Long-term health status and trajectories of seriously injured patients: A population-based longitudinal study

Abstract

Background

Improved understanding of the quality of survival of patients is crucial in evaluating trauma care, understanding recovery patterns and timeframes, and informing healthcare, social, and disability service provision. We aimed to describe the longer-term health status of seriously injured patients, identify predictors of outcome, and establish recovery trajectories by population characteristics.

Methods and findings

A population-based, prospective cohort study using the Victorian State Trauma Registry (VSTR) was undertaken. We followed up 2,757 adult patients, injured between July 2011 and June 2012, through deaths registry linkage and telephone interview at 6-, 12-, 24-, and 36-months postinjury. The 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3L) was collected, and mixed-effects regression modelling was used to identify predictors of outcome, and recovery trajectories, for the EQ-5D-3L items and summary score. Mean (SD) age of participants was 50.8 (21.6) years, and 72% were male. Twelve percent ( n = 333) died during their hospital stay, 8.1% ( n = 222) of patients died postdischarge, and 155 (7.0%) were known to have survived to 36-months postinjury but were lost to follow-up at all time points. The prevalence of reporting problems at 36-months postinjury was 37% for mobility, 21% for self-care, 47% for usual activities, 50% for pain/discomfort, and 41% for anxiety/depression. Continued improvement to 36-months postinjury was only present for the usual activities item; the adjusted relative risk (ARR) of reporting problems decreased from 6 to 12 (ARR 0.87, 95% CI: 0.83–0.90), 12 to 24 (ARR 0.94, 95% CI: 0.90–0.98), and 24 to 36 months (ARR 0.95, 95% CI: 0.95–0.99). The risk of reporting problems with pain or discomfort increased from 24- to 36-months postinjury (ARR 1.06, 95% CI: 1.01, 1.12). While loss to follow-up was low, there was responder bias with patients injured in intentional events, younger, and less seriously injured patients less likely to participate; therefore, these patient subgroups were underrepresented in the study findings.

Conclusions

The prevalence of ongoing problems at 3-years postinjury is high, confirming that serious injury is frequently a chronic disorder. These findings have implications for trauma system design. Investment in interventions to reduce the longer-term impact of injuries is needed, and greater investment in primary prevention is needed.

Abstract

In a population-based longitudinal study, Belinda Gabbe and colleagues report 3-year outcomes for seriously injured patients in Victoria, Australia.

Author summary

Why was this study done?

• Improvements in trauma care have improved the chances of surviving serious injury, requiring a shift in focus to better understanding how well people recover from injury and how long this takes.

• Longitudinal studies of the long-term health outcomes of seriously injured people are few. This study was undertaken to close this knowledge gap and provide valuable data necessary to inform trauma system design, injury rehabilitation programs, compensation schemes, and estimates of injury burden.

What did the researchers do and find?

• We followed a cohort of 2,757 major trauma patients in Victoria, Australia at 6 months, 12 months, 24 months, and 36 months after injury to collect health outcomes using the 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3L).

• We found that 20% of patients had died by 36-months postinjury. The proportion of survivors reporting persistent problems was high for each of the EQ-5D-3L items, although improvement was continuing at 36 months after injury for the usual activities item.

• After adjusting our analyses to account for possible confounding factors, we found that lower levels of education, claiming compensation for injury, and age were consistent predictors of reporting problems at follow-up. The nature of injuries sustained, gender, preinjury employment, and level of socioeconomic disadvantage were also important predictors of problems on many of the 5 EQ-5D-3L items.

What do these findings mean?

• The prevalence of ongoing problems following serious injury was high at 36 months, though continued improvement was evident.

• Investment in interventions designed to prevent major trauma overall, and to reduce the impact of injury, is clearly needed.