Assessment of quality of life and functional outcome in patients sustaining moderate and major trauma: A multicentre, prospective cohort study

Background: Trauma care systems aim to reduce both death and disability, yet there is little data on post-trauma health status and functional outcome. Objectives: To evaluate baseline, discharge, six month and 12 month post-trauma quality of life, functional outcome and predictors of quality of life in Hong Kong. Methods: Multicentre, prospective cohort study using data from the trauma registries of three regional trauma centres in Hong Kong. Trauma patients with an ISS >= 9 and aged >= 18 years were included. The main outcome measures were the physical component summary (PCS) score and mental component summary (MCS) scores of the Short-Form 36 (SF36) for health status, and the extended Glasgow Outcome Scale (GOSE) for functional outcome. Results: Between 1 January 2010 and 31 September 2010, 400 patients (mean age 53.3 years; range 18-106; 69.5% male) were recruited to the study. There were no statistically significant differences in baseline characteristics between responders (N = 177) and surviving non-responders (N = 163). However, there were significant differences between these groups and the group of patients who died (N = 60). Only 16/400 (4%) cases reported a GOSE >= 7. 62/400 (15.5%) responders reached the HK population norm for PCS. 125/400 (31%) responders reached the HK population norm for MCS. If non-responders had similar outcomes to responders, then the percentages for GOSE >= 7 would rise from 4% to 8%, for PCS from 15.5% to 30%, and for MCS from 31% to 60%. Univariate analysis showed that 12-month poor quality of life was significantly associated with age > 65 years (OR 4.77), male gender (OR 0.44), pre-injury health problems (OR 2.30), admission to ICU (OR 2.15), ISS score 26-40 (OR 3.72), baseline PCS (OR 0.89), one-month PCS (OR 0.89), one-month MCS (OR 0.97), 6-month PCS (OR 0.76) and 6-month MCS (OR 0.97). Conclusion: For patients sustaining moderate or major trauma in Hong Kong at 12 months after injury < 1 in 10 patients had an excellent recovery, <= 3 in 10 reached a physical health status score >= Hong Kong norm, although as many as 6 in 10 patients had a mental health status score which is >= Hong Kong norm. (C) 2013 Elsevier Ltd. All rights reserved.