Long-term functional health status of severely injured patients
Introduction
Traumatic injury is not only the leading cause of death, but also the most important cause of functional limitations in adults younger than 45 years of age.16 As the number of individuals who survive severe trauma increases, the study of long-term outcomes in this patient population has become an increasingly important focus of trauma research. Bare “survival” offers little information about the “quality of life”, or a person's functioning and satisfaction. Furthermore, the social costs associated with acute and long-term care and possible permanent disability of these mostly young patients justify the increasing research into the long-term consequences of major trauma and evaluation of the quality of trauma care.1, 7, 12, 18, 26
Most studies performed to date focussed not on severe trauma in general, but on orthopaedic trauma like pelvic ring fractures,15 lower extremity injury,5, 13, 31, 36 spinal cord injury23, 46 or traumatic brain injury.28, 40 Several studies including consecutive severely injured patients have been performed.3, 7, 11, 12, 16, 17, 18, 24, 25, 29, 30, 32 Some of these studies, however, included also patients with a low injury severity29, 32; had a small sample size,1 or studied only short term consequences.30 This study adds to the literature an unselected group of consecutive severely injured patients, who were referred to a level-1 trauma hospital in The Netherlands. We examined the influence of personal and injury characteristics on functional health. We also compared our results to interpretation of these results population figures to allow a more complete interpretation of these results.
The aims of this study were, firstly, to investigate long-term functional health status in a large, unselected group of severely injured patients, and secondly to explore the relation between personal and injury characteristics on the one hand and long-term health-related quality of life on the other.
Section snippets
Patients
A prospective cohort study was conducted from January 1999 to December 2000 at the University Medical Centre Utrecht, The Netherlands. This hospital is a level-1 trauma hospital with a catchment population of 1.1 million people in a densely populated region with high traffic intensity. The study included consecutive severely injured patients admitted to our hospital who had an injury severity score (ISS)2 of 16 and higher and who were 16 years of age or older.
Surviving patients were asked in
Results
Four hundred and ninety-nine (n = 499) consecutive severely injured patients presented to the emergency department. Children below the age of 16 (n = 40) were excluded from the follow-up study, and 100 persons died before final assessment. Of the 359 eligible patients, 335 (93%) gave informed consent to participate in the outcome study. The reasons for non-response were: three patients lived abroad, seven addresses were untraceable, 11 patients refused to participate and three had incomplete data.
Discussion
Evaluation of the effectiveness of trauma care has traditionally focused on mortality as an outcome parameter. The purpose of this study was to investigate the long-term functional health status in a large, unselected group of severely injured patients, and to explore the relation between personal and injury characteristics and long-term outcome. Our findings show the impact of major trauma, as a high proportion of the survivors had an impaired functional health status due to persistent
Conclusion
In conclusion, our assessment of the long-term health-related quality of life of severely injured patients by means of the sickness impact profile-136 indicated mild to moderate disability. Patients older than 60 years were performing well, except in ambulation. Injury severity and injuries to the chest or abdomen did not influence the outcome. Lower quality of life was particular experienced in young, male patients and those with traumatic brain, spinal cord, and extremity injuries. The
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