Main factors predicting somatic, psychological, and cognitive patient outcomes after significant injury: a pilot study of a simple prognostic tool

Thomas Gross, Felix Amsler, Thomas Gross, Felix Amsler

Abstract

Background: There are still insufficient data on the complexity and predictability of patient-related outcomes following trauma. The aim of this study was to assess longer-term outcomes in patients with significant injury and to develop a simple scoring method to identify patients at high risk of subsequent deficits 1-2 years after injury.

Methods: We conducted a prospective cohort study of survivors of significant injury (New Injury Severity Score, NISS greater than or equal to 8), with analysis of patients' 1- to 2-year health-related quality of life (HRQoL) and their functional outcomes based on Short Form-36 (SF-36), Trauma Outcome Profile (TOP), and Quality Of Life after Brain Injury (QOLIBRI). Documented variables suspected or known from the literature to be possible factors associated with outcome were first analysed by univariate analysis, and significant variables were entered into a stepwise logistic regression analysis. Scores predicting longer-term impaired outcome were constructed from risk factors resulting from multivariate analysis.

Results: Depending on the patient-reported outcome measure (PROM) used, up to 30 per cent of 1052 study patients (mean NISS 18.6) indicated somatic, 27 per cent psychological, and 54 per cent cognitive deficits. The investigated sociodemographic, injury-related, treatment, and early hospital outcome variables demonstrated only low associations with longer-term outcome in univariate analysis that were highest for preinjury pain or function (R = 0.4) and outcome at hospital discharge (R = 0.3). After logistic regression, the study variables explained a maximum variance of 23 per cent for somatic, 11 per cent for psychological, and 14 per cent for cognitive longer-term outcomes. The resulting Aarau trauma prognostic longer-term outcome scoring (ATPLOS) system, developed by checking eight risk factors, had a specificity of up to 80 per cent, and importantly may facilitate early detection of patients at risk of a poorer longer-term outcome.

Conclusion: Despite the high rate of deficits recorded for survivors of significant injury, particularly in loss of cognitive function, the multiple variables analysed only led to a limited characterization of patient-related longer-term outcomes. Until more is known about additional individual influencing factors, the proposed scoring system may serve well for clinical evaluation.

Registration number: NCT02165137 (http://www.clinicaltrials.gov).

© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.

Figures

Fig. 1
Fig. 1
Patient flow chart NISS, New Injury Severity Score; GOS, Glasgow Outcome Scale.
Fig. 2
Fig. 2
Somatic longer-term outcome: distribution of longer-term impaired outcome according to number of risk factors (preinjury pain or functional restriction, age at time of trauma of at least 80 years, age-unadjusted Charlson Comorbidity Index > 1, AIS 5 extremities > 1, not discharged home or hospital stay > 21 days) AIS, Abbreviated Injury Scale (body regions 1–6); SF-36, Short Form-36; TOP, Trauma Outcome Profile. Somatic subscores for SF-36 and TOP.
Fig. 3
Fig. 3
Psychological longer-term outcome: distribution of longer-term impaired outcome according to number of risk factors (preinjury pain or functional restriction, no vocational education, AIS 5 extremities > 1, ICU stay, not discharged home or hospital stay >21 days) AIS, Abbreviated Injury Scale (body regions 1–6); ICU, intensive care unit; SF-36, Short Form-36; TOP, Trauma Outcome Profile. Psychological subscores for SF-36 and TOP.
Fig. 4
Fig. 4
Cognitive longer-term outcome: distribution of longer-term impaired outcome according to number of risk factors (preinjury pain or functional restriction, no vocational education, AIS 1 head/neck > 2, not discharged home or hospital stay > 21 days) AIS, Abbreviated Injury Scale (body regions 1–6); QOLIBRI, Quality Of Life after Brain Injury; TOP, Trauma Outcome Profile. Cognitive subscores for QOLIBRI and TOP.
Fig. 5
Fig. 5
Sensitivity and specificity analysis of investigated scores indicating high-risk patients for specified reduced longer-term outcomes (ATPLOS procedure) SF-36, Short Form-36; TOP, Trauma Outcome Profile; QOLIBRI, Quality Of Life after Brain Injury; and specific subscores.

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