Health Outcome after Major Trauma: What Are We Measuring?

Abstract

ImportanceTrauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients.ObjectiveTo systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma.Data SourcesMEDLINE, EMBASE, and CINAHL (from 2006–2012) were searched for studies evaluating health outcome after traumatic injuries.Study selection and data extractionStudies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts.Results34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%).ConclusionOutcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.

Effects of an Integrated ‘Fast Track’ Rehabilitation Service for Multi-Trauma Patients: A Non-Randomized Clinical Trial in the Netherlands

“…However, they concluded that the existing outcome measures did not fully describe the impact of major trauma on function, disability and health. The health outcomes of trauma patients may therefore not be fully understood [27]. The Trauma Outcomes Profile (TOP), a trauma-specific tool, was shown to cover the largest representation of the International Classification of Function, Disability and Health (ICF).…”

“…The TOP may have potential use in trauma population but requires further validation [28]. The outcome evaluation and understanding of the true health impact of injury may be limited due to the lack of an ICF-based framework [27]. …”

Development of a trauma-specific quality-of-life measurement

“…2 These injuries account for the loss of more disability-adjusted life years than any other disease, but many of the instruments and measurements used to assess outcome in this population are non-standardized or are adapted from other populations. 3,4 Additionally, the acute cost associated with each patient, when medical care and work loss are considered, is around $66,150 or $406 billion annually. 1,5 Thus, it is essential that a concerted effort be made to improve post-traumatic quality of life, thereby easing the current and future burden of the disease.…”

Rehabilitation of traumatic brain injury in the light of the ICF

“…Another advantage of using the TBI ICF Core Sets as a guide for the assessment is that it improves quality assurance of assessing the four different domains that interact in functioning. For example, research has shown that professionals tend to assess according to their area of knowledge (Laxe et al, 2014) and environmental factors that have a significant effect on functioning are not systematically assessed (Hoffman et al, 2014;Laxe et al, 2012).…”