Health status and psychological outcomes after trauma: A prospective multicenter cohort study

Nena Kruithof, Suzanne Polinder, Leonie de Munter, Cornelis L P van de Ree, Koen W W Lansink, Mariska A C de Jongh, BIOS-group, Nena Kruithof, Suzanne Polinder, Leonie de Munter, Cornelis L P van de Ree, Koen W W Lansink, Mariska A C de Jongh, BIOS-group

Abstract

Introduction: Survival after trauma has considerably improved. This warrants research on non-fatal outcome. We aimed to identify characteristics associated with both short and long-term health status (HS) after trauma and to describe the recovery patterns of HS and psychological outcomes during 24 months of follow-up.

Methods: Hospitalized patients with all types of injuries were included. Data were collected at 1 week 1, 3, 6, 12, and 24 months post-trauma. HS was assessed with the EuroQol-5D-3L (EQ-5D-3L) and the Health Utilities Index Mark 2 and 3 (HUI2/3). For the screening of symptoms of post-traumatic stress, anxiety and depression, the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS) subscale anxiety (HADSA) and subscale depression (HADSD) were used. Recovery patterns of HS and psychological outcomes were examined with linear mixed model analyses.

Results: A total of 4,883 patients participated (median age 68 (Interquartile range 53-80); 50% response rate). The mean (Standard Deviation (SD)) pre-injury EQ-5D-3L score was 0.85 (0.23). One week post-trauma, mean (SD) EQ-5D-3L, HUI2 and HUI3 scores were 0.49 (0.32), 0.61 (0.22) and 0.38 (0.31), respectively. These scores significantly improved to 0.77 (0.26), 0.77 (0.21) and 0.62 (0.35), respectively, at 24 months. Most recovery occurred up until 3 months. At long-term follow-up, patients of higher age, with comorbidities, longer hospital stay, lower extremity fracture and spine injury showed lower HS. The mean (SD) scores of the IES, HADSA and HADSD were respectively 14.80 (15.80), 4.92 (3.98) and 5.00 (4.28), respectively, at 1 week post-trauma and slightly improved over 24 months post-trauma to 10.35 (14.72), 4.31 (3.76) and 3.62 (3.87), respectively.

Discussion: HS and psychological symptoms improved over time and most improvements occurred within 3 months post-trauma. The effects of severity and type of injury faded out over time. Patients frequently reported symptoms of post-traumatic stress.

Trial registration: ClinicalTrials.gov identifier: NCT02508675.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Number of participants troughout the…
Fig 1. Number of participants troughout the Brabant Injury Outcome Surveillance (n = 4,883).
Fig 2. Prevalence of moderate or severe…
Fig 2. Prevalence of moderate or severe problems (%) on each EuroQol-5D-3L dimension up until 2 years of follow-up.
Fig 3. Mean summary scores of the…
Fig 3. Mean summary scores of the EuroQol-5D-3L questionnaire and patients reporting symptoms on the Impast of Event Scale.

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