title: Prevalence and determinants of disabilities and return to work after major trauma.
abstract: OBJECTIVE
  The purpose of this study was to assess the prevalence and determinants of disabilities and return to work after severe injury in a Dutch, Level I trauma center.
  
  
  METHODS
  We prospectively included 295 patients with an Injury Severity Score > or = 16 treated between January 1996 and January 1999. All survivors received a mailed questionnaire in 2000, at least 1 year after their initial hospital admission. Health status was measured by the EuroQol-5D instrument, and the Glasgow Outcome Scale. Additional questions were asked about cognitive functioning and return-to-work rates. Regression analyses was conducted to explore the associations between these functional outcome measures and patient characteristics.
  
  
  RESULTS
  Of the 295 patients included, 99 (34%) died in hospital or during follow-up. From the 196 survivors, a response was obtained from 166 (85%). Of the survivors, 33% had to change their work or daily activity as a result of their injuries. Of the 127 patients of working age (18-65 years), 33 (26%) were unable to work and depended on social security. Problems with mobility, self-care, daily activities, pain/discomfort, anxiety/depression, and cognitive ability were found in 34%, 15%, 51%, 58%, 37%, and 57%, respectively. The EuroQol-5D summary score (0.76) was far below that of the general population norms. The number of body areas affected, injury severity (Injury Severity Score > or = 25), and gender (female) were significant independent predictors of worse long-term functional outcome.
  
  
  CONCLUSIONS
  Severe trauma has a substantial impact on long-term functioning. Empiric quantitative data, as presented in this study, enable us to estimate the burden of injury and to evaluate the quality of trauma care programs.
authors.affiliation: Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands. w.j.vles@ikazia.nl
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Vles
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
authors.forename: Ed F
authors.initials: EF
authors.lastname: van Beeck
authors.forename: J Dik
authors.initials: JD
authors.lastname: Meeuwis
authors.forename: Loek P H
authors.initials: LP
authors.lastname: Leenen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D023261:Glasgow Outcome Scale; D006304:Health Status; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology*