Prognostic factors for recovery of health status after injury: a prospective multicentre cohort study

OBJECTIVES: To determine prognostic factors for health status and recovery patterns during the first 2 years after injury in the clinical trauma population. DESIGN: A prospective longitudinal cohort study. SETTING: Ten participating hospitals in Brabant, the Netherlands. PARTICIPANTS: Injured adult patients admitted to a hospital between August 2015 and November 2016 were followed: 4883 (50%) patients participated. MAIN OUTCOME MEASURES: Primary outcome was health status, measured with the EuroQol-5-dimensions-3-levels (EQ-5D), including a cognition item and the EuroQol Visual Analogue Scale. Health status was collected at 1 week, 1, 3, 6, 12 and 24 months after injury. Potential prognostic factors were based on literature and clinical experience (eg, age, sex, pre-injury frailty (Groningen Frailty Index), pre-injury EQ-5D). RESULTS: Health status increased mainly during the first 6 months after injury with a mean EQ-5D utility score at 1 week of 0.49 and 0.79 at 24 months. The dimensions mobility, pain/discomfort and usual activities improved up to 2 years after injury. Lower pre-injury health status, frailty and longer length of stay at the hospital were important prognostic factors for poor recovery. Spine injury, lower and upper extremity injury showed to be prognostic factors for problems after injury. Traumatic brain injury was a prognostic factor for cognitive problems. CONCLUSION: This study contributes to the increase in knowledge of health recovery after injury. It could be a starting point to develop prediction models for specific injury classifications and implementation of personalised medicine. TRIAL REGISTRATION NUMBER: NCT02508675.