BACKGROUND: Persisting back pain is a frequent consequence after severe trauma including injury to the spine. Reports on the incidence and relevance of back pain in severely injured patients in the absence of direct injury to the spine are scarce. OBJECTIVE: To assess the frequency of relevant backpain and its effect on health-related quality of life (HRQoL) in trauma patients with spine injury compared to patients without direct impact to spine postdischarge and two years after trauma within an observational study. METHODS: A two-year follow-up survey by using the Polytrauma Outcome Chart (PoloChart) and a set of specific questionnaires on socioeconomic and other HRQoL aspects was conducted among adult patients that had been treated for severe traumatic injuries (ISS ⩾ 9) at a German level 1 trauma center between 2008 and 2017. Patient subgroups included patients with relevant (VAS ⩾ 3) versus non-relevant back pain (VAS < 3) stratified by visual analogue scale (VAS 0–10). Patients with relevant back pain were separated into patients with (AIS spine ⩾ 1) and without spine injury (AIS spine = 0) according to the Abbreviated Injury Score (AIS). RESULTS: 543/1010 questionnaires were returned yielding a response rate of 54%. Patients were predominantly male (n= 383/543; 71%) with a mean age 45 ± 19 years, mostly blunt trauma (n= 524/543; 97%) and a mean ISS 18 ± 12 points. 32.4% of patients had sustained a spine injury defined by an AIS spine ⩾ 1 (n= 176/543). Half of these patients suffered from relevant back pain two years after trauma (n= 90/176; 51.1%); in contrast, in non-spine injured patients one in three patients reported relevant back pain (n= 127/367; 34.6%). Patients with relevant back pain reported significantly lower HRQoL as measured by the 36-Item Short Form Health Survey and the Trauma Outcome Profile. The use of pain medication after discharge and at two years after trauma was significantly higher in patients with relevant back pain (n= 183/211; 86.7% vs. n= 214/318; 75.8%; p< 0.001; pain medication 2 years after trauma: n= 113/210, 53.8% vs. 68/317, 21.5%, p< 0.001). CONCLUSION: Persisting back pain is frequent at two years after trauma independent of presence or absence of initial injury to the spine and associated with lower HRQoL in almost every dimension including physical, mental and social domains.

中文翻译：

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创伤后两年相关背痛的频率及其对健康相关生活质量的影响

背景：持续性背痛是包括脊柱损伤在内的严重创伤后的常见后果。在脊柱没有直接损伤的情况下，关于严重受伤患者背痛的发生率和相关性的报告很少。目的：在一项观察性研究中，与没有对脊柱产生直接影响的出院后和创伤后两年的脊柱损伤患者相比，评估相关背痛的频率及其对脊柱损伤患者与健康相关生活质量 (HRQoL) 的影响。方法：使用多发性创伤结果表 (PoloChart) 和一组关于社会经济和其他 HRQoL 方面的特定问卷，对接受过严重创伤性损伤 (ISS  9) 治疗的成年患者进行为期两年的随访调查2008 年至 2017 年德国一级创伤中心。患者亚组包括相关（VAS  3）与非相关背痛（VAS < 3）的患者，通过视觉模拟量表（VAS 0-10）分层。根据简明损伤评分 (AIS)，将相关背痛患者分为有（AIS 脊柱  1）和无脊柱损伤（AIS 脊柱 = 0）的患者。结果：回收了 543/1010 份问卷，回复率为 54%。患者主要是男性 (n= 383/543; 71%)，平均年龄 45 ± 19 岁，主要是钝器外伤 (n= 524/543; 97%)，平均 ISS 18 ± 12 分。32.4% 的患者遭受了由 AIS 脊柱定义的脊柱损伤  1 (n= 176/543)。这些患者中有一半在创伤后两年出现相关背痛 (n= 90/176; 51.1%)；相比之下，在非脊柱受伤的患者中，三分之一的患者报告有相关的背痛（n=127/367；34.6%）。根据 36 项短期健康调查和创伤结果概况，患有相关背痛的患者报告的 HRQoL 显着降低。出院后和外伤后两年使用止痛药的患者有相关背痛的比例明显更高（n=183/211；86.7% vs. n=214/318；75.8%；p<0.001；止痛药 2 年创伤后：n=113/210，53.8% vs. 68/317，21.5%，p<0.001）。结论：持续性背痛在创伤后两年内很常见，与是否存在脊柱初始损伤无关，并且与包括身体、心理和社会领域在内的几乎所有维度的较低 HRQoL 相关。出院后和外伤后两年使用止痛药的患者有相关背痛的比例明显更高（n=183/211；86.7% vs. n=214/318；75.8%；p<0.001；止痛药 2 年创伤后：n=113/210，53.8% vs. 68/317，21.5%，p<0.001）。结论：持续性背痛在创伤后两年内很常见，与是否存在脊柱初始损伤无关，并且与包括身体、心理和社会领域在内的几乎所有维度的较低 HRQoL 相关。出院后和外伤后两年使用止痛药的患者有相关背痛的比例明显更高（n=183/211；86.7% vs. n=214/318；75.8%；p<0.001；止痛药 2 年创伤后：n=113/210，53.8% vs. 68/317，21.5%，p<0.001）。结论：持续性背痛在创伤后两年内很常见，与是否存在脊柱初始损伤无关，并且与包括身体、心理和社会领域在内的几乎所有维度的较低 HRQoL 相关。