Patient education and recall regarding postsplenectomy immunizations.

BACKGROUND: The purpose of this study was to determine the rates of initial vaccinations after splenectomy for trauma, assess the effectiveness of patient education on reimmunizations, and evaluate patients' utilization of their knowledge regarding immunization after discharge. METHODS: From June 1996-December 2011, 144 patients underwent splenectomy after traumatic injury. A telephone survey was completed in 100 of 144 splenectomized patients (69%) at a mean of 7.9 y after their splenectomy. Questions were directed to determine the quality of patients' recall of the implications of splenectomy, the need for vaccinations, and the quality of the health information administered. Research electronic data capture tool was used for collecting data, and data were analyzed with Stata 11.2. RESULTS: Only 27% of participants recall receiving education on postsplenectomy vaccination and 41% of those patients rated their education as poor or minimal. Ninety-one percent of patients indicated that they would like more information in the form of a brochure. Our overall initial vaccination rates among patients who had splenectomy from 1996-2011 were 76%, 75%, and 68% for Streptococcus pneumoniae, Neisseria meningitidis, and Hemophilus influenza type b, respectively. Since 2004, 95% of those who had splenectomy between 2004 and 2007 received all three vaccines. Since 2008, our institution has maintained 100% initial vaccination rates for all three vaccines. The revaccination rates in this group of patients (from 1996-2007) were 39% and 15% for pneumococcal and meningococcal vaccines, respectively. CONCLUSIONS: Patients had poor recall of the information provided during hospitalization for splenectomy. There were low revaccination rates in our patient cohort. Specific educational and vaccination surveillance strategies are required to improve vaccination rates.

Obesity delays functional recovery in trauma patients.

BACKGROUND: Obesity is known to complicate trauma hospital stays. We hypothesize that obesity delays functional recovery in trauma patients. MATERIALS AND METHODS: Between 2005 and 2007, adult patients with a hospital length of stay >24 h were prospectively recruited for the study. Functional Independence Measurement (FIM) scores were calculated at the time of admission, discharge, and 6 mo after discharge. Patients were classified as nonobese (body mass index [BMI] <25), overweight (BMI ≥25 and <30), obese (BMI ≥30 and <35), and morbidly obese (BMI ≥35). Multivariate analyses were performed to determine the impact of obesity on FIM scores. RESULTS: Two hundred thirty-five patients met the study inclusion criteria. Average injury severity scores was >18. We recorded no mortality at the time of discharge and follow-up. During acute hospital stay stage, nonobese patients had an average of 24 points increase on FIM scores compared with morbidly obese patients with 16 points improvement (P = 0.023). Compared with nonobese patients, the rate of recovery was reduced by 30% in overweight (P = 0.034), 37% in obese (P = 0.025), and 48% in morbidly obese patients (P = 0.003). Alternatively, we found that for every unit increase in BMI, the functional recovery rate was reduced by 4% (P < 0.001). Changes in FIM scores during the postdischarge period were not significantly different by obesity classification, and all groups achieve similar functional outcome at follow-up (P = 0.482). CONCLUSIONS: Most trauma patients achieve full functional recovery some time after hospital discharge, but the recovery is delayed in obese patients and the delay is directly correlated with the severity of obesity.