Abstract
Introduction to the problem
Though declining in the recent decades, high-energy musculoskeletal trauma remains a major contributor to the burden of disease in high-income countries (HICs). However, due to limitations in the available body of the literature, evaluation of this burden is challenging. The purpose of this review is to assess: (1) the current epidemiologic data on the surgical burden of high-energy musculoskeletal trauma in HICs; (2) the current data on the economic impact of high-energy musculoskeletal trauma; and (3) potential strategies for addressing gaps in musculoskeletal trauma care for the future.
Review of literature
In 2016, mortality from road traffic injuries (RTIs) between the ages of 15–49 was reported to be 9.5% (9.0–9.9) in high-income countries, accounting for approximately 255 million DALYs. While RTIs do not fully capture the extent of high-energy musculoskeletal trauma, as the most common mechanism, they serve as a useful indicator of the impact on the surgical and economic burden. In 2009, the global losses related to RTIs were estimated to be 518 billion USD, costing governments between 1 and 3% of their gross domestic product (GDP). In the last decade, both the total direct per-person healthcare cost and the incremental direct per-person costs for those with a musculoskeletal injury in the USA rose 75 and 58%, respectively.
Future directions: addressing the gaps
While its impact is large, research on musculoskeletal conditions, including high-energy trauma, is underfunded compared to other fields of medicine. An increased awareness among policy makers and healthcare professionals of the importance of care for the high-energy musculoskeletal trauma patient is critical. Full implementation of trauma systems is imperative, and metrics such as the ICD–DALY have the potential to allow for real-time evaluation of prevention and treatment programs aimed to reduce injury-related morbidity and mortality. The dearth in knowledge in optimal and cost-effective post-acute care for high-energy musculoskeletal trauma is a reason for concern, especially since almost half of the costs are attributed to this phase of care. Multidisciplinary rehabilitation teams as part of a musculoskeletal trauma system may be of interest to decrease further the long-term negative effects and the economic burden of high-energy musculoskeletal trauma.
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References
Institute for Health Metrics and Evaluation (IHME). Data visualizations. https://vizhub.healthdata.org/gbd-compare/. Accessed 6 June 2018
Centers for Disease Control and Prevention. Nonfatal injury data. http://www.cdcgov/injury/wisqars/nonfatalhtml. Accessed 6 June 2018
Mock C, Cherian MN (2008) The global burden of musculoskeletal injuries: challenges and solutions. Clin Orthop Relat Res 466:2306–2316
Mock C, Joshipura M, Arreola-Risa C et al (2012) An estimate of the number of lives that could be saved through improvements in trauma care globally. World J Surg 36:959–963. https://doi.org/10.1007/s00268-012-1459-6
Mock CLJ, Goosen J, Joshipura M, Peden M (2004) Guidelines for essential trauma care. World Health Organization, Geneva
National Highway Traffic Safety Administration (NHTSA). Trauma system agenda for the future. https://one.nhtsa.gov/people/injury/ems/emstraumasystem03/traumasystem.htm. Accessed 6 June 2018
MacKenzie EJ, Bosse MJ, Pollak AN et al (2005) Long-term persistence of disability following severe lower-limb trauma. Results of a seven-year follow-up. J Bone Joint Surg Am 87:1801–1809
Morshed S, Knops S, Jurkovich GJ et al (2015) The impact of trauma-center care on mortality and function following pelvic ring and acetabular injuries. J Bone Joint Surg Am 97:265–272
Stinner DJ, Edwards D (2017) Surgical management of musculoskeletal trauma. Surg Clin North Am 97:1119–1131
Weinstein SYE (2018) United States Bone and Joint Initiative: The burden of musculoskeletal diseases in the United States, 4th edn. (forthcoming). Rosemont, IL. Available at http://www.boneandjointburden.org. Accessed 6 June 2018
Mortality GBD, Causes of Death C (2015) Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385:117–171
Gansslen A, Pohlemann T, Paul C et al (1996) Epidemiology of pelvic ring injuries. Injury 27(Suppl 1):S-A13–S-A20
Melton LJ 3rd, Sampson JM, Morrey BF et al (1981) Epidemiologic features of pelvic fractures. Clin Orthop Relat Res 155:43–47
Ragnarsson B, Jacobsson B (1992) Epidemiology of pelvic fractures in a Swedish county. Acta Orthop Scand 63:297–300
Balogh Z, King KL, Mackay P et al (2007) The epidemiology of pelvic ring fractures: a population-based study. J Trauma 63:1066–1073 (discussion 1072–1063)
Winkler D, Goudie ST, Court-Brown CM (2018) The changing epidemiology of open fractures in vehicle occupants, pedestrians, motorcyclists and cyclists. Injury 49:208–212
Passias PG, Poorman GW, Segreto FA et al (2018) Traumatic fractures of the cervical spine: analysis of changes in incidence, cause, concurrent injuries, and complications among 488,262 patients from 2005 to 2013. World Neurosurg 110:e427–e437
Laird A, Keating JF (2005) Acetabular fractures: a 16-year prospective epidemiological study. J Bone Joint Surg Br 87:969–973
Rinne PP, Laitinen MK, Huttunen T et al (2017) The incidence and trauma mechanisms of acetabular fractures: a nationwide study in Finland between 1997 and 2014. Injury 48:2157–2161
Hu R, Mustard CA, Burns C (1996) Epidemiology of incident spinal fracture in a complete population. Spine 21:492–499
Fredo HL, Rizvi SA, Lied B et al (2012) The epidemiology of traumatic cervical spine fractures: a prospective population study from Norway. Scand J Trauma Resusc Emerg Med 20:85
Weiss RJ, Montgomery SM, Al Dabbagh Z et al (2009) National data of 6409 Swedish inpatients with femoral shaft fractures: stable incidence between 1998 and 2004. Injury 40:304–308
Enninghorst N, McDougall D, Evans JA et al (2013) Population-based epidemiology of femur shaft fractures. J Trauma Acute Care Surg 74:1516–1520
Weiss RJ, Montgomery SM, Ehlin A et al (2008) Decreasing incidence of tibial shaft fractures between 1998 and 2004: information based on 10,627 Swedish inpatients. Acta Orthop 79:526–533
Thur CK, Edgren G, Jansson KA et al (2012) Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients. Acta Orthop 83:276–281
Ekholm R, Adami J, Tidermark J et al (2006) Fractures of the shaft of the humerus: an epidemiological study of 401 fractures. J Bone Joint Surg Br 88:1469–1473
Robinson CM, Hill RM, Jacobs N et al (2003) Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 17:38–47
Diamantopoulos AP, Rohde G, Johnsrud I et al (2012) The epidemiology of low- and high-energy distal radius fracture in middle-aged and elderly men and women in Southern Norway. PLoS ONE 7:e43367
Dijkink S, Nederpelt CJ, Krijnen P et al (2017) Trauma systems around the world: a systematic overview. J Trauma Acute Care Surg 83:917–925
Zetlen HL, LaGrone LN, Foianini JE et al (2017) Status of trauma quality improvement programs in the Americas: a survey of trauma care providers. J Surg Res 220:213–222
World Health Organization (WHO). GDB data. http://www.who.int/healthinfo/global_burden_disease/metrics_daly/en/. Accessed 6 June 2018
DALYs GBD, Collaborators H (2017) Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1260–1344
Beck B, Cameron PA, Fitzgerald MC et al (2017) Road safety: serious injuries remain a major unsolved problem. Med J Aust 207:244–249
Kim YJ, Shin SD, Park HS et al (2016) International classification of diseases 10th edition-based disability adjusted life years for measuring of burden of specific injury. Clin Exp Emerg Med 3:219–238
Thorpe KE, Florence CS, Howard DH et al (2005) The rising prevalence of treated disease: effects on private health insurance spending. Health Aff 24:W5-317–W315-325
Dalal K, Lin Z, Gifford M et al (2013) Economics of global burden of road traffic injuries and their relationship with health system variables. Int J Prev Med 4:1442–1450
Hemmila MR, Jakubus JL, Maggio PM et al (2008) Real money: complications and hospital costs in trauma patients. Surgery 144:307–316
Court-Brown CM, Aitken SA, Duckworth AD et al (2013) The relationship between social deprivation and the incidence of adult fractures. J Bone Joint Surg Am 95:e321–e327
Palmera-Suarez R, Lopez-Cuadrado T, Fernandez-Cuenca R et al (2018) Inequalities in the risk of disability due to traffic injuries in the Spanish adult population, 2009–2010. Injury 49:549–555
Charters KE, Gabbe BJ, Mitra B (2017) Population incidence of pedestrian traffic injury in high-income countries: a systematic review. Injury 48:1331–1338
Tominaga GT, Dandan IS, Schaffer KB et al (2017) Trauma resource designation: an innovative approach to improving trauma system overtriage. Trauma Surg Acute Care Open 2:e000102
Castillo RC, Raja SN, Frey KP et al (2017) Improving pain management and long-term outcomes following high-energy orthopaedic trauma (pain study). J Orthop Trauma 31(Suppl 1):S71–S77
Phillips TD, Shoemaker MJ (2017) Early access to physical therapy and specialty care management for american workers with musculoskeletal injuries. J Occup Environ Med 59:402–411
Scholz SM, Andermatt P, Tobler BL et al (2016) Work incapacity and treatment costs after severe accidents: standard versus intensive case management in a 6-year randomized controlled trial. J Occup Rehabilit 26:319–331
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Hoogervorst, P., Shearer, D.W. & Miclau, T. The Burden of High-Energy Musculoskeletal Trauma in High-Income Countries. World J Surg 44, 1033–1038 (2020). https://doi.org/10.1007/s00268-018-4742-3
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DOI: https://doi.org/10.1007/s00268-018-4742-3