Longitudinal analysis of health status the first year after trauma in severely injured patients

Roos Johanna Maria Havermans,Leonie De Munter,Mariska Adriana Cornelia De Jongh,Koen Willem Wouter Lansink

doi:10.1186/s13049-020-00719-8

Roos Johanna Maria Havermans, Leonie De Munter + Show 2 more

Open Access

https://doi.org/10.1186/s13049-020-00719-8

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Abstract

PurposeWhile survival rates after a trauma are increasing a considerable part of the trauma population are still at risk for both short and long term disabilities. Little is known about prognostic factors over time after a severe trauma. The aim of the present prospective cohort study was to examine trauma and patient related prognostic factors for a lower health status over time after a severe trauma.MethodsA multicentre prospective observational cohort study was conducted. Adult trauma patients with severe injuries (ISS ≥ 16) were included from August 2015 until November 2016 if admitted to one of the hospitals in Noord-Brabant (the Netherlands). Outcome measure was health status, measured by the EuroQol-5D (EQ-5D utility and EQ-Visual analogue scale) and the Health Utilities Index (HUI2 and HUI3) one week and one, three, six, and twelve months after injury. Patient and trauma characteristics were analysed as prognostic factors with linear mixed models. The effect of each prognostic factor over time was analysed by adding the interaction term between the prognostic factor and time point in a multivariable linear mixed model, adjusted for confounders. Additionally, the risk factors for problems in the EQ-5 dimensions of HS and cognition were analysed.ResultsIn total 239 severely injured patients participated. Pre-injury health status, hospital length of stay, ISS and comorbidities were significant prognostic factors for a lower health status. A younger age and extremity injury were prognostic factors for a lower health status until one month after trauma and unemployment before trauma and comorbidities six until twelve months after trauma. In the EQ-5 dimensions 44.1% remained problems in mobility, 15.3% in self-care, 46.4% in activity, 53.3% in pain, 32.5% in anxiety and 35.7% in cognition.ConclusionsLower pre-injury health status, longer hospital length of stay, higher ISS, and comorbidities were significant prognostic factors for a lower health status during one year after a severe injury. A younger age and an extremity injury were short-term prognostic factors and unemployment before trauma and comorbidities were long-term prognostic factors. Even after twelve months patients in our population reported more problems in all EQ-5D dimensions when compared to the Dutch reference population.

Highlights

Over the last several decades many studies have shown improved mortality rates in trauma centres [1,2,3,4,5,6,7,8,9]
Significant differences are shown between Intensive Care Unit (ICU) and non-ICU patients, patients admitted to the ICU reported a significant lower physical function [21]
Baseline characteristics Responders were significant more often healthy and a higher proportion of responders had an extremity injury compared to non-responders

Summary

Introduction

Over the last several decades many studies have shown improved mortality rates in trauma centres [1,2,3,4,5,6,7,8,9]. These patients might be at risk of short and long-term disabilities [10,11,12,13,14,15]. Living alone, inability to return to work, comorbidities, low educational level, brain injury, spinal cord injury, lower extremity injury, and a higher Injury Severity Score (ISS) are shown to be associated with a lower post-injury health status [22,23,24]

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