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Title: Long-term health status and trajectories of seriously injured patients: A population-based longitudinal study.
Epworth Authors: Ponsford, Jennie
Other Authors: Gabbe, Belinda
Simpson, Pamela
Cameron, Peter
Lyons, Ronan
Collie, Alex
Fitzgerald, Mark
Judson, Rodney
Teague, Warwick
Braaf, Sandra
Nunn, Andrew
Ameratunga, Shanthi
Harrison, James
Keywords: Trauma Care
Victorian State Trauma Registry
3-Level EuroQol 5 Dimensions Questionnaire
Trauma System Design
Population Based Design
Adjusted Relative Risk
Quality of Survival
Recovery Patterns
Recovery Timeframes
Predictors of Outcome
Recovery Trajectories
Organised Trauma Systems
REcovery after Serious Trauma Outcomes, Resource use, and patient Experiences
Rehabilitation, Mental Health and Chronic Pain Clinical Institute, Epworth healthCare, Victoria, Australia
Monash-Epworth Rehabilitation Research Centre, Melbourne, Victoria, Australia.
Issue Date: Jul-2014
Publisher: Public Library of Science
Citation: PLoS Med. 2017 Jul 5;14(7):e1002322
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.
DOI: doi: 10.1371/journal.pmed.1002322
PubMed URL:
ISSN: 1549-1277
Journal Title: PLoS Medicine
Type: Journal Article
Affiliated Organisations: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Farr Institute, Swansea University Medical School, Swansea University, Swansea, United Kingdom.
Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia.
School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.
Insurance Work and Health Group, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Trauma Service, The Alfred, Melbourne, Victoria, Australia.
Department of Surgery, Monash University, Melbourne, Victoria, Australia.
Trauma Service, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Victorian Spinal Cord Service, Austin Health, Heidelberg, Victoria, Australia.
Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
Research Centre for Injury Studies, Flinders University, Adelaide, South Australia, Australia.
Type of Clinical Study or Trial: Prospective Cohort Study
Appears in Collections:Critical Care

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