title: Association between the number of injuries sustained and 12-month disability outcomes: evidence from the injury-VIBES study.
abstract: OBJECTIVE
  To determine associations between the number of injuries sustained and three measures of disability 12-months post-injury for hospitalised patients.
  
  
  METHODS
  Data from 27,840 adult (18+ years) participants, hospitalised for injury, were extracted for analysis from the Validating and Improving injury Burden Estimates (Injury-VIBES) Study. Modified Poisson and linear regression analyses were used to estimate relative risks and mean differences, respectively, for a range of outcomes (Glasgow Outcome Scale-Extended, GOS-E; EQ-5D and 12-item Short Form health survey physical and mental component summary scores, PCS-12 and MCS-12) according to the number of injuries sustained, adjusted for age, sex and contributing study.
  
  
  RESULTS
  More than half (54%) of patients had an injury to more than one ICD-10 body region and 62% had sustained more than one Global Burden of Disease injury type. The adjusted relative risk of a poor functional recovery (GOS-E<7) and of reporting problems on each of the items of the EQ-5D increased by 5-10% for each additional injury type, or body region, injured. Adjusted mean PCS-12 and MCS-12 scores worsened with each additional injury type, or body region, injured by 1.3-1.5 points and 0.5 points, respectively.
  
  
  CONCLUSIONS
  Consistent and strong relationships exist between the number of injury types and body regions injured and 12-month functional and health status outcomes. Existing composite measures of anatomical injury severity such as the NISS or ISS, which use up to three diagnoses only, may be insufficient for characterising or accounting for multiple injuries in disability studies. Future studies should consider the impact of multiple injuries to avoid under-estimation of injury burden.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Centre for Improvement of Population Health through E-records Research, Swansea University, Swansea, United Kingdom.
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Pam M
authors.initials: PM
authors.lastname: Simpson
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Centre for Improvement of Population Health through E-records Research, Swansea University, Swansea, United Kingdom; Public Health Wales NHS Trust, Cardiff, United Kingdom.
authors.forename: Ronan A
authors.initials: RA
authors.lastname: Lyons
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Shanthi
authors.initials: S
authors.lastname: Ameratunga
authors.affiliation: Research Centre for Injury Studies, Flinders University, Adelaide, South Australia, Australia.
authors.forename: James E
authors.initials: JE
authors.lastname: Harrison
authors.affiliation: Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; School of Health and Social Services, College of Health, Massey University, Palmerston North, New Zealand.
authors.forename: Sarah
authors.initials: S
authors.lastname: Derrett
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polinder
authors.affiliation: Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Davie
authors.affiliation: Departments of Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000503:physiopathology