Do foot injuries significantly affect the functional outcome of multiply injured patients?

Objective: To assess the functional outcome of multiply injured trauma pati ents With foot injuries and to determine which outcome measures are most ap propriate for this assessment. Design: Prospective, matched pair analysis. Setting: University-affiliated Level I trauma center with a prospectively e ntered trauma database. Patients: Twenty-eight multiply injured patients with foot injuries were ra ndomly identified in our prospective trauma database (Group 1). The patient s in Group 1 were randomly matched in a blinded fashion to twenty-eight mul tiply injured patients without foot injuries who were selected from the ent ire group of patients in our trauma database (Group 2). The patients were m atched by age, sex, length of follow-up, and Injury Severity Score. Main Outcome Measures: Three outcome tools were used: the Short Form 36 (SF -36), the Western Ontario and McMaster Universities Osteoarthritis Index (W OMAC), and the modified Boston Children's Hospital Grading System. Results: The outcome of multiply injured patients with foot injuries was si gnificantly worse than that of patients without foot injuries when using an y of the three outcome measures (SF-36, p = 0.008; WOMAC, p = 0.00007; modi fied Boston Children's score, p = 0.001). The outcome of patients with foot injuries was worse than that of those without foot injuries in five of the eight components of the SF-36 score (physical functioning, p = 0.0004; rol e physical, p = 0.01; bodily pain, p = 0.01; social functioning, p = 0.01; role emotional, p = 0.006). The outcome of patients with foot injuries was worse than that of patients without foot injuries in all three components o f the WOMAC (pain score, p = 0.0001; stiffness score, p = 0.007; physical f unction score, p = 0.00006). For the patients with foot injuries, there was strong correlation across all three scales (SF 36 vs. WOMAC, r = 0.84; SF- 36 vs. modified Boston Children's Hospital, r = 0.88; WOMAC vs, modified Bo ston Children's Hospital, r = 0.78). Conclusions: The SF-36, WOMAC, and modified Boston Children's Hospital Grad ing System are all useful in assessing the outcome of multiply injured pati ents with foot injuries. The outcome of these patients is poor when using a ny of these measures. Foot injuries cause significant disability to multipl y injured patients. More attention should be given to these injuries, and m ore aggressive management should be considered to improve the outcome of th is group of multiply injured patients.