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

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, id...

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Vydané v:PLoS medicine Ročník 14; číslo 7; s. e1002322
Hlavní autori: 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.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Public Library of Science 05.07.2017
Public Library of Science (PLoS)
Predmet:
Adolescent
Adult
Aged
Aged, 80 and over
Anxiety
Care and treatment
Compensation
Depression
Discomfort
Female
Health care
Health education
Health literacy
Health Status
Hospitals
Humans
Injuries
Investment
Longitudinal Studies
Male
Management
Medical care
Medical prognosis
Medicine and Health Sciences
Mental depression
Middle Aged
Pain
Patients
People and Places
Population characteristics
Population studies
Population-based studies
Preventive medicine
Prospective Studies
Public health
Quality of Life
Studies
Systems design
Trajectories
Trajectories (Physics)
Trauma
Trauma care
Trauma centers
Victoria - epidemiology
Wounds and Injuries - epidemiology
Wounds and Injuries - etiology
Wounds and Injuries - therapy
Young Adult
Australia
Victoria Australia
ISSN:1549-1676, 1549-1277, 1549-1676
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Shrnutí: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. 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. 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.
Bibliografia:ObjectType-Article-1
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Conceptualization: BJG PAC RAL PMS JEH RJ MF JP SA AC.Data curation: BJG PMS SB.Formal analysis: BJG PMS.Funding acquisition: BJG PAC RAL JEH SA JP MF RJ AC.Investigation: BJG PMS SB.Methodology: BJG PAC RAL JEH SA JP MF RJ AC SB WJT AN.Project administration: BJG SB.Resources: BJG PAC RAL JEH SA JP MF RJ AC SB WJT AN.Supervision: BJG PAC RAL JEH SA JP MF RJ AC SB WJT AN.Validation: PMS BJG.Visualization: BJG PMS.Writing – original draft: BJG PAC RAL JEH SA JP MF RJ AC SB WJT AN.Writing – review & editing: BJG PAC RAL JEH SA JP MF RJ AC SB WJT AN PMS.
The authors have declared that no competing interests exist.
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1002322