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. Objectives 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). Conclusion 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. © 2013 Elsevier Ltd.