Abstract
BackgroundThe long-term fate of severely injured patients in terms of their quality of life is not well known. Our aim was to assess the quality of life of patients who have suffered moderate to severe trauma and to identify primary factors of long-term quality of life impairment.MethodsA prospective monocentric study conducted on a number of patients who were victims of moderate to severe injuries during the year 2012. Patients were selected based on an Injury Severity Score (ISS) more than or equal to 9. Quality of life was assessed by the MOS SF-36 and NHP scores as a primary evaluation criterion. The secondary evaluation criteria were the determination of the socio-economic impact on quality of life and the identification of factors associated with disability.ResultsTwo hundred and eight patients were contacted by e-mail or telephone. Fifty-five patients participated in this study (with a participation level of 26.4%), including 78.2% men, with a median age of 46. Significant alterations in quality of life were observed with the NHP and MOS SF-36 scale, including physical and psychological components. This resulted in a major socio-economic impact as 26% of the patients could not resume their professional activities (n = 10), 20% required retraining in other lines of work, and 36.4% had a disability status. The study showed that scores ≤ 85 on the physical functioning variable of the MOS SF 36 scale was associated with disability.ConclusionMore than five years after a moderate to severe injury, patients’ quality of life was significantly impacted, resulting in significant socio-economic consequences. Disability secondary to major trauma seems to be associated with a score ≤ 85 on the physical functioning dimension of the MOS SF-36 scale. This study raises the question of whether or not early rehabilitation programs should be implemented in order to limit the long-term impact of major trauma.
Highlights
The long-term fate of severely injured patients in terms of their quality of life is not well known
For every dimension of the MOS Medical Outcome Study Short Form-36 (SF-36), the minimal threshold that defined a severely altered quality of life was calculated from data observed in the French general population (source: French Statistics and Economic Studies Institute (INSEE) (French Institute of Statistics and Economic Studies) study of health and medical care conducted in 2002–2003)
Our study showed that physical functioning scores with a threshold ≤ 85 on the MOS SF-36 scale were predictive of disability according to criteria established by the French Health Insurance Agency
Summary
The long-term fate of severely injured patients in terms of their quality of life is not well known. Trauma is a frequent reason for admission to intensive care units (ICU) [1]. There is a major socio-economic impact, with medical fees for severely injured patients resulting in an estimated annual cost of 16 million dollars, while costs related to secondary disabilities from these traumas are estimated at 150 billion dollars annually [3]. Numerous studies conducted in patients with Acute Respiratory Distress Syndrome (ARDS) and/or sepsis [4,5,6,7,8], have helped to highlight the development of varying but often very frequent cases of functional and neuropsychological disorders after hospitalization in the ICU. In an extensive research review including 19 articles, Wolters et al [9] highlight the fact that 4 to 62% of patients present with cognitive impairments after care in the ICU
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