Memories and health-related quality of life after intensive care: A follow-up study

Objective: The overall aim of this study was to describe changes in health-related quality of life, anxiety, depression, and return to work from 0.5-1.5 yrs to 4.5-5.5 yrs after injury in patients with and without delusional memories during their intensive care unit stay. A secondary aim was to explore factors that were related to health-related quality of life and to compare trauma patients' health-related quality of life 4.5 to 5.5 yrs after injury with a reference group. Design: Longitudinal, prospective. Settings: Multicentre study. Patients: Trauma patients treated in the intensive care unit. Interventions: None. Measurements and main results: A follow-up study was conducted with 153 consenting adults. Each patent answered a postal questionnaire twice, 0.5-1.5 yrs to 4.5-5.5 yrs after the injury. Health-related quality of life was assessed by Short Form-36 and anxiety and depression by the Hospital Anxiety and Depression Scale. Delusional memories and other clinical variables were assessed in a previous study and used in this study as possible precipitants of poor health-related quality of life. Seventy-five percent were males and mean Injury Severity Scores were 10.7 +/- 7.1. When comparing health-related quality of life over time, there was significant improvement in five domains of health-related quality of life for patents with delusional memories compared with 4 yrs previously. Significantly more patents with delusions had anxiety and depression (Hospital Anxiety and Depression Scale >= 8). Patents with delusional memories were Still significantly separated from the other patents in all health-related quality-of-life domains except for general health. Seventy-five percent of all patients had returned to work. Despite a poorer health-related quality of life, patents with delusions had returned to work to the same degree. Patients with trauma still scored significantly lower in all domains 4.5 to 5.5 yrs after the injury compared with the Swedish population in the reference group (p < .001). Two factors, delusional memories during intensive care unit stay and preexisting disease prior the trauma, had the most influence on a poorer health-related quality of life. Conclusions: From a long-term perspective, health-related quality of life has improved but nut reached the reference sample scores in Short Form-36. Seventy-five percent had returned to work. Patents with delusional memories still experienced poorer health-related quality of life and more patients had anxiety and depression compared with patients without those memories. (Crit Care Med 2010; 38:38-44)