Longitudinal analysis of health status the first year after trauma in severely injured patients

PURPOSE: While survival rates after a trauma are increasing a considerable part of the trauma population are still at risk for both short and long term disabilities. Little is known about prognostic factors over time after a severe trauma. The aim of the present prospective cohort study was to examine trauma and patient related prognostic factors for a lower health status over time after a severe trauma. METHODS: A multicentre prospective observational cohort study was conducted. Adult trauma patients with severe injuries (ISS ≥ 16) were included from August 2015 until November 2016 if admitted to one of the hospitals in Noord-Brabant (the Netherlands). Outcome measure was health status, measured by the EuroQol-5D (EQ-5D utility and EQ-Visual analogue scale) and the Health Utilities Index (HUI2 and HUI3) one week and one, three, six, and twelve months after injury. Patient and trauma characteristics were analysed as prognostic factors with linear mixed models. The effect of each prognostic factor over time was analysed by adding the interaction term between the prognostic factor and time point in a multivariable linear mixed model, adjusted for confounders. Additionally, the risk factors for problems in the EQ-5 dimensions of HS and cognition were analysed. RESULTS: In total 239 severely injured patients participated. Pre-injury health status, hospital length of stay, ISS and comorbidities were significant prognostic factors for a lower health status. A younger age and extremity injury were prognostic factors for a lower health status until one month after trauma and unemployment before trauma and comorbidities six until twelve months after trauma. In the EQ-5 dimensions 44.1% remained problems in mobility, 15.3% in self-care, 46.4% in activity, 53.3% in pain, 32.5% in anxiety and 35.7% in cognition. CONCLUSIONS: Lower pre-injury health status, longer hospital length of stay, higher ISS, and comorbidities were significant prognostic factors for a lower health status during one year after a severe injury. A younger age and an extremity injury were short-term prognostic factors and unemployment before trauma and comorbidities were long-term prognostic factors. Even after twelve months patients in our population reported more problems in all EQ-5D dimensions when compared to the Dutch reference population.