Determinants of long-term functional consequences after major trauma.
OBJECTIVE
The purpose of this study was to describe the long-term functional consequences from major trauma and to quantify the effect of sociodemographic, injury-related, and physical determinants of its outcome.


METHODS
A prospective cohort study was performed at the University Medical Center Utrecht (Level I trauma center) in the Netherlands during 1999 and 2000. All severely (injury severity score [ISS] >or=16) injured adult (age >or=16) trauma survivors (n = 359) were selected for follow-up. Between 12 and 18 months after trauma, outcome was assessed by means of Glasgow Outcome Scale (GOS), EuroQol (EQ-5D), and cognitive complaints.


RESULTS
Follow-up assessments (overall response rate 93%) were obtained of 335 patients (249 men, 86 women) with a mean age of 38 years (SD = 17) and a mean ISS of 25 (SD = 10.6). The mean visual analog scale score on the EuroQol (EQvas) was 73.5 (SD = 17.8) and the mean utility score (EQus) was 69.1 (SD = 29.9), both below the norm. Patients reported limitations of mobility (48%); self-care (18%); daily activities (55%); pain and discomfort (63%); anxiety or depression (28%); and cognitive complaints (65%). In multivariate analyses, injury localization (spinal cord injury, lower extremity injury, or brain injury) was significantly associated with EQvas, EQus, and other outcome measures. Educational level was significantly associated with EQvas, anxiety/depression, and cognitive complaints. Comorbidity was significantly associated with EQvas, EQus, all dimensions of the EQ-5D (except anxiety/depression), and cognitive complaints.


CONCLUSIONS
In addition to the injury localization, educational level and comorbidity were identified as important independent predictors of long-term functional consequences after major trauma. These determinants need further attention in outcome research and clinical practice.
Holtslag
Herman R
HR
Department of Rehabilitation, University Medical Center, The Netherlands. h.r.holtslag@umcutrecht.nl
van Beeck
Ed F
EF
Lindeman
Eline
E
Leenen
Loek P H
LP
D000328:Adult; D003071:Cognition; D015897:Comorbidity; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D023261:Glasgow Outcome Scale; D006304:Health Status; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000145:classification / Q000534:rehabilitation*; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life