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Injury, Int. J.

Care Injured 42 (2011) 231

Contents lists available at ScienceDirect

Injury
journal homepage: www.elsevier.com/locate/injury

Editorial

Assessing patient outcomes: Pearls for clinical practice and research

The ‘‘outcomes’’ movement in orthopaedic surgery involves ers in making the right choice of the ideal outcome measure in
careful attention to the design of clinical research. The delineation trauma and orthopaedic surgery.
between ‘‘outcomes’’ research and ‘‘evidence-based medicine’’
remains vague.11 Central to practicing evidence based orthopae- References
dics involves integration of our clinical expertise and judgement
1. Au EH, Holdgate A. Characteristics and outcomes of patients discharged home
with patients’ perceptions and societal values, and with the best from the Emergency Department following trauma team activation. Injury
available research evidence. Evidence becomes more trustworthy 2010;41(May (5)):465–9.
when it reflects the underlying ‘truth’ about a particular treatment 2. Borg T, Berg P, Fugl-Meyer K, Larsson S. Health-related quality of life and life
satisfaction in patients following surgically treated pelvic ring fractures: a pro-
and its outcome. Fundamental to the reduction of bias in clinical spective observational study with two years follow-up. Injury 2010;41(4):
research is the choice of valid and reliable outcomes. 400–4.
The choice of the ideal outcome in a clinical study has become 3. Clay FJ, Newstead SV, McClure RJ. A systematic review of early prognostic
factors for return to work following acute orthopaedic trauma. Injury
increasingly complex, largely due to the variety of measures 2010;41(August (8)):787–803.
promoted in orthopaedics.1–5 The search term ‘orthopaedic 4. Fraschini G, Ciampi P, Scotti C, et al. Surgical treatment of chronic acromio-
outcomes’ retrieves over 3.5 million webpages in the Google clavicular dislocation: comparison between two surgical procedures for ana-
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search engine and over 6500 publications in PubMED. The
5. Giannoudis PV, Harwood PJ, Kontakis G, et al. Long-term quality of life in trauma
consistency in which outcomes are chosen or applied in the patients following the full spectrum of tibial injury (fasciotomy, closed fracture,
orthopaedic literature is highly variable. grade IIIB/IIIC open fracture and amputation). Injury 2009;40(2):213–9.
Given the ever-increasing body of outcomes used in orthopae- 6. Intiso D, Grimaldi G, Russo M, et al. Functional outcome and health status of
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dics,6–10 we enlisted the support of several researchers with 7. Irie F, Pollard C, Bellamy N. Characteristics and outcomes of injury patients in an
experience in orthopaedic clinical research to provide a practical Aboriginal and Torres Strait Islander population—Queensland Trauma Registry.
guide to outcomes assessment. Getting outcomes assessment right Australia. Injury 2010;41(July (7)):731–6.
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requires a basic understanding of the language of the outcomes following antegrade versus retrograde nailing of femoral shaft fractures. Injury
movement. To this end, we provide readers with a primer on 2009;40(2):S19.
validity, reliability and criteria for evaluating the quality of an 9. Reuther F, Mühlhäusler B, Wahl D, Nijs S. Functional outcome of shoulder
hemiarthroplasty for fractures: a multicentre analysis. Injury 2010;41(June
outcome. We further provide annotated checklists of existing (6)):606–12.
outcome measures across a variety of injuries including shoulder, 10. Stengel D, Ekkernkamp A, Wich M. Functional outcomes and health-related
hand and wrist, spine, hip, knee and foot and ankle. We provide quality of life after intramedullary nailing of tibia shaft fractures. Injury
2009;40(2):S9.
insight into outcomes following severe trauma, and post traumatic 11. Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med
stress disorder as well as head injury. 1996;334(13):835–40.
Despite decades of fracture research, we continue to struggle
with basic definitions of healing including fracture healing as well
as spine fusion. Our symposium addresses the literature focusing Mohit Bhandari
on fracture healing and spine fusion with a goal to provide Division of Orthopaedic Surgery, Department of Surgery,
recommended guidelines for clinical research. Operationalising McMaster University, Hamilton, Ontario, Canada
fracture healing outcomes in today’s environment requires
specialised infrastructure and outcome assessment tools. We Peter V. Giannoudis*
present guidelines for outcomes adjudication in fracture healing Academic Department of Trauma and Orthopaedics,
trials to emphasise the practical aspects of endpoint committees in School of Medicine, University of Leeds,
research and regulatory requirements when evaluating a device or LIMM Section of Musculoskeletal Disease, LGI, Clarendon Wing,
drug. Great George St, LS1 3EX Leeds, UK
The purpose of the ‘‘outcomes movement’’ and ‘‘evidence-based
medicine’’ is to provide surgeons with tools that allow them to *Corresponding author. Tel.: +44 113 392 2750;
gather, access, interpret, and summarise the evidence. It is not an fax: +44 113 392 3290
end in itself, but rather a set of principles and tools that help us E-mail address: pgiannoudi@aol.com (P.V. Giannoudis)
ultimately provide better patient care. bhandam@mcmaster.ca
We hope that this special issue will become a practical guide to (M. Bhandari)
outcomes assessment and will assist both clinicians and research-

0020–1383/$ – see front matter ß 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.injury.2010.11.055