Prospects after Major Trauma

Introduction. After patients survived major trauma, their prospects, in terms of the consequences for functioning, are uncertain, which may impact severely on patient, family and society. The studies in this thesis describes the long-term outcomes of severe injured patients after major trauma. In addition, we tried to discover independent prognostic factors for different outcomes and we quantified the burden of major trauma at individual and population level. Chapter 1 reviews some of the literature on this topic, and describes the aims, population and outcome assessments of the studies performed, ending with an outline of the thesis. Chapter 2 reported on aspects of functional health status, measured with the Sickness Impact Profile-136. The aims of the studies described in this chapter were, firstly, to describe the long-term functional health status (Sickness Impact Profile-136) in a large, unselected group of severely injured patients one year after injury and to compare this with normative data, and secondly, to explore possible relations between functional health status on the one hand and individual and injury characteristics on the other. Chapter 3 addresses the issue of quality of life, measured with the EuroQol-5D. In this chapter, the prevalence and determinants (socio-demographic, injury-related and physical factors) of the outcome are quantified. Outcome was assessed by means of the Glasgow Outcome Scale, EuroQol-5D domains (visual analogue score, utility score, mobility, self-care, daily activities, pain and discomfort, anxiety or depression) and the presence of cognitive complaints. Chapter 4 discusses the long-term functional outcomes of severely injured patients who also suffer from lower extremity injuries. Using a model developed by the World Health Organization and health-related quality of life. This International Classification of Functioning, Disability and Health model (ICF model) model is divided in domains of functions, activity and participation. The associations between these domains were assessed. Chapter 5 addresses the issue of return to work after major trauma. Work is a part of the participation domain of the ICF. We quantified the post-injury work status of those who were actually employed at the time before the injury, and investigated determinants of post-injury work status such as socio-demographic factors, physical factors, injury-related factors and hospital factors. Chapter 6 reports on a study in which the burden of major trauma at the individual and population levels was quantified for the catchment area of our regional trauma care centre. In this study we calculated the number of disability-adjusted life years, consisting the number of years of life lost and the number of years lived with disability. This is an entire other method, but commonly used in public health research, to evaluate the consequences of disease and injury proposed by the World Health Organization. Chapter 7 summarized and evaluated in the work reported on in this thesis is, which reviews the results of the studies and provides recommendations to improve future research into the long-term outcome of severely injured patients