Castillo RC, et al. - In this cohort study, researchers examined if individuals could be classified with respect to risk and protective factors measured at 6 weeks after injury into risk clusters and evaluated if these clusters explain variations in 12-month outcomes. Outcomes suggest that during early recovery, patients with orthopedic trauma can be classified into clinically useful risk and protective clusters. A substantial amount of variance in 12-month functional and health outcomes was accounted with these clusters. Hence they suggest performing early screening and classification that may allow a personalized approach to postsurgical care conserving resources and targeting appropriate levels of care to more patients.

Methods

• Researchers performed a prospective observational study between July 16, 2013, and January 15, 2016, among 352 patients with severe orthopedic injuries at 6 US level I trauma centers.
• From October 9, 2017, to July 13, 2018, they performed statistical analysis.
• Main outcomes and measures comprised standardized measures for 5 risk factors (pain intensity, depression, posttraumatic stress disorder, alcohol abuse, and tobacco use) and 4 protective factors (resilience, social support, self-efficacy for return to usual activity, and self-efficacy for managing the financial demands of recovery) completed at 6 weeks after discharge by patients.
• Using latent class analysis, they classified participants into clusters, which were evaluated against measures of function, depression, posttraumatic stress disorder, and self-rated health collected at 12 months.

Results

• Researchers identified 6 distinct patient clusters as the optimal solution among the 352 patients (121 women and 231 men; mean [SD] age, 37.6 [12.5] years) using latent class analysis.
• These clusters can be collapsed into 4 groups for clinical use, sorted from low risk and high protection (best) to high risk and low protection (worst).
• The 4 clinical groupings displayed worsening of all outcomes.
• As per Bayesian analysis, the mean Short Musculoskeletal Function Assessment dysfunction scores at 12 months differed by 7.8 points (95% CI, 3.0-12.6) between the best and second groups, by 10.3 points (95% CI, 1.6-20.2) between the second and third groups, and by 18.4 points (95% CI, 7.7-28.0) between the third and worst groups.