title: Return to work after major trauma.
abstract: OBJECTIVE
  To quantify the prevalence of return to work after major trauma, and to investigate the determinants of postinjury work status.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  University Medical Centre Utrecht, a level 1 trauma centre in the Netherlands.
  
  
  METHODS
  All severely injured (ISS > 16) adult (age = 16+) trauma survivors admitted from January 1999 to December 2000 who were full-time employed at the time of the injury were selected for follow-up (n = 214). Response rate was 93%. Outcome was assessed at a mean of 15 months (SD = 1.5) after injury. Multivariate logistic regression analyses identified determinants at hospital discharge and at follow-up.
  
  
  RESULTS
  Following injury 58.4% of the patients (n = 125) were able to return to full-time employment, 21.5% had a part-time job, and 20.1% did not return to work. Univariate analysis yielded the following significant determinants of postinjury work status: age, comorbidity, injury severity score, brain injury, spinal cord injury, length of stay in an intensive care unit, hospital stay, discharge destination, percentage of permanent impairment (according to the fourth American Medical Association guide (AMA)), limitations in activities of daily living and cognitive complaints. Logistic regression analyses (23% explained variance) identified spinal cord injury, duration of hospital stay, discharge destination and age as determinants of return to work at hospital discharge. At follow-up, determinants of return to work included AMA, activities of daily living, cognitive complaints and being discharged home (51% explained variance).
  
  
  CONCLUSIONS
  Around 60% of the patients returned to their pre-injury work status after major trauma. The return to work rate was only partly explained by disability at follow-up. Independent determinants of return to work differ with the time of assessment.
authors.affiliation: University Medical Centre Utrecht, Department of Rehabilitation Medicine and Rudolf Magnus Institute of Neuroscience, PO Box 85500, HP F00.810, 3508 GA Utrecht, The Netherlands. h.r.holtslag@umcutrecht.nl
authors.forename: Herman R
authors.initials: HR
authors.lastname: Holtslag
authors.forename: Marcel W
authors.initials: MW
authors.lastname: Post
authors.forename: Chris
authors.initials: C
authors.lastname: van der Werken
authors.forename: Eline
authors.initials: E
authors.lastname: Lindeman
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003072:Cognition Disorders / Q000453:epidemiology; D004185:Disability Evaluation; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D010351:Patient Discharge; D011446:Prospective Studies; D014947:Wounds and Injuries / Q000453:epidemiology*