Predictors of Change in Functional Outcome at six months and twelve months after Severe Injury: A Retrospective Cohort Study

Abstract

BackgroundThere is increasing focus on long-term survival, function and quality-of-life for trauma patients. There are few studies tracking longitudinal changes in functional outcome over time. The goal of our study was to compare the Glasgow Outcome Scale-Extended (GOSE) at 6 months and 12 months in blunt trauma survivors with an Injury Severity Score (ISS) of more than 15.MethodsUsing the Singapore National Trauma Registry 2011–2013, patients with 6-month GOSE and 12-month GOSE scores were analysed. Patients were grouped into three categories—those with the same score at 6 months and 12 months, an improvement in score, and a worse score at 12 months. Ordinal regression was used to identify risk factors for improved score. Patients with missing scores at either 6 months or 12 months were excluded.ResultsWe identified 478 patients: 174 had an improvement in score, 233 stayed the same, and 71 had worse scores at 12 months compared to 6 months. On univariate ordinal regression, the following variables were associated with same or better function at 12-months compared to 6-months: male gender, being employed pre-injury, thoracic Abbreviated Injury Scale (AIS) of 3 or more, anatomical polytrauma (AIS of 3 or more in 2 or more body regions), and road traffic injury mechanism. Older age, low fall, increasing Charlson comorbidity scores, new injury severity score, and head and neck AIS of 3 or more were associated with worse function at 12 months compared to 6 months. ISS and revised trauma score were not significant predictors on univariate or multivariable analysis.On multivariable ordinal regression, motor vehicle mechanism (OR 2.78, 1.51–5.12, p = 0.001) was associated with improved function, while male gender (OR 1.36, 95% CI 1.02–1.82, p = 0.039) predicted improved function at 12 months.ConclusionsFemales experience worse functional outcomes at 12 months, potentially due to majority of female injuries being low falls in the elderly. In contrast, motor vehicle injury patients had better functional outcomes at 12 months. Additional interventional strategies for high-risk groups should be explored.

Functional status, pain and return to work of injured motorcyclists involved in a motorcycle crash over one-year post-injury in Vietnam

“…Of interest, our study also showed that better physical and mental well-being, measured by the SF-12 were associated with increased improvements in pain over time, which concurs with research showing that an inability to exercise and depressing can exacerbate pain [39]. Overall, better physical and mental well-being are associated with higher functioning over time [33,35]. This reinforces the need for easy access to cost-neutral or low cost rehabilitation programs as part of the comprehensive discharge plan to improve physical and mental health outcomes [38].…”

“…A middle-aged person may have more difficulty securing a job when they have recovered from their injury as either employers may have found alternative employees or the physically demanding nature of certain jobs may make finding employment more difficult for older people [33]. Consistent with other research [33][34][35] this study found lower functional status among those aged over 55 years, and those with a higher ISS. This could be due to natural physical decline related to advancing age, which impacts on recovery time [36].…”

The feasibility and acceptability of mobile health monitoring for real-time assessment of traumatic injury outcomes

“…This highlights the urgent need for interventions that initiate and extend a continuity of longterm engagement with tools like mobile health monitoring. Similar to the limited corpus of research on long-term outcomes after trauma, we found that many patients in this pilot study continued to express signs and symptoms of poor recovery and chronic injury sequalae months and years after their hospitalization (13,15,(44)(45)(46)(47).…”

Rehabilitation nach Mehrfachverletzung

“…Auch der prätraumatische physische und psychische Zustand hat erheblichen Einfluss auf den funktionellen Outcome. Begleiterkrankungen und BMI beeinflussen nicht nur die Überlebensrate der Traumapatienten, sondern auch deren Lebensqualität [26,27]. Prognostische Einflüsse können in Relation zum Unfallzeitpunkt in prätraumatische, traumabedingte oder posttraumatische Faktoren eingeteilt werden (.…”