Ms Nichola Foster1,2,3,6, Dr Lisa Martin3,6, Dr Edward Raby3,5,6, Prof Fiona M. Wood3,5,6, Dr Mark Fear3,5,6, Dr Nathan Pavlos4, A/Prof Dale W. Edgar2,3,5,6
1Physiotherapy Department, Sir Charles Gairdner Osborne Park Health Care Group, North Metropolitan Health Service, Nedlands, Australia, 2Burn Injury Research Node, Institute for Health Research, School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia, 3Burn Injury Research Unit, University of Western Australia, Nedlands, Australia, 4School of Biomedical Sciences, University of Western Australia, Nedlands, Australia, 5State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Australia, 6Fiona Wood Foundation, Murdoch, Australia
Abstract:
Background:
Traumatic heterotopic ossification (tHO) refers to the development of extra-skeletal bone in muscle and soft tissues following trauma. This presents a persistent clinical concern associated with significant patient morbidity and expense to diagnose and treat. Traumatic HO is a substantial barrier to rehabilitation for trauma-injured patients and is hypothesised to prolong inpatient length of stay (LOS) and associated care costs.
Objective:
To investigate the association between an inpatient tHO diagnosis and hospital LOS in trauma patients.
Methods:
A retrospective audit of trauma patients over a 14-year period was completed using data from four WA hospitals. Burn and neurological trauma patients diagnosed with tHO as an inpatient (tHO+) and matched control subjects (tHO-) were identified. Data relating to patient and injury-related determinants of LOS from tHO+ and tHO- subjects were analysed to model the association of tHO on total hospital LOS.
Results:
188 patients were hospitalised due to traumatic injury; 47 patients with tHO following burn injury (n =17), spinal cord injury (n =13) and traumatic brain injury (n =17), and 141 control patients. Multivariate regression analyses identified novel independent predictive factors of a prolonged hospital LOS. Trauma patients diagnosed with tHO during hospital admission stayed 1.6 times longer than matched trauma patients without a tHO diagnosis (IRR 1.56, 95% CI 1.35–1.79, p<0.001).
Conclusion:
Traumatic heterotopic ossification is an independent explanatory factor for increased hospital LOS in trauma patients. Early diagnosis may assist in reducing the impact of tHO on hospital stay after trauma.
Biography:
Dr. Nichola Foster is a senior physiotherapist and researcher. She holds a PhD from the University of Notre Dame, Australia, where her research focused on the pathophysiological mechanisms, epidemiological characteristics, and risk factors of Traumatic Heterotopic Ossification, a devastating complication of burn, neurological and orthopaedic trauma. Her work has contributed to advancing diagnostic accuracy and understanding the molecular pathways underlying this condition. Nichola currently serves as a Senior Physiotherapist in Oncology, Haematology, and Prehabilitation at Sir Charles Gairdner Hospital, with a commitment to evidence-based practice and interdisciplinary collaboration. In addition to her clinical and research roles, Nichola is a sessional academic at Curtin University, where she mentors physiotherapy students. She is passionate about advancing practice through research, education, and collaboration, fostering a healthcare environment that prioritises excellence and innovation.