Short- and long-term subjective medical treatment outcome of trauma surgery patients: the importance of physician empathy

Figures & data

Figure 1 Flowchart of study participants.

Table 1 Evaluation plan

Characteristics	On general wards	6 weeks after discharge	12 months after discharge	From medical records
Sociodemographics	×			×
ISS				×
Extremity injury				×
Length of stay				×
Posttraumatic stress (IES-R)	×
Anxiety (HADS-D)	×		×
Depression (HADS-D)	×		×
Empathy (CARE measure)		x
Patient satisfaction:
CPQ-PSC		×
CPQ-SEMTO		×	×
Quality of life (SF-36)		×	×

Abbreviations: CARE, Consultation and Relational Empathy; CPQ, Cologne Patient Questionnaire; HADS-D, German Hospital Anxiety and Depression Scale; IES-R, Impact of Event Scale – Revised; ISS, Injury Severity Score; PSC, psychosocial care; SEMTO, subjective evaluation of medical treatment outcome; SF-36, 36-Item Short Form Survey Instrument.

Table 2 Patient and health-related characteristics

	N	%
Sex	217
Male	126	58.1
Female	91	41.9
High School	217
Yes	57	26.3
No	138	63.6
Unknown	22	10.1
Living with partner	217
Yes	135	62.2
No	63	29.0
Unknown	19	8.8
Extremity injury	202
None	49	24.3
Up to AIS 2	121	59.9
AIS 3 to 4	32	15.8
Anxietya	194
Yes	31	16.0
No	91	84.0
Depressiona	195
Yes	12	11.3
No	96	88.7
Posttraumatic stressa	194
Yes	14	7.2
No	180	92.8
Mental disordera	196
Yes	39	19.9
No	157	80.1
Anxietyb	140
Yes	20	14.3
No	120	85.7
Depressionb	140
Yes	14	10.0
No	126	90.0
Mental disorderb	140
Yes	25	17.9
No	115	88.1
	Mean	SD	Range [possible]
Age (years)	45.8 (N=217)	14.6	18–70 [18–70]
Length of stay (days)	13.1 (N=216)	13.2	3–5 [5–∞]
ISS	6.35 (N=202)	5.5	1–48 [1–75]

Notes:

a At hospitalization.

b At 12-month follow-up.

Abbreviations: AIS, Abbreviated Injury Scale; ISS, Injury Severity Score; SD, standard deviation.

Table 3 Descriptive statistics for patient evaluations and outcome measures

Characteristics	N	%
SEMTO6W dichotomized*	183
High (3.5+)	101	55.2
Low (<3.5)	82	44.89
SEMTO12M dichotomized**	158
High (3.5+)	78	49.4
Low (<3.5)	80	50.6
Empathy 3 groups	183
Low (10–30)	38	20.8
Middle (31–40)	56	30.6
High (41–50)	89	48.6
	Mean	SD	Median	Range [theoretical]
SEMTO6W scale	3.37	0.61	3.5	1.5–4.0 [1–4]
SEMTO12M scale	3.22	0.73	3.25	1–4 [1–4]
Δ SEMTO	−0.102	0.66	0	−2.0 to 2.0 [−4 to 4]
Empathy scale	38.26	9.19	40	12–50 [10–50]
CPQ Scale PSC	3.03	0.66	3.09	1–4 [1–4]
6 W SF-36 PSS	35.93	7.47	35.08	14–59 [0–100]
12 M SF-36 PSS	44.76	9.35	46.67	18.9–62 [0–100]
6 W SF-36 MSS	43.72	13.03	45.91	16.8–70.2 [0–100]
12 M SF-36 MSS	48.45	12.38	52.93	12.4–67.2 [0–100]
Δ SF-36 PSS	9.15	9.01	7.67	−11.1 to 37.3 [−100 to 100]
Δ SF-36 MSS	5.32	12.00	5.32	−28.9 to 38.1 [−100 to 100]

Notes:

* SEMTO6W split at a value of 3.5 points.

** SEMTO12M split at a value of 3.5 points.

Abbreviations: 6 W SF-36, 6-week 36-Item Short Form Survey Instrument; 12 M SF-36, 12-month 36-Item Short Form Survey Instrument; CPQ, Cologne Patient Questionnaire; MSS, Mental Summary Score; PSC, psychosocial care; PSS, Physical Summary Score; SD, standard deviation; SEMTO, subjective evaluation of medical treatment outcome; SEMTO6W, subjective evaluation of medical treatment outcome 6 weeks after discharge; SEMTO12M, subjective evaluation of medical treatment outcome 12 months after discharge; Δ, change from 6 weeks to 12 months measurement.

Table 4 Patients with high versus patients with low SEMTO6W: means (two-sided t-test for independent samples), medium ranking (Mann–Whitney U-test), percentages (chi-square test), and P-values

Characteristics	High SEMTO (n=101) (%)	Low SEMTO (n=82) (%)	P-value
Agea, years	49.04	44.19	0.023
Sexc
Female (n=87)	47 (46.5)	40 (48.8)	0.762
Male (n=96)	54 (53.5)	42 (51.2)
Partnerc
Yes (n=119)	76 (75.2)	43 (52.4)	0.006
No (n=51)	20 (19.8)	31 (37.8)
Unknown (n=13)	5 (5.0)	8 (9.8)
High schoolc
Yes (n=49)	25 (32.1)	24 (30.0)	0.181
No (n=100)	46 (59.0)	54 (67.5)
Unknown (n=9)	7 (9.0)	2 (2.5)
ISS^Citation2	89.1	84.3	0.495
Length of stayb	94.8	88.5	0.425
Extremity injuryc
No (n=39)	20 (20.6)	19 (25.0)	0.568
AIS ≤2 (n=110)	65 (67.0)	45 (59.2)
AIS ≥3 (n=24)	12 (12.4)	12 (15.8)
Empathya	42.29	33.30	<0.001
CPQ-PSCb	115.1	63.5	<0.001
SEMTO12Mb	89.53	52.4	<0.001
6 W SF-36 PSSa	36.10	35.74	0.750
6 W SF-36 MSSa	45.64	41.39	0.029
12 M SF-36 PSCa	45.87	43.91	0.202
12 M SF-36 MSCa	49.69	47.40	0.270
Mental disorder in hospitalc,d
Yes (n=33)	13 (13.7)	20 (27.0)	0.021
No (n=140)	86 (86.9)	54 (73.0)
Mental disorder at 12 monthsc,e
Yes (n=22)	7 (10.0)	15 (25.9)	0.018
No (n=106)	63 (90.0)	43 (74.1)

Notes:

a Independent samples t-test.

b Mann–Whitney U-Test.

c Chi-square test.

d Measured with German Hospital Anxiety and Depression Scale and Impact of Event-Scale Revised at hospitalization.

e Measured with German Hospital Anxiety and Depression Scale 12 months after discharge.

Abbreviations: 6 W SF-36, 6-week 36-Item Short Form Survey Instrument; 12 M SF-36, 12-month 36-Item Short Form Survey Instrument; CPQ, Cologne Patient Questionnaire; ISS, Injury Severity Score; MSS, Mental Summary Score; PSC, psychosocial care; PSS, Physical Summary Score; SEMTO, subjective evaluation of medical treatment outcome; SEMTO6W, subjective evaluation of medical treatment outcome 6 weeks after discharge; SEMTO12M, subjective evaluation of medical treatment outcome 12 months after discharge.

Table 5 Patients with high versus patients with low SEMTO12M: means (two-sided t-test for independent samples), medium ranking (Mann–Whitney U-test), percentages (chi-square test), and P-values

Characteristics	High SEMTO (n=78) (%)	Low SEMTO (n=80) (%)	P-value
Agea, years	47.76	46.46	0.573
Sexc
Female (n=74)	35 (44.9)	39 (48.8)	0.625
Male (n=84)	43 (55.1)	41 (51.3)
Partnerc
Yes (n=106)	59 (75.6)	47 (58.8)	0.055
No (n=44)	15 (19.2)	29 (36.3)
Unknown (n=8)	4 (5.1)	4 (5.0)
High schoolc
Yes (n=49)	25 (32.1)	24 (30.0)	0.181
No (n=100)	46 (59.0)	54 (67.5)
Unknown (n=9)	7 (9.0)	2 (2.5)
ISSb	81.4	67.6	0.031
Length of stayb	80.0	79.1	0.900
Extremity injuryc
No (n=35)	16 (21.6)	19 (25.7)	0.799
AIS ≤2 (n=91)	46 (62.2)	45 (60.8)
AIS ≥3 (n=22)	12 (16.2)	10 (13.5)
Empathya	40.9	35.5	<0.001
PSCb	88.9	57.0	<0.001
SEMTO6Wb	88.2	57.7	<0.001
6 W SF-36 PSSa	37.39	34.31	0.009
6 W SF-36 MSSa	44.59	42.42	0.316
12 M SF-36 PSCa	46.85	42.7	0.005
12 M SF-36 MSCa	50.21	46.71	0.077
Mental disorder in hospitalc,d
Yes (n=29)	13 (17.3)	16 (20.8)	0.589
No (n=123)	62 (82.7)	61 (79.2)
Mental disorder at 12 monthsc,e
Yes (n=25)	9 (12.9)	16 (24.2)	0.087
No (n=111)	61 (87.1)	50 (75.8)

Notes:

a Independent samples t-test.

b Mann–Whitney U-test.

c Chi-square test.

d Measured with German Hospital Anxiety and Depression Scale and Impact of Event-Scale Revised at hospitalization.

e Measured with German Hospital Anxiety and Depression Scale 12 months after discharge.

Abbreviations: 6 W SF-36, 6-week 36-Item Short Form Survey Instrument; 12 M SF-36, 12-month 36-Item Short Form Survey Instrument; CPQ, Cologne Patient Questionnaire; ISS, Injury Severity Score; MSS, Mental Summary Score; PSC, psychosocial care; PSS, Physical Summary Score; SEMTO, subjective evaluation of medical treatment outcome; SEMTO6W, subjective evaluation of medical treatment outcome 6 weeks after discharge; SEMTO12M, subjective evaluation of medical treatment outcome 12 months after discharge.

Table 6 Results of logistic regression models with the dichotomized variable SEMTO6W after discharge as the dependent variable

Dependent variable: SEMTO6W dichotomized	Model 1A odds ratios (P-values) N=169	Model 2A odds ratios (P-values) N=169
Age (per year)	1.022 (0.092)	1.017 (0.239)
Sex (female)	0.805 (0.545)	1.337 (0.486)
High school (yes)	1.124 (0.758)	1.188 (0.686)
Partner (yes)	2.396 (0.023)	3.176 (0.010)
Length of stay in hospital (days)	1.010 (0.525)	1.018 (0.300)
ISS (per point on scale)	1.013 (0.721)	1.047 (0.273)
Mental Disorder hospitalization (yes)	0.436 (0.061)	0.515 (0.176)
Physician empathy low (10–30 points)		(<0.001)
Physician empathy middle (31–40 points)		4.720 (0.008)
Physician empathy high (41–50 points)		18.188 (<0.001)
Constant	0.255 (0.081)	0.021 (<0.001)
R^2	0.160	0.375

Notes: Model 1A: basic model. Model 2A: physician empathy.

Abbreviations: ISS, Injury Severity Score; SEMTO6W, subjective evaluation of medical treatment outcome 6 weeks after discharge.

Table 7 Results of logistic regression models with the dichotomized variable SEMTO12M as the dependent variable

Dependent variable: SEMTO12M dichotomized	Model 1B odds ratios (P-values) N=136	Model 2B odds ratios (P-values) N=136	Model 3B odds ratios (P-values) N=136
Age (per year)	1.009 (0.508)	1.010 (0.505)	1.005 (0.745)
Sex (female)	0.835 (0.647)	1.010 (0.981)	1.329 (0.534)
High school (yes)	1.715 (0.186)	1.304 (0.540)	1.311 (0.556)
Partner (yes)	2.479 (0.039)	3.175 (0.015)	3.696 (0.011)
Length of stay in hospital (days)	0.999 (0.943)	1.003 (0.871)	1.006 (0.753)
ISS (per point on scale)	1.021 (0.611)	1.036 (0.419)	1.048 (0.291)
6 W SF-36 PSS (per point)		1.087 (0.007)	1.088 (0.008)
6 W SF-36 MSS (per point)		1.018 (0.261)	1.016 (0.327)
Physician empathy low (10–30 points)			(0.002)
Physician empathy middle (31–40 points)			0.987 (0.982)
Physician empathy high (41–50 points)			4.265 (0.009)
Constant	0.262 (0.127)	0.005 (0.003)	0.001 (0.002)
R^2	0.161	0.230	0.335

Notes: Model 1B: basic model. Model 2B: quality of life. Model 3B: quality of life and physician empathy.

Abbreviations: 6 W SF-36, 6-week 36-Item Short Form Survey Instrument; ISS, Injury Severity Score; MSS, Mental Summary Score; PSS, Physical Summary Score; SEMTO12M, subjective evaluation of medical treatment outcome 12 months after discharge.

Table 8 Comparison of the study population with dropout patients: means (t-test), percentages (chi-square test), and P-values

	Participants	Dropouts	P-value
6-weeks follow-up
Agea, years	46.6	39.7	0.021
Sexb
Female, n (%)	88 (46.3)	3 (11.1)	0.001
Male, n (%)	102 (53.7)	24 (88.9)
ISSa, mean	6.2	7.73	0.493
Length of staya (days), mean	13.8	13.5	0.915
12-months follow-up
Agea, years	47.5	40.2	0.002
Sexb
Female, n (%)	78 (47.3)	13 (25.0)	0.005
Male, n (%)	87 (52.7)	39 (75.0)
ISSa, mean	6.6	5.5	0.236
Length of staya (days), mean	13.8	13.7	0.926

Notes:

a Independent samples t-test.

b Chi-square test.

Abbreviation: ISS, Injury Severity Score.

Table 9 Mean differences of SEMTO6W and SEMTO12M by physician empathy groups

	SEMTO6Wa (n=183)	SEMTO12Ma (n=144)
	Mean (SD)	Mean (SD)
Physician empathy
10 to 30 points	2.86 (0.57)	2.77 (0.82)
31 to 40 points	3.28 (0.57)	3.13 (0.62)
41 to 50 points	3.63 (0.49)	3.55 (0.51)
P-valueb	<0.005	<0.05

Notes:

a Possible values between 1 and 4.

b For ANOVA post-hoc tests: Scheffé, Bonferroni, and Gabriel.

Abbreviations: SD, standard deviation; SEMTO6W, subjective evaluation of medical treatment outcome 6 weeks after discharge; SEMTO12M, subjective evaluation of medical treatment outcome 12 months after discharge.

SobergHLRoiseOBautz-HolterEFinsetAReturning to work after severe multiple injuries: multidimensional functioning and the trajectory from injury to work at 5 yearsJ Trauma201171242543421045746

 PubMedGoogle Scholar