Prevalence and determinants of disabilities and return to work after major trauma

Objective: The purpose of this study was to assess the prevalence and determinants of disabilities and return to work after severe injury in a Dutch, Level I trauma center. Methods: We prospectively included 295 patients with an Injury Severity Score ≥ 16 treated between January 1996 and January 1999. All survivors received a mailed questionnaire in 2000, at least 1 year after their initial hospital admission. Health status was measured by the EuroQol-SD instrument, and the Glasgow Outcome Scale. Additional questions were asked about cognitive functioning and return-to-work rates. Regression analyses was conducted to explore the associations between these functional outcome measures and patient characteristics. Results: Of the 295 patients included, 99 (34%) died in hospital or during follow-up. From the 196 survivors, a response was obtained from 166 (85%). Of the survivors, 33% had to change their work or daily activity as a result of their injuries. Of the 127 patients of working age (18-65 years), 33 (26%) were unable to work and depended on social security. Problems with mobility, self-care, daily activities, pain/discomfort, anxiety/depression, and cognitive ability were found in 34%, 15%, 51%, 58%, 37%, and 57%, respectively. The EuroQol-5D summary score (0.76) was far below that of the general population norms. The number of body areas affected, injury severity (Injury Severity Score a 25), and gender (female) were significant independent predictors of worse long-term functional outcome. Conclusion: Severe trauma has a substantial impact on long-term functioning. Empiric quantitative data, as presented in this study, enable us to estimate the burden of injury and to evaluate the quality of trauma care programs.

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