Objective Empirical head-to-head comparison of the health utility index (HUI) mark 2 and 3 and the EuroQol-5D (EQ-5D) in injury patients of all severity levels to obtain more insight into the strengths and limitations of the multi-attribute utility measures (MAUI) to estimate utility losses in injury populations.

Design A self-assessment survey that included the EQ-5D, HUI2 and HUI3 to measure generic health-related quality of life.

Patients Injury patients in The Netherlands 2 years after they attended the emergency department.

Main Outcome Measures Shannon's index and Shannon's evenness index were used to assess absolute and relative informativity, both for the summary scores and by dimension. The study also analysed convergent and construct validity of the MAUI.

Results Mean summary scores significantly differed between the instruments, with highest summary scores for HUI2 (0.88), followed by HUI3 (0.80) and EQ-5D (0.78). Absolute and relative informativity by dimension was highest for the HUI3 descriptive system. The HUI3 was most sensitive for ageing and comorbidity. The largest differences between the MAUI were found for pain/discomfort and anxiety/depression/emotion. The largest differences in discriminative power between EQ-5D and HUI (mark 2 and 3) were seen for skull–brain injury, internal organ injury and upper extremity fractures.

Conclusions Different MAUI resulted in significantly different summary scores. The instruments and their dimensions performed differently for injury severity levels, ageing, comorbidity and injury groups. A combination of the HUI and EQ-5D should be used in studies on injury-related disability, because the combination covers all relevant health dimensions, is applicable in all kinds of injury populations and in widely different age ranges.