Prognostic factors for recovery of health status after injury: a prospective multicentre cohort study

Leonie de Munter, Suzanne Polinder, Roos J M Havermans, Ewout W Steyerberg, Mariska A C de Jongh, Leonie de Munter, Suzanne Polinder, Roos J M Havermans, Ewout W Steyerberg, Mariska A C de Jongh

Abstract

Objectives: To determine prognostic factors for health status and recovery patterns during the first 2 years after injury in the clinical trauma population.

Design: A prospective longitudinal cohort study.

Setting: Ten participating hospitals in Brabant, the Netherlands.

Participants: Injured adult patients admitted to a hospital between August 2015 and November 2016 were followed: 4883 (50%) patients participated.

Main outcome measures: Primary outcome was health status, measured with the EuroQol-5-dimensions-3-levels (EQ-5D), including a cognition item and the EuroQol Visual Analogue Scale. Health status was collected at 1 week, 1, 3, 6, 12 and 24 months after injury. Potential prognostic factors were based on literature and clinical experience (eg, age, sex, pre-injury frailty (Groningen Frailty Index), pre-injury EQ-5D).

Results: Health status increased mainly during the first 6 months after injury with a mean EQ-5D utility score at 1 week of 0.49 and 0.79 at 24 months. The dimensions mobility, pain/discomfort and usual activities improved up to 2 years after injury. Lower pre-injury health status, frailty and longer length of stay at the hospital were important prognostic factors for poor recovery. Spine injury, lower and upper extremity injury showed to be prognostic factors for problems after injury. Traumatic brain injury was a prognostic factor for cognitive problems.

Conclusion: This study contributes to the increase in knowledge of health recovery after injury. It could be a starting point to develop prediction models for specific injury classifications and implementation of personalised medicine.

Trial registration number: NCT02508675.

Keywords: accident & emergency medicine; epidemiology; trauma management.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow diagram of study participation. Non-survivors are participants who died during the follow-up period. ACT, usual activities; ANX, anxiety/depression; COG, cognition; EQ-5D, EuroQol-5-dimensions-3-levels; EQ-VAS, EuroQol Visual Analogue Scale; MOB, mobility; N, number; PAIN, pain/discomfort; SELF, self-care.
Figure 2
Figure 2
(A) Health status scores (95% CI) and (B, C) percentage of patients reporting problems (95% CI) on the dimensions of the EQ-5D-3L, including whether there was a significant change in health status scores compared with the previous time point. EQ-5D-3L, EuroQol-5-dimensions-3-levels; EQ-VAS, EuroQol Visual Analogue Scale.

References

    1. Liberman M, Mulder DS, Lavoie A, et al. . Implementation of a trauma care system: evolution through evaluation. J Trauma 2004;56:1330–5. 10.1097/01.TA.0000071297.76727.8B
    1. Cameron PA, Gabbe BJ, Cooper DJ, et al. . A statewide system of trauma care in Victoria: effect on patient survival. Med J Aust 2008;189:546–50. 10.5694/j.1326-5377.2008.tb02176.x
    1. Moore L, Hanley JA, Turgeon AF, et al. . Evaluation of the long-term trend in mortality from injury in a mature inclusive trauma system. World J Surg 2010;34:2069–75. 10.1007/s00268-010-0588-z
    1. Christensen MC, Banner C, Lefering R, et al. . Quality of life after severe trauma: results from the global trauma trial with recombinant factor VII. J Trauma 2011;70:1524–31. 10.1097/TA.0b013e3181f053c2
    1. Andelic N, Hammergren N, Bautz-Holter E, et al. . Functional outcome and health-related quality of life 10 years after moderate-to-severe traumatic brain injury. Acta Neurol Scand 2009;120:16–23. 10.1111/j.1600-0404.2008.01116.x
    1. Gabbe BJ, Simpson PM, Cameron PA, et al. . Long-Term health status and trajectories of seriously injured patients: a population-based longitudinal study. PLoS Med 2017;14:e1002322. 10.1371/journal.pmed.1002322
    1. Sluys K, Häggmark T, Iselius L. Outcome and quality of life 5 years after major trauma. J Trauma 2005;59:223–32. 10.1097/01.TA.0000173832.01547.CB
    1. Ulvik A, Kvåle R, Wentzel-Larsen T, et al. . Quality of life 2-7 years after major trauma. Acta Anaesthesiol Scand 2008;52:195–201. 10.1111/j.1399-6576.2007.01533.x
    1. Holtslag HR, van Beeck EF, Lindeman E, et al. . Determinants of long-term functional consequences after major trauma. J Trauma 2007;62:919–27. 10.1097/01.ta.0000224124.47646.62
    1. Aitken LM, Davey TM, Ambrose J, et al. . Health outcomes of adults 3 months after injury. Injury 2007;38:19–26. 10.1016/j.injury.2006.05.020
    1. Sampalis JS, Liberman M, Davis L, et al. . Functional status and quality of life in survivors of injury treated at tertiary trauma centers: what are we neglecting? J Trauma 2006;60:806–13. 10.1097/01.ta.0000215103.62783.4d
    1. Harris I, Dao ATT, Young J, et al. . Factors predicting patient satisfaction following major trauma. Injury 2007;38:1102–8. 10.1016/j.injury.2007.05.004
    1. Ringburg AN, Polinder S, van Ierland MCP, et al. . Prevalence and prognostic factors of disability after major trauma. J Trauma 2011;70:916–22. 10.1097/TA.0b013e3181f6bce8
    1. Steel J, Youssef M, Pfeifer R, et al. . Health-Related quality of life in patients with multiple injuries and traumatic brain injury 10+ years postinjury. J Trauma 2010;69:523–31. 10.1097/TA.0b013e3181e90c24
    1. Holbrook TL, Hoyt DB. The impact of major trauma: quality-of-life outcomes are worse in women than in men, independent of mechanism and injury severity. J Trauma 2004;56:284–90. 10.1097/01.TA.0000109758.75406.F8
    1. Polinder S, van Beeck EF, Essink-Bot ML, et al. . Functional outcome at 2.5, 5, 9, and 24 months after injury in the Netherlands. J Trauma 2007;62:133–41. 10.1097/TA.0b013e31802b71c9
    1. de Jongh MAC, Kruithof N, Gosens T, et al. . Prevalence, recovery patterns and predictors of quality of life and costs after non-fatal injury: the Brabant injury outcome surveillance (bios) study. Inj Prev 2017;23:59–62. 10.1136/injuryprev-2016-042032
    1. Gabbe BJ, Lyons RA, Sutherland AM, et al. . Level of agreement between patient and proxy responses to the EQ-5D health questionnaire 12 months after injury. J Trauma Acute Care Surg 2012;72:1102–5. 10.1097/TA.0b013e3182464503
    1. EuroQol Group EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199–208. 10.1016/0168-8510(90)90421-9
    1. Lamers LM, McDonnell J, Stalmeier PFM, et al. . The Dutch tariff: results and arguments for an effective design for national EQ-5D valuation studies. Health Econ 2006;15:1121–32. 10.1002/hec.1124
    1. Steverink N, Slaets J, Schuurmans H. Measuring frailty: developing and testing the GFI (Groningen frailty indicator). Gerontologist 2001;41:236–7.
    1. Gennarelli TA, Wodzin E. Abbreviated injury scale 2005: update 2008. Russ Reeder, 2008.
    1. van Buuren S, Oudshoorn K. Flexible multivariate imputation by MICE. PG/VGZ/99.054, 1999.
    1. Kruithof N, Polinder S, de Munter L, et al. . Health status and psychological outcomes after trauma: a prospective multicenter cohort study. PLoS One 2020;15:e0231649. 10.1371/journal.pone.0231649
    1. Moons KG, Altman DG, Reitsma JB. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): explanation and ElaborationThe TRIPOD statement: explanation and elaboration. Ann Intern Med 2015;162:W1–73.
    1. Gabbe BJ, Simpson PM, Harrison JE, et al. . Return to work and functional outcomes after major trauma. Ann Surg 2016;263:623–32. 10.1097/SLA.0000000000001564
    1. Geraerds AJLM, Bonsel GJ, Janssen MF, et al. . The added value of the EQ-5D with a cognition dimension in injury patients with and without traumatic brain injury. Qual Life Res 2019;28:1931–9. 10.1007/s11136-019-02144-6
    1. Ophuis RH, Janssen MF, Bonsel GJ, et al. . Health-Related quality of life in injury patients: the added value of extending the EQ-5D-3L with a cognitive dimension. Qual Life Res 2019;28:1941–9. 10.1007/s11136-019-02156-2
    1. Frencham KAR, Fox AM, Maybery MT. Neuropsychological studies of mild traumatic brain injury: a meta-analytic review of research since 1995. J Clin Exp Neuropsychol 2005;27:334–51. 10.1080/13803390490520328
    1. Carroll L, Cassidy JD, Peloso P, et al. . Prognosis for mild traumatic brain injury: results of the who collaborating centre Task force on mild traumatic brain injury. J Rehabil Med 2004;36:84–105. 10.1080/16501960410023859
    1. Rabinowitz AR, Levin HS. Cognitive sequelae of traumatic brain injury. Psychiatr Clin North Am 2014;37:1–11. 10.1016/j.psc.2013.11.004
    1. Bazarian JJ, Blyth B, Mookerjee S, et al. . Sex differences in outcome after mild traumatic brain injury. J Neurotrauma 2010;27:527–39. 10.1089/neu.2009.1068
    1. Quale AJ, Schanke A-K, Frøslie KF, et al. . Severity of injury does not have any impact on posttraumatic stress symptoms in severely injured patients. Injury 2009;40:498–505. 10.1016/j.injury.2008.11.006
    1. Wiseman TA, Curtis K, Lam M, et al. . Incidence of depression, anxiety and stress following traumatic injury: a longitudinal study. Scand J Trauma Resusc Emerg Med 2015;23:29. 10.1186/s13049-015-0109-z
    1. Scholten AC, Haagsma JA, Steyerberg EW, et al. . Assessment of pre-injury health-related quality of life: a systematic review. Popul Health Metr 2017;15:10. 10.1186/s12963-017-0127-3
    1. Watson WL, Ozanne-Smith J, Richardson J. Retrospective baseline measurement of self-reported health status and health-related quality of life versus population norms in the evaluation of post-injury losses. Inj Prev 2007;13:45–50. 10.1136/ip.2005.010157
    1. Haider AH, Herrera-Escobar JP, Al Rafai SS. Factors associated with long-term outcomes after injury: results of the functional outcomes and recovery after trauma emergencies (forte) multicenter cohort study. Ann Surg 2018;271:1165–73.
    1. Sleney J, Christie N, Earthy S, et al. . Improving recovery-Learning from patients' experiences after injury: a qualitative study. Injury 2014;45:312–9. 10.1016/j.injury.2012.12.025
    1. Mancuso CA, Sculco TP, Salvati EA. Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty 2003;18:872–8. 10.1016/S0883-5403(03)00276-6

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