Return to Work and Functional Outcomes After Major Trauma: Who Recovers, When, and How Well?

To describe the long-term outcomes of major trauma patients and factors associated with the rate of recovery. As injury-related mortality decreases, there is increased focus on improving the quality of survival and reducing nonfatal injury burden. Adult major trauma survivors to discharge, injured b...

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Published in:	Annals of surgery Vol. 263; no. 4; p. 623
Main Authors:	Gabbe, Belinda J, Simpson, Pamela M, Harrison, James E, Lyons, Ronan A, Ameratunga, Shanthi, Ponsford, Jennie, Fitzgerald, Mark, Judson, Rodney, Collie, Alex, Cameron, Peter A
Format:	Journal Article
Language:	English
Published:	United States 01.04.2016
Subjects:	Adolescent Adult Aged Aged, 80 and over Female Follow-Up Studies Humans Male Middle Aged Models, Statistical Quality of Life Recovery of Function Registries Regression Analysis Return to Work - statistics & numerical data Trauma Severity Indices Wounds and Injuries - rehabilitation Young Adult
ISSN:	1528-1140, 1528-1140
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Abstract	To describe the long-term outcomes of major trauma patients and factors associated with the rate of recovery. As injury-related mortality decreases, there is increased focus on improving the quality of survival and reducing nonfatal injury burden. Adult major trauma survivors to discharge, injured between July 2007 and June 2012 in Victoria, Australia, were followed up at 6, 12, and 24 months after injury to measure function (Glasgow Outcome Scale-Extended) and return to work/study. Random-effects regression models were fitted to identify predictors of outcome and differences in the rate of change in each outcome between patient subgroups. Among the 8844 survivors, 8128 (92%) were followed up. Also, 23% had achieved a good functional recovery, and 70% had returned to work/study at 24 months. The adjusted odds of reporting better function at 12 months was 27% (adjusted odds ratio 1.27, 95% confidence interval [CI] 1.19-1.36) higher compared with 6 months, and 9% (adjusted odds ratio 1.09, 95% CI, 1.02-1.17) higher at 24 months compared with 12 months. The adjusted relative risk (RR) of returning to work was 14% higher at 12 months compared with 6 months (adjusted RR 1.14, 95% CI, 1.12-1.16) and 8% (adjusted RR 1.08, 95% CI, 1.06-1.10) higher at 24 months compared with 12 months. Improvement in outcomes over the study period was observed, although ongoing disability was common at 24 months. Recovery trajectories differed by patient characteristics, providing valuable information for informing prognostication and service planning, and improving our understanding of the burden of nonfatal injury.
AbstractList	To describe the long-term outcomes of major trauma patients and factors associated with the rate of recovery.OBJECTIVETo describe the long-term outcomes of major trauma patients and factors associated with the rate of recovery.As injury-related mortality decreases, there is increased focus on improving the quality of survival and reducing nonfatal injury burden.BACKGROUNDAs injury-related mortality decreases, there is increased focus on improving the quality of survival and reducing nonfatal injury burden.Adult major trauma survivors to discharge, injured between July 2007 and June 2012 in Victoria, Australia, were followed up at 6, 12, and 24 months after injury to measure function (Glasgow Outcome Scale-Extended) and return to work/study. Random-effects regression models were fitted to identify predictors of outcome and differences in the rate of change in each outcome between patient subgroups.METHODSAdult major trauma survivors to discharge, injured between July 2007 and June 2012 in Victoria, Australia, were followed up at 6, 12, and 24 months after injury to measure function (Glasgow Outcome Scale-Extended) and return to work/study. Random-effects regression models were fitted to identify predictors of outcome and differences in the rate of change in each outcome between patient subgroups.Among the 8844 survivors, 8128 (92%) were followed up. Also, 23% had achieved a good functional recovery, and 70% had returned to work/study at 24 months. The adjusted odds of reporting better function at 12 months was 27% (adjusted odds ratio 1.27, 95% confidence interval [CI] 1.19-1.36) higher compared with 6 months, and 9% (adjusted odds ratio 1.09, 95% CI, 1.02-1.17) higher at 24 months compared with 12 months. The adjusted relative risk (RR) of returning to work was 14% higher at 12 months compared with 6 months (adjusted RR 1.14, 95% CI, 1.12-1.16) and 8% (adjusted RR 1.08, 95% CI, 1.06-1.10) higher at 24 months compared with 12 months.RESULTSAmong the 8844 survivors, 8128 (92%) were followed up. Also, 23% had achieved a good functional recovery, and 70% had returned to work/study at 24 months. The adjusted odds of reporting better function at 12 months was 27% (adjusted odds ratio 1.27, 95% confidence interval [CI] 1.19-1.36) higher compared with 6 months, and 9% (adjusted odds ratio 1.09, 95% CI, 1.02-1.17) higher at 24 months compared with 12 months. The adjusted relative risk (RR) of returning to work was 14% higher at 12 months compared with 6 months (adjusted RR 1.14, 95% CI, 1.12-1.16) and 8% (adjusted RR 1.08, 95% CI, 1.06-1.10) higher at 24 months compared with 12 months.Improvement in outcomes over the study period was observed, although ongoing disability was common at 24 months. Recovery trajectories differed by patient characteristics, providing valuable information for informing prognostication and service planning, and improving our understanding of the burden of nonfatal injury.CONCLUSIONSImprovement in outcomes over the study period was observed, although ongoing disability was common at 24 months. Recovery trajectories differed by patient characteristics, providing valuable information for informing prognostication and service planning, and improving our understanding of the burden of nonfatal injury. To describe the long-term outcomes of major trauma patients and factors associated with the rate of recovery. As injury-related mortality decreases, there is increased focus on improving the quality of survival and reducing nonfatal injury burden. Adult major trauma survivors to discharge, injured between July 2007 and June 2012 in Victoria, Australia, were followed up at 6, 12, and 24 months after injury to measure function (Glasgow Outcome Scale-Extended) and return to work/study. Random-effects regression models were fitted to identify predictors of outcome and differences in the rate of change in each outcome between patient subgroups. Among the 8844 survivors, 8128 (92%) were followed up. Also, 23% had achieved a good functional recovery, and 70% had returned to work/study at 24 months. The adjusted odds of reporting better function at 12 months was 27% (adjusted odds ratio 1.27, 95% confidence interval [CI] 1.19-1.36) higher compared with 6 months, and 9% (adjusted odds ratio 1.09, 95% CI, 1.02-1.17) higher at 24 months compared with 12 months. The adjusted relative risk (RR) of returning to work was 14% higher at 12 months compared with 6 months (adjusted RR 1.14, 95% CI, 1.12-1.16) and 8% (adjusted RR 1.08, 95% CI, 1.06-1.10) higher at 24 months compared with 12 months. Improvement in outcomes over the study period was observed, although ongoing disability was common at 24 months. Recovery trajectories differed by patient characteristics, providing valuable information for informing prognostication and service planning, and improving our understanding of the burden of nonfatal injury.
Author	Harrison, James E Collie, Alex Simpson, Pamela M Cameron, Peter A Gabbe, Belinda J Lyons, Ronan A Judson, Rodney Ameratunga, Shanthi Ponsford, Jennie Fitzgerald, Mark
Author_xml	– sequence: 1 givenname: Belinda J surname: Gabbe fullname: Gabbe, Belinda J organization: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia †The Farr Institute Centre for Improvement of Population Health through E-records Research, College of Medicine, Swansea University, Swansea, UK ‡Research Centre for Injury Studies, Flinders University, Adelaide, South Australia, Australia §Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand ¶Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia \|\|Trauma Service, The Alfred, Melbourne, Australia Department of Surgery, Monash University, Melbourne, Australia ††Trauma Service, Royal Melbourne Hospital, Parkville, Australia ‡‡Institute for Safety, Compensation and Recovery Research, Monash University, Melbourne, Australia §§Emergency and Trauma Centre, The Alfred, Melbourne, Australia – sequence: 2 givenname: Pamela M surname: Simpson fullname: Simpson, Pamela M – sequence: 3 givenname: James E surname: Harrison fullname: Harrison, James E – sequence: 4 givenname: Ronan A surname: Lyons fullname: Lyons, Ronan A – sequence: 5 givenname: Shanthi surname: Ameratunga fullname: Ameratunga, Shanthi – sequence: 6 givenname: Jennie surname: Ponsford fullname: Ponsford, Jennie – sequence: 7 givenname: Mark surname: Fitzgerald fullname: Fitzgerald, Mark – sequence: 8 givenname: Rodney surname: Judson fullname: Judson, Rodney – sequence: 9 givenname: Alex surname: Collie fullname: Collie, Alex – sequence: 10 givenname: Peter A surname: Cameron fullname: Cameron, Peter A
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Title	Return to Work and Functional Outcomes After Major Trauma: Who Recovers, When, and How Well?
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