Adverse childhood experiences and their effect on the orthopaedic surgery patient

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The Adverse Childhood Experiences (ACE) study sought to determine if a relationship between adverse childhood experiences and long-term medical and public health problems exist. Ten risk factors that contribute to the leading cause of mortality in the United States were chosen for further analysis in the ACE study. The ten risk factors chosen were smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, alcoholism, drug abuse, parenteral drug abuse, a high number of sexual partners, and history of sexually transmitted infections. The patients identified with one or more of these risk factors noted in the ACE study may present to an orthopaedic surgeon more frequently, with more severe injuries, reporting a decreased quality of life and increased pain when compared to those not falling into one of these risk categories. This patient population may also undergo more procedures and may suffer an increase in postoperative complications and a decrease in overall improvement after recovery. The goal of this literature review was to examine the ten risk factors suggested to be more prevalent in patients who have suffered from a greater number of adverse childhood experiences, and determine their potential effect on the management, treatment, and outcome for orthopaedic conditions. Available literature supports that the presentation and management of orthopaedic surgical cases may be more challenging in patients who fall into one of the above-discussed risk categories. Based on the results of ACE, this information can be inferred, although not conclusively, to mean that patients with a high ACE score may require the use of additional resources to provide the best outcome when being treated by the orthopaedic surgical team. This review is unable to conclude that using an ACE score in patients presenting for treatment by an orthopaedic surgeon would be beneficial. However, it may highlight the importance of the history, including the social history, to better determine what effect psychosocial factors may have in the assessment, management, and potential benefit of treatment for a patient.

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