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

Belinda J. Gabbe, Pam M. Simpson, Peter A. Cameron, Jennie Ponsford, Ronan A. Lyons, Alex Collie, Mark Fitzgerald, Rodney Judson, Warwick J. Teague, Sandra Braaf, Andrew Nunn, Shanthi Ameratunga, James E. Harrison

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Pages (from-to)e1002322
Number of pages18
JournalPLoS Medicine
Volume14
Issue number7
DOIs
Publication statusPublished - 5 Jul 2017

Keywords

  • traumatic injury
  • patients
  • spinal cord injury
  • head injury
  • burns
  • socioeconomic aspects of health
  • age groups
  • falls

Cite this

@article{b47c77a685bb4f559033e2d55e85987a,
title = "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.",
keywords = "traumatic injury, patients, spinal cord injury, head injury, burns, socioeconomic aspects of health, age groups, falls",
author = "Gabbe, {Belinda J.} and Simpson, {Pam M.} and Cameron, {Peter A.} and Jennie Ponsford and Lyons, {Ronan A.} and Alex Collie and Mark Fitzgerald and Rodney Judson and Teague, {Warwick J.} and Sandra Braaf and Andrew Nunn and Shanthi Ameratunga and Harrison, {James E.}",
year = "2017",
month = "7",
day = "5",
doi = "10.1371/journal.pmed.1002322",
language = "English",
volume = "14",
pages = "e1002322",
journal = "PLoS Medicine",
issn = "1549-1676",
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}

Long-term health status and trajectories of seriously injured patients : A population-based longitudinal study. / Gabbe, Belinda J.; Simpson, Pam M.; Cameron, Peter A.; Ponsford, Jennie; Lyons, Ronan A.; Collie, Alex; Fitzgerald, Mark; Judson, Rodney; Teague, Warwick J.; Braaf, Sandra; Nunn, Andrew; Ameratunga, Shanthi; Harrison, James E.

In: PLoS Medicine, Vol. 14, No. 7, 05.07.2017, p. e1002322.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Long-term health status and trajectories of seriously injured patients

T2 - A population-based longitudinal study

AU - Gabbe, Belinda J.

AU - Simpson, Pam M.

AU - Cameron, Peter A.

AU - Ponsford, Jennie

AU - Lyons, Ronan A.

AU - Collie, Alex

AU - Fitzgerald, Mark

AU - Judson, Rodney

AU - Teague, Warwick J.

AU - Braaf, Sandra

AU - Nunn, Andrew

AU - Ameratunga, Shanthi

AU - Harrison, James E.

PY - 2017/7/5

Y1 - 2017/7/5

N2 - 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.

AB - 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.

KW - traumatic injury

KW - patients

KW - spinal cord injury

KW - head injury

KW - burns

KW - socioeconomic aspects of health

KW - age groups

KW - falls

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U2 - 10.1371/journal.pmed.1002322

DO - 10.1371/journal.pmed.1002322

M3 - Article

VL - 14

SP - e1002322

JO - PLoS Medicine

JF - PLoS Medicine

SN - 1549-1676

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