life in severely injured patients depends on psychosocial factors rather than on severity or type of injury. Injury. 2014;45(1):320–6.CrossRef
11.
Zurück zum Zitat Kruithof N, Traa MJ, Karabatzakis M, Polinder S, de Vries J, de Jongh MAC. Perceived changes in Quality of Life in trauma patients: a focus group study. J Trauma Nurs. 2018;25(3):177–86.CrossRef Kruithof N, Traa MJ, Karabatzakis M, Polinder S, de Vries J, de Jongh MAC. Perceived changes in Quality of Life in trauma patients: a focus group study. J Trauma Nurs. 2018;25(3):177–86.CrossRef
12.
Zurück zum Zitat de Tejada MGS, Escobar A, Bilbao A, et al. A prospective study of the association of patient expectations with changes in health-related quality of life outcomes, following total joint replacement. BMC Musculoskelet Disord. 2014;15(1):248.CrossRef de Tejada MGS, Escobar A, Bilbao A, et al. A prospective study of the association of patient expectations with changes in health-related quality of life outcomes, following total joint replacement. BMC Musculoskelet Disord. 2014;15(1):248.CrossRef
13.
Zurück zum Zitat Gandhi R, Davey JR, Mahomed N. Patient expectations predict greater pain relief with joint arthroplasty. J Arthroplasty. 2009;24(5):716–21.CrossRef Gandhi R, Davey JR, Mahomed N. Patient expectations predict greater pain relief with joint arthroplasty. J Arthroplasty. 2009;24(5):716–21.CrossRef
14.
Zurück zum Zitat Mancuso CA, Sculco TP, Salvati EA. Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty. 2003;18(7):872–8.CrossRef Mancuso CA, Sculco TP, Salvati EA. Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty. 2003;18(7):872–8.CrossRef
15.
Zurück zum Zitat Sleney J, Christie N, Earthy S, Lyons RA, Kendrick D, Towner E. Improving recovery—learning from patients’ experiences after injury: a qualitative study. Injury. 2014;45(1):312–9.CrossRef Sleney J, Christie N, Earthy S, Lyons RA, Kendrick D, Towner E. Improving recovery—learning from patients’ experiences after injury: a qualitative study. Injury. 2014;45(1):312–9.CrossRef
18.
Zurück zum Zitat Olling K, Stie M, Winther B, Steffensen KD. The impact of a patient decision aid on shared decision-making behaviour in oncology care and pulmonary medicine—a field study based on real-life observations. J Eval Clin Pract. 2019;25(6):1121–30.CrossRef Olling K, Stie M, Winther B, Steffensen KD. The impact of a patient decision aid on shared decision-making behaviour in oncology care and pulmonary medicine—a field study based on real-life observations. J Eval Clin Pract. 2019;25(6):1121–30.CrossRef
19.
Zurück zum Zitat Bartolucci F, Farcomeni A, Pennoni F. Latent Markov models: a review of a general framework for the analysis of longitudinal data with covariates. TEST. 2014;23(3):433–65.CrossRef Bartolucci F, Farcomeni A, Pennoni F. Latent Markov models: a review of a general framework for the analysis of longitudinal data with covariates. TEST. 2014;23(3):433–65.CrossRef
20.
Zurück zum Zitat Group TE. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.CrossRef Group TE. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.CrossRef
21.
22.
Zurück zum Zitat Furlong WJ, Feeny DH, Torrance GW, Barr RD. The Health Utilities Index (HUI®) system for assessing health-related quality of life in clinical studies. Ann Med. 2001;33(5):375–84.CrossRef Furlong WJ, Feeny DH, Torrance GW, Barr RD. The Health Utilities Index (HUI®) system for assessing health-related quality of life in clinical studies. Ann Med. 2001;33(5):375–84.CrossRef
23.
Zurück zum Zitat Horsman J, Furlong W, Feeny D, Torrance G. The Health Utilities Index (HUI®): concepts, measurement properties and applications. Health Qual Life Outcomes. 2003;1(1):54.CrossRef Horsman J, Furlong W, Feeny D, Torrance G. The Health Utilities Index (HUI®): concepts, measurement properties and applications. Health Qual Life Outcomes. 2003;1(1):54.CrossRef
25.
Zurück zum Zitat Gennarelli TA, Wodzin E. Abbreviated injury scale 2005: update 2008. Russ Reeder; 2008. Gennarelli TA, Wodzin E. Abbreviated injury scale 2005: update 2008. Russ Reeder; 2008.
26.
Zurück zum Zitat Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma Acute Care Surg. 1974;14(3):187–96.CrossRef Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma Acute Care Surg. 1974;14(3):187–96.CrossRef
27.
Zurück zum Zitat Baker SP, O’Neill B. The injury severity score: an update. J Trauma Acute Care Surg. 1976;16(11):882–5.CrossRef Baker SP, O’Neill B. The injury severity score: an update. J Trauma Acute Care Surg. 1976;16(11):882–5.CrossRef
28.
Zurück zum Zitat Van Buuren S, Oudshoorn K. Flexible multivariate imputation by MICE. Leiden: TNO; 1999. Van Buuren S, Oudshoorn K. Flexible multivariate imputation by MICE. Leiden: TNO; 1999.
29.
Zurück zum Zitat Collins LM, Lanza ST. Latent class and latent transition analysis: With applications in the social, behavioral, and health sciences, vol 718. New York: Wiley; 2009.CrossRef Collins LM, Lanza ST. Latent class and latent transition analysis: With applications in the social, behavioral, and health sciences, vol 718. New York: Wiley; 2009.CrossRef
30.
Zurück zum Zitat Dempster AP, Laird NM, Rubin DB. Maximum likelihood from incomplete data via the EM algorithm. J R Stat Soc Ser B (Methodol). 1977;39(1):1–22. Dempster AP, Laird NM, Rubin DB. Maximum likelihood from incomplete data via the EM algorithm. J R Stat Soc Ser B (Methodol). 1977;39(1):1–22.
31.
Zurück zum Zitat Vermunt JK, Langeheine R, Bockenholt U. Discrete-time discrete-state latent Markov models with time-constant and time-varying covariates. J Educ Behav Stat. 1999;24(2):179–207.CrossRef Vermunt JK, Langeheine R, Bockenholt U. Discrete-time discrete-state latent Markov models with time-constant and time-varying covariates. J Educ Behav Stat. 1999;24(2):179–207.CrossRef
32.
Zurück zum Zitat Vermunt JK, Magidson J. Technical guide for Latent GOLD 4.0: basic and advanced. Belmont: Statistical Innovations; 2005. Vermunt JK, Magidson J. Technical guide for Latent GOLD 4.0: basic and advanced. Belmont: Statistical Innovations; 2005.
33.
Zurück zum Zitat Friedman J, Hastie T, Tibshirani R. The elements of statistical learning, vol. 1. Springer series in statistics. New York: Springer; 2001. Friedman J, Hastie T, Tibshirani R. The elements of statistical learning, vol. 1. Springer series in statistics. New York: Springer; 2001.
34.
Zurück zum Zitat Vermunt JK, Magidson J. Upgrade manual for Latent GOLD 6.0. 2020; Vermunt JK, Magidson J. Upgrade manual for Latent GOLD 6.0. 2020;
35.
Zurück zum Zitat Collins GS, Reitsma JB, Altman DG, Moons KGM. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. Br J Surg. 2015;102(3):148–58.CrossRef Collins GS, Reitsma JB, Altman DG, Moons KGM. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. Br J Surg. 2015;102(3):148–58.CrossRef
36.
Zurück zum Zitat de Munter L, Polinder S, Havermans RJ, Steyerberg EW, de Jongh MA. Prognostic factors for recovery of health status after injury: a prospective multicentre cohort study. BMJ Open. 2021;11(1):e038707.CrossRef de Munter L, Polinder S, Havermans RJ, Steyerberg EW, de Jongh MA. Prognostic factors for recovery of health status after injury: a prospective multicentre cohort study. BMJ Open. 2021;11(1):e038707.CrossRef
38.
Zurück zum Zitat Busse JW, Heels-Ansdell D, Makosso-Kallyth S, et al. Patient coping and expectations predict recovery after major orthopaedic trauma. Br J Anaesth. 2019;122(1):51–9.CrossRef Busse JW, Heels-Ansdell D, Makosso-Kallyth S, et al. Patient coping and expectations predict recovery after major orthopaedic trauma. Br J Anaesth. 2019;122(1):51–9.CrossRef
39.
Zurück zum Zitat Chen J, Ou L, Hollis SJ. A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC Health Serv Res. 2013;13(1):211.CrossRef Chen J, Ou L, Hollis SJ. A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC Health Serv Res. 2013;13(1):211.CrossRef
40.
Zurück zum Zitat van den Heuvell CVL, van Zuuren F, Wells M, van der Laan G, Reintsema H. Paradigm shift in head and neck oncology patient management. J Otolaryngol Head Neck Surg. 2017;46(1):57.CrossRef van den Heuvell CVL, van Zuuren F, Wells M, van der Laan G, Reintsema H. Paradigm shift in head and neck oncology patient management. J Otolaryngol Head Neck Surg. 2017;46(1):57.CrossRef
41.
Zurück zum Zitat Søndergaard SR, Madsen PH, Hilberg O, Jensen KM, Olling K, Steffensen KD. A prospective cohort study of shared decision making in lung cancer diagnostics: impact of using a patient decision aid. Patient Educ Couns. 2019;102(11):1961–8.CrossRef Søndergaard SR, Madsen PH, Hilberg O, Jensen KM, Olling K, Steffensen KD. A prospective cohort study of shared decision making in lung cancer diagnostics: impact of using a patient decision aid. Patient Educ Couns. 2019;102(11):1961–8.CrossRef
42.
Zurück zum Zitat Kongsted A, Nielsen AM. Latent class analysis in health research. J Physiother. 2017;63(1):55–8.CrossRef Kongsted A, Nielsen AM. Latent class analysis in health research. J Physiother. 2017;63(1):55–8.CrossRef
Metadaten
Titel
Prediction of recovery in trauma patients using Latent Markov models
verfasst von
Roos Johanna Maria Havermans
Felix Johannes Clouth
Koen Willem Wouter Lansink
Jeroen Kornelis Vermunt
Mariska Adriana Cornelia de Jongh
Leonie de Munter
Publikationsdatum
15.11.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 3/2022
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-021-01798-7

Weitere Artikel der Ausgabe 3/2022

European Journal of Trauma and Emergency Surgery 3/2022 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.