Post-trauma morbidity, measured as sick leave, is substantial and influenced by factors unrelated to injury: a retrospective matched observational cohort study

Abstract

BackgroundMortality as an endpoint has been the focus of trauma research whereas few studies investigate long-term outcomes in terms of morbidity. An adequate analysis of post-injury morbidity includes several dimensions, for this reason sick leave has been used as a proxy for morbidity in the current study. The aim of this retrospective matched observational cohort study was to investigate sick leave before and after trauma and factors associated with prolonged sick leave.MethodsPatients from a level one trauma centre 2005–2010 were matched in a 1:5 ratio with uninjured controls. By linkage to national registries, sick leave rates were compared. The association between potential risk factors and full-time sick leave at twelve months post injury, the primary end-point, was examined in trauma patients by logistic regression.ResultsFour thousand seven hundred twelve patients and 25,013 controls aged 20–63 were included. Trauma patients had more sick leave both before and after trauma. Age, psychiatric disease, low level of education, serious injury, spinal injury, reduced consciousness at admission, discharge destination other than home, and hospital length of stay >7 days were all associated with the primary end-point. The strongest risk factor was sick leave before trauma; this was also noted in the most seriously injured patients.DiscussionIn this retrospective matched observational cohort study we found a significant long-term morbidity, measured as sick leave, among trauma patients. Compared to controls the difference was maximal early after trauma and sustained throughout the follow up period. In the logistic regression, factors associated with the traumatic injury as well as host factors increased the probability of not returning to work. Full sick leavemonth twelve post injury was strongly associated with pre-injury sick leave but also with age, psychiatric comorbidity, level of education, injury severity, spinal injury, low GCS at admission, length of stay at hospital and discharge to other destination than home.ConclusionsTrauma patients suffer from significant long-term morbidity. The sustained post-trauma morbidity is largely influenced by factors not related to injury per se. These insights enable identification of patients at risk for prolonged sick leave after trauma.

Population-based analysis of the impact of trauma on longer-term functional outcomes

“…Although this difference declined during follow-up (36 months), the non-injured controls had lower rates of sick leave many years after the incident 30 . This was explained by an increased prevalence of preinjury sick leave rates, substance abuse, and psychiatric and somatic co-morbidity in injured patients 30 . A similar observation was made in the present study, with a persisting long-term effect of the injury on receipt of medical benefits, although this study population may be considered healthier as they were either in education or working at the time of the injury.…”

“…There was a substantial increase in the rates of sick leave among injured patients compared with non‐injured controls. Although this difference declined during follow‐up (36 months), the non‐injured controls had lower rates of sick leave many years after the incident. This was explained by an increased prevalence of preinjury sick leave rates, substance abuse, and psychiatric and somatic co‐morbidity in injured patients.…”

“…Those with a severe head injury were more likely to be receiving medical benefits. In a recent Scandinavian publication 30 , linkages with national registries were used to assess the long-term effects of morbidity after trauma. There was a substantial increase in the rates of sick leave among injured patients compared with non-injured controls.…”

Sickness absence, disability pension and permanent medical impairment among 64 000 injured car occupants of working ages: A two-year prospective cohort study

“…Road traffic injuries may result in different types of social and economic consequences for the individual. One such important consequence is that it might lead to work incapacity and thus loss of income from work 75,76 .…”

Health Related Quality of Life after Multiple Trauma in Adolescents

“…Facing the socio-economic impact, morbidity is evolving as a critical outcome parameter. 16 The main focus of this study is the evaluation of posttraumatic HRQoL in adolescent multiple trauma patients. We used the EQ-5D HRQoL outcome score.…”