Economic Impact of Trauma- A Meta-Analysis

Abstract

Introduction: Orthopaedic trauma is any severe injury to the bones, joints, and/or soft tissue that is caused by an external source. These injuries are often the result of a sudden incident, such as a car accident or fall, but not always. Trauma can also be caused by overuse - for example, running long distances is a common cause of tibial stress fractures, small hairline cracks in the lower leg. The Main objective of this study was to determine the socioeconomic impact of orthopaedic trauma in the available literature. We aimed to achieve this objective by defining the various socioeconomic outcome measures and calculating pooled socioeconomic outcomes for extremity fracture patients at commonly reported time points. Materials and Methods: In our study, Studies were eligible for inclusion if more than 75% of the study population sustained an appendicular fracture due to acute trauma, the mean age of the study population was between 18 and 65 years of age, and the study included a socio-economic outcome, defined as a measure of income, employment status, or educational status. An experienced academic research librarian conducted searches in MEDLINE (Ovid), Embase (Elsevier), and Scopus on December 3, 2020, without restrictions on publication date or language. Searches comprised of two concepts: socio-economic consequences and orthopaedic trauma. Keywords were used in combination with database-specific terminology. The reference lists of the included studies were examined for additional papers. Results: A total of 1702 titles and abstracts, 486 full-text articles were screened in this study; 103 met our eligibility criteria and were included in the review and meta analysis. The included studies comprised of retrospective cohort studies (35.6%) and case series (31.7%). The majority of the studies were performed at a single site (78.0%) with a median sample size of 31 patients (IQR: 34–145), and over half were conducted in either Europe (37.6%) or North America (27.3%). In the included prospective studies, the median follow-up was 12 months (IQR: 6–24 months). Retrospective studies had a median follow-up of 18 months (IQR: 12–25). Fractures of the tibia (31.2%) and hand (31.2%) were the most commonly studied. While calcaneus (n = 15), scaphoid (n = 12), and malleolus (n=9) were the most frequently included fracture locations in the included studies. Over 80% of the included studies were published from 2000 through 2019. Conclusion: The findings of this meta-analysis suggest that orthopaedic trauma can have a substantial socio-economic impact on patients, and therefore also affect a person's psychological well-being and happiness. However, the current techniques to measure socio-economic outcomes following orthopaedic trauma are widely varied in both design and implementation. Informative and accurate socio-economic outcome assessment requires a multifaceted approach and further standardization.