title: Assessment of quality of life and functional outcome in patients sustaining moderate and major trauma: a multicentre, prospective cohort study.
abstract: BACKGROUND
  Trauma care systems aim to reduce both death and disability, yet there is little data on post-trauma health status and functional outcome.
  
  
  OBJECTIVE
  To evaluate baseline, discharge, six month and 12 month post-trauma quality of life, functional outcome and predictors of quality of life in Hong Kong.
  
  
  METHODS
  Multicentre, prospective cohort study using data from the trauma registries of three regional trauma centres in Hong Kong. Trauma patients with an ISS≥9 and aged≥18 years were included. The main outcome measures were the physical component summary (PCS) score and mental component summary (MCS) scores of the Short-Form 36 (SF36) for health status, and the extended Glasgow Outcome Scale (GOSE) for functional outcome.
  
  
  RESULTS
  Between 1 January 2010 and 31 September 2010, 400 patients (mean age 53.3 years; range 18-106; 69.5% male) were recruited to the study. There were no statistically significant differences in baseline characteristics between responders (N=177) and surviving non-responders (N=163). However, there were significant differences between these groups and the group of patients who died (N=60). Only 16/400 (4%) cases reported a GOSE≥7. 62/400 (15.5%) responders reached the HK population norm for PCS. 125/400 (31%) responders reached the HK population norm for MCS. If non-responders had similar outcomes to responders, then the percentages for GOSE≥7 would rise from 4% to 8%, for PCS from 15.5% to 30%, and for MCS from 31% to 60%. Univariate analysis showed that 12-month poor quality of life was significantly associated with age>65 years (OR 4.77), male gender (OR 0.44), pre-injury health problems (OR 2.30), admission to ICU (OR 2.15), ISS score 26-40 (OR 3.72), baseline PCS (OR 0.89), one-month PCS (OR 0.89), one-month MCS (OR 0.97), 6-month PCS (OR 0.76) and 6-month MCS (OR 0.97).
  
  
  CONCLUSIONS
  For patients sustaining moderate or major trauma in Hong Kong at 12 months after injury<1 in 10 patients had an excellent recovery, ≤3 in 10 reached a physical health status score≥Hong Kong norm, although as many as 6 in 10 patients had a mental health status score which is≥Hong Kong norm.
authors: Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong. Electronic address: thrainer@cuhk.edu.hk.
authors: T H
authors: TH
authors: Rainer
authors: Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong.
authors: J H H
authors: JH
authors: Yeung
authors: Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong.
authors: S K C
authors: SK
authors: Cheung
authors: Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong.
authors: Y K Y
authors: YK
authors: Yuen
authors: Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Hong Kong.
authors: W S
authors: WS
authors: Poon
authors: Accident and Emergency Department, Queen Elizabeth Hospital, Hong Kong.
authors: H F
authors: HF
authors: Ho
authors: Accident and Emergency Department, Tuen Mun Hospital, Hong Kong.
authors: C W
authors: CW
authors: Kam
authors: Emergency Department, Princess Royal University Hospital, Orpington, UK.
authors: G N
authors: GN
authors: Cattermole
authors: Accident and Emergency Department, Queen Elizabeth Hospital, Hong Kong.
authors: A
authors: A
authors: Chang
authors: Accident and Emergency Department, Tuen Mun Hospital, Hong Kong.
authors: F L
authors: FL
authors: So
authors: Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong.
authors: C A
authors: CA
authors: Graham
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*
keywords: Functional outcome; Morbidity; Quality of life; Trauma; Wounds and injuries