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Predicting health status in the first year after trauma. BJS 2019; 106: 701-710.

Published: 20th March 2019

Authors: L. de Munter, S. Polinder, C. L. P. van de Ree, N. Kruithof, K. W. W. Lansink, E. W. Steyerberg et al.

Background

Although mortality rates following major trauma are continuing to decline, a growing number of patients are experiencing long‐term disability. The aim of this study was to identify factors associated with health status in the first year following trauma and develop prediction models based on a defined trauma population.

Method

The Brabant Injury Outcome Surveillance (BIOS) study was a multicentre prospective observational cohort study. Adult patients with traumatic injury were included from August 2015 to November 2016 if admitted to one of the hospitals of the Noord‐Brabant region in the Netherlands. Outcome measures were EuroQol Five Dimensions 5D‐3L (EQ‐5D™ utility and visual analogue scale (VAS)) and Health Utilities Index (HUI) 2 and 3 scores 1 week and 1, 3, 6 and 12 months after injury. Prediction models were developed using linear mixed models, with patient characteristics, preinjury health status, injury severity and frailty as possible predictors. Predictors that were significant (P < 0·050) for one of the outcome measures were included in all models. Performance was assessed using explained variance (R2).

Results

In total, 4883 patients participated in the BIOS study (50·0 per cent of the total), of whom 3366 completed the preinjury questionnaires. Preinjury health status and frailty were the strongest predictors of health status during follow‐up. Age, sex, educational level, severe head or face injury, severe torso injury, injury severity, Functional Capacity Index score, co‐morbidity and duration of hospital stay were also relevant in the multivariable models predicting health status. R2 ranged from 35 per cent for EQ‐VAS to 48 per cent for HUI 3.

Conclusion

The most important predictors of health status in the first year after trauma in this population appeared to be preinjury health status and frailty.

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