327 Predicting Probability of Return to Work After Moderate and Major Trauma in Hong Kong: A Preliminary, Prospective, Multicenter, Cohort Study

Abstract

Study Objective: There is very little published data on post-trauma return to work in the developed world, including Hong Kong. The aims of this preliminary study were firstly to investigate the 12-month return to work status in patients with moderate and major trauma in Hong Kong, and secondly to derive an early prediction score for return to work. Methods: From 1 January 2010 to 31 December 2011, a multi-centre prospective cohort study of trauma patients was conducted in Hong Kong. Patients admitted to the 3 Trauma Centres in Hong Kong were recruited. Adult patients aged ≥18 years with moderate or major trauma (defined as an injury severity score, ISS >8) and who were entered into the trauma registry were included. Return to work was defined as patients who had been working or were seeking employment before their injury. The primary outcome was return to work at 12-month post injury. Results: Of 400 patients initially recruited to the study (mean age 53.3 years; range 18-106; 69.5% male), the successful follow-up rates at 1, 6 and 12 months were 81.3%, 61.3% and 44.0%. 197 (49.3%) had been working or seeking employment prior to injury. The actual return to work was 20.9% at 1 month, and 37.5% at 12 months. Independent variables entered into a multiple logistic regression analysis included age, ISS, preexisting morbidity, ICU admission, head/neck injury, extremity injury, abdominal injury, one-month PCS and one-month MCS. No abdominal injury (OR 4.146, p=0.047), one-month PCS (Q4: OR 5.1, Q3: OR 4.6, Q2: OR 0.6, p=0.016) and one-month MCS (4Q: OR 9.1, Q3: OR 1.5, Q2: OR 1.5, p=0.023) significantly predicted return to work at 12 months. A scoring tool with scores from 0 to 20 was developed. At a cut off of >9, the sensitivity was 94%, and specificity was 65%, and the area under the ROC was 0.786. The overall correct classification rate was 69%. Patients with a score of 0 - 9 had a 12.2% chance of return to work by 12 months, whereas those patients with a score of 10 - 20 had a 50.8% chance of return to work. Conclusion: The 12-month post-trauma return to work rate for patients with the pre-injury potential to work was 37.5%. A score predicting 12-month return to work has been derived but needs refinement and validation in a much larger study. When validated it should aid patient care planning, rehabilitation, and guide medical assessment boards.