Abstract
BackgroundTrauma patients have impaired health-related quality of life (HRQOL) after trauma. The aim of the study was to assess HRQOL during the first year after trauma and hospital stay in trauma patients admitted to an intensive-care unit (ICU) for >24 hours compared with non-ICU trauma patients and the general population, and to identify predictors of HRQOL.MethodsA prospective one-year follow-up study of 242 trauma patients received by the trauma team of a trauma referral centre in Norway was performed. HRQOL was measured using the Medical Outcomes Study Short Form 36 (SF-36) at 3 and 12 months.ResultsThe mean age of the cohort was 42.3 years (95% CI, 40.4-44.3 years). The median Injury Severity Score (ISS) was 10, interquartile range 16. The HRQOL improved significantly from the 3 to the 12 months follow up in the trauma patients. However their scores were significantly lower for most subscales of SF-36 compared to the general population. Significant differences between ICU and non-ICU patients at 12 months were observed only for physical functioning and role physical subscales. Optimism was an independent predictor of good HRQOL at 12 months, in all dimensions (beta, 0.95-2.45). A higher depression score at baseline predicted lower HRQOL in four of eight dimensions (beta -1.1 to -1.70). In addition, better physical functioning was predicted by lower age (beta, -0.20), and having head injury (reference) as the most severe injury vs. spine or extremity injuries (beta, -9.49 and -10.85), and better mental health by higher age (beta, 0.21) and being employed or studying before the trauma (beta, 12.27). In addition to optimism good general health was predicted by lower score for post-traumatic stress (PTS) symptoms at baseline (beta, -0.27) and lower ISS score (beta -10.59).ConclusionsThe HRQOL improved significantly from the 3 to the 12 months follow up in our sample. However their scores were significantly lower for most subscales of SF-36 compared to the general population. Significant differences between ICU and non-ICU patients were observed for only two subscales. Better HRQOL at 12 months was predicted mainly by optimism, low score for depression and PTS symptoms at baseline. High ISS predicted low general health exclusively.
Highlights
Trauma patients have impaired health-related quality of life (HRQOL) after trauma
The main findings in this study of trauma patients with different degrees of injury severity were that the mean scores for all subscales of HRQOL, with the exception of social functioning, were significantly lower than those observed in the Norwegian general population
Optimism was an independent predictor of good HRQOL at 12 months, in all dimensions
Summary
Trauma patients have impaired health-related quality of life (HRQOL) after trauma. As trauma care has improved substantially during recent decades and has led to higher survival rates [1], there has been an increasing focus on the patients’ perceived health-related quality of life (HRQOL) as an outcome after trauma [2]. There is growing evidence that trauma population with different levels of injury severity provides an opportunity to investigate the impact of the relative contribution of physical and mental factors to HRQOL. Three studies examined the impact of psychological distress on HRQOL after injury and hospital stay in a mixedtrauma population [5,19,27]. To assess the relative contribution of physical and mental factors after trauma to HRQOL, it is important to investigate the impact of psychological distress in these patients
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