Importance Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients. Objective To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma. Data Sources MEDLINE, EMBASE, and CINAHL (from 2006–2012) were searched for studies evaluating health outcome after traumatic injuries. Study selection and data extraction Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts. Results 34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%). Conclusion Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.
References
[1]
Gore FM, Bloem PJN, Patton GC, Ferguson J, Joseph V, et al. (2011) Global burden of disease in young people aged 10–24 years: a systematic analysis. The Lancet 377: 2093–2102. doi: 10.1016/s0140-6736(11)60512-6
[2]
Horwitz DA, Schuerer DJ (2008) Trauma rehabilitation outcome scoring. Current opinion in critical care 14: 445–450. doi: 10.1097/mcc.0b013e328307f25f
[3]
Khan F, Amatya B, Hoffman K (2012) Systematic review of multidisciplinary rehabilitation in patients with multiple trauma. Br J Surg 99 Suppl 188–96. doi: 10.1002/bjs.7776
[4]
Stelfox HT, Boyd JM, Straus SE, Gagliardi AR (2013) Developing a patient and family-centred approach for measuring the quality of injury care: a study protocol. BMC Health Serv Res 13: 31. doi: 10.1186/1472-6963-13-31
[5]
Bowling A (2005) Just one question: If one question works, why ask several? J Epidemiol Community Health. England. pp. 342–345.
[6]
Cameron PA, Gabbe BJ, McNeil JJ (2006) The importance of quality of survival as an outcome measure for an integrated trauma system. Injury 37: 1178–1184. doi: 10.1016/j.injury.2006.07.015
[7]
Weninger P, Aldrian S, Koenig F, Vecsei V, Nau T (2008) Functional recovery at a minimum of 2 years after multiple injury-development of an outcome score. J Trauma. United States. pp. 799–808; discussion 808.
[8]
Soberg HL, Bautz-Holter E, Roise O, Finset A (2007) Long-term multidemensional functional consequences of severe multiple injuries two years after trauma: a prospective longitudinal cohort study. Journal of Trauma 62: 461–471. doi: 10.1097/01.ta.0000222916.30253.ea
[9]
Soberg HL, Finset A, Roise O, Bautz-Holter E (2012) The trajectory of physical and mental health from injury to 5 years after multiple trauma: a prospective, longitudinal cohort study. Arch Phys Med Rehabil 93: 765–774. doi: 10.1016/j.apmr.2011.08.050
[10]
Jackson JC, Obremskey W, Bauer R, Greevy R, Cotton BA, et al. (2007) Long-term cognitive, emotional, and functional outcomes in trauma intensive care unit survivors without intracranial hemorrhage. J Trauma 62: 80–88. doi: 10.1097/ta.0b013e31802ce9bd
[11]
Black JA, Herbison GP, Lyons RA, Polinder S, Derrett S (2011) Recovery after injury: an individual patient data meta-analysis of general health status using the EQ-5D. J Trauma 71: 1003–1010. doi: 10.1097/ta.0b013e3182238833
[12]
Sleat GK, Ardolino AM, Willett KM (2011) Outcome measures in major trauma care: a review of current international trauma registry practice. Emerg Med J 28: 1008–1012. doi: 10.1136/emermed-2011-200326
[13]
World Health Organisation (2001) World Health Organisation, International Classification of Function, Disability and Health. Geneva: WHO.
[14]
Ashley J (1990) The International Classification of Diseases: the structure and content of the Tenth Revision. Health Trends 22: 135–137.
[15]
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6: e1000097. doi: 10.1371/journal.pmed.1000097
[16]
Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustün B, et al. (2005) ICF linking rules: an update based on lessons learned. J Rehabil Med 37: 212–218. doi: 10.1080/16501970510040263
[17]
Cieza A, Brockow T, Ewert T, Amman E, Kollerits B, et al. (2002) Linking health-status measurements to the international classification of functioning, disability and health. J Rehabil Med 34: 205–210. doi: 10.1080/165019702760279189
[18]
Jenkinson C, Wright L, Coulter A (1993) The SF 36 health survey questionnaire if used within its limits. BMJ 307: 449. doi: 10.1136/bmj.307.6901.449
[19]
Dodds TA, Martin DP, Stolov WC, Deyo RA (1993) A validation of the functional independence measurement and its performance among rehabilitation inpatients. Arch Phys Med Rehabil 74: 531–536. doi: 10.1016/0003-9993(93)90119-u
[20]
Geyh S, Cieza A, Kollerits B, Grimby G, Stucki G (2007) Content comparison of health-related quality of life measures used in stroke based on the international classification of functioning, disability and health (ICF): a systematic review. Qual Life Res 16: 833–851. doi: 10.1007/s11136-007-9174-8
[21]
Velstra IM, Ballert CS, Cieza A (2011) A systematic literature review of outcome measures for upper extremity function using the international classification of functioning, disability, and health as reference. PM R 3: 846–860. doi: 10.1016/j.pmrj.2011.03.014
[22]
Laxe S, Tschiesner U, Zasler N, López-Blazquez R, Tormos JM, et al. (2012) What domains of the International Classification of Functioning, Disability and Health are covered by the most commonly used measurement instruments in traumatic brain injury research? Clin Neurol Neurosurg 114: 645–650. doi: 10.1016/j.clineuro.2011.12.038
[23]
Gradinger F, Gl？ssel A, Bentley A, Stucki A (2011) Content comparison of 115 health status measures in sleep medicine using the International Classification of Functioning, Disability and Health (ICF) as a reference. Sleep Med Rev 15: 33–40. doi: 10.1016/j.smrv.2010.07.001
[24]
Sutherland AG, Alexander DA, Hutchison JD (2006) The mind does matter: Psychological and physical recovery after musculoskeletal trauma. Journal of Trauma 61: 1408–1415. doi: 10.1097/01.ta.0000197562.34651.df
[25]
Sutherland AG, Suttie S, Alexander DA, Hutchison JD (2011) The mind continues to matter: psychologic and physical recovery 5 years after musculoskeletal trauma. Journal of Orthopaedic Trauma 25: 228–233. doi: 10.1097/bot.0b013e3181ee40a9
[26]
Christensen MC, Banner C, Lefering R, Vallejo-Torres L, Morris S (2011) Quality of Life After Severe Trauma: Results From the Global Trauma Trial With Recombinant Factor VII. Journal of Trauma 70: 1524–1532. doi: 10.1097/ta.0b013e3181f053c2
[27]
Pirente N, Blum C, Wortberg S, Bostanci S, Berger E, et al. (2007) Quality of life after multiple trauma: The effect of early onset psychotherapy on quality of life in trauma patients. Langenbeck's Archives of Surgery 392: 739–745. doi: 10.1007/s00423-007-0171-8
[28]
Franzén C, Brulin C, Stenlund H, Bj？rnstig U (2009) Injured road users' health-related quality of life after telephone intervention: a randomised controlled trial. Journal of Clinical Nursing 18: 108–117. doi: 10.1111/j.1365-2702.2008.02436.x
[29]
Steel J, Youssef M, Pfeifer R, Ramirez JM, Probst C, et al. (2010) Health-related quality of life in patients with multiple injuries and traumatic brain injury 10+ years postinjury. Journal of Trauma 69: 523–532. doi: 10.1097/ta.0b013e3181e90c24
[30]
Jackson JC, Obremskey W, Bauer R, Greevy R, Cotton BA, et al. (2007) Long-term cognitive, emotional, and functional outcomes in trauma intensive care unit survivors without intracranial hemorrhage. Journal of Trauma 62: 80–89. doi: 10.1097/ta.0b013e31802ce9bd
[31]
Kiely JM, Brasel KJ, Weidner KL, Guse CE, Weigelt JA (2006) Predicting quality of life six months after traumatic injury. Journal of Trauma 61: 791–799. doi: 10.1097/01.ta.0000239360.29852.1d
[32]
Livingston DH, Tripp T, Biggs C, Lavery RF (2009) A fate worse than death? Long-term outcome of trauma patients admitted to the surgical intensive care unit. Journal of Trauma 67: 341–349. doi: 10.1097/ta.0b013e3181a5cc34
[33]
Mackenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Egleston BL, et al. (2008) The impact of trauma-center care on functional outcomes following major lower-limb trauma. Journal of Bone & Joint Surgery, American Volume 90A: 101–110. doi: 10.2106/jbjs.f.01225
[34]
Sayer NA, Chiros CE, Sigford B, Scott S, Clothier B, et al. (2008) Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror. Archives of Physical Medicine & Rehabilitation 89: 163–171. doi: 10.1016/j.apmr.2007.05.025
[35]
Siddharthan K, Scott S, Bass E, Nelson A (2008) Rehabilitation outcomes for veterans with polytrauma treated at the Tampa VA. Rehabilitation Nursing 33: 221–226. doi: 10.1002/j.2048-7940.2008.tb00231.x
[36]
Harris IA, Young JM, Rae H, Jalaludin BB, Solomon MJ (2008) Predictors of general health after major trauma. J Trauma 64: 969–974. doi: 10.1097/01.ta.0000245972.83948.1a
[37]
Gabbe BJ, Cameron PA, Hannaford AP, Sutherland AM, McNeil JJ (2006) Routine follow up of major trauma patients from trauma registries: What are the outcomes? J Trauma 61: 1393–1399. doi: 10.1097/01.ta.0000225926.34180.47
[38]
Gabbe BJ, Simpson PM, Sutherland AM, Wolfe R, Fitzgerald MC, et al. (2012) Improved functional outcomes for major trauma patients in a regionalized, inclusive trauma system. Ann Surg 255: 1009–1015. doi: 10.1097/sla.0b013e31824c4b91
[39]
Gabbe BJ, Cameron PA (2013) Importance of functional and quality of life outcomes in trauma. Surgeon 11: 114. doi: 10.1016/j.surge.2012.11.002
[40]
Derrett S, Davie G, Ameratunga S, Langley J (2010) Capturing outcomes following injury: a New Zealand pilot study. N Z Med J 123: 66–74.
[41]
Langley J, Derrett S, Davie G, Ameratunga S, Wyeth E (2011) A cohort study of short-term functional outcomes following injury: the role of pre-injury socio-demographic and health characteristics, injury and injury-related healthcare. Health & Quality of Life Outcomes 9.
[42]
Probst C, Zelle B, Panzica M, Lohse R, Sitarro NA, et al. (2010) Clinical re-examination 10 or more years after polytrauma: is there a gender related difference? Journal of Trauma 68: 706–712. doi: 10.1097/ta.0b013e3181a8b21c
[43]
Zeckey C, Hildebrand F, Pape H-C, Mommsen P, Panzica M, et al. (2011) Head injury in polytrauma—Is there an effect on outcome more than 10 years after the injury?? Brain Injury 25: 551–560. doi: 10.3109/02699052.2011.568036
[44]
Pape HC, Probst C, Lohse R, Zelle BA, Panzica M, et al. (2010) Predictors of late clinical outcome following orthopedic injuries after multiple trauma. Journal of Trauma 69: 1243–1252. doi: 10.1097/ta.0b013e3181ce1fa1
[45]
Baranyi A, Leithgob O, Kreiner B, Tanzer K, Ehrlich G, et al. (2010) Relationship between posttraumatic stress disorder, quality of life, social support, and affective and dissociative status in severely injured accident victims 12 months after trauma. Psychosomatics 51: 237–247. doi: 10.1016/s0033-3182(10)70691-5
[46]
Holtslag H, Buskens E, Rommers C, Prevo A, van der Werken C (2006) Long-term outcome after lower extremity injuries in severely injured patients. European Journal of Trauma 32: 365–374. doi: 10.1007/s00068-006-5112-7
[47]
Holtslag HR, van EFE, Lindeman E, Leenen LP (2007) Determinants of long-term functional consequences after major trauma. Journal of Trauma 62: 919–928. doi: 10.1097/01.ta.0000224124.47646.62
[48]
Polinder S, van EFE, Essink-Bot ML, Toet H, Looman CW, et al. (2007) Functional outcome at 2.5, 5, 9, and 24 months after injury in the Netherlands. Journal of Trauma 62: 133–142. doi: 10.1097/ta.0b013e31802b71c9
[49]
Ringburg AN, Polinder S, van Ierland MC, Steyerberg EW, van Lieshout EM, et al. (2011) Prevalence and prognostic factors of disability after major trauma. Journal of Trauma 70: 916–923. doi: 10.1097/ta.0b013e3181f6bce8
[50]
Soberg HL, Finset A, Bautz-Holter E, Sandvik L, Roise O (2007) Return to work after severe multiple injuries: a multidimensional approach on status 1 and 2 years postinjury. J Trauma 62: 471–481. doi: 10.1097/ta.0b013e31802e95f4
[51]
Soberg HL, Bautz-Holter E, Roise O, Finset A (2010) Mental health and posttraumatic stress symptoms 2 years after severe multiple trauma: self-reported disability and psychosocial functioning. Archives of Physical Medicine & Rehabilitation 91: 481–489. doi: 10.1016/j.apmr.2009.11.007
[52]
Orwelius L, Bergkvist M, Nordlund A, Simonsson E, Nordlund P, et al. (2012) Physical effects of trauma and the psychological consequences of preexisting diseases account for a significant portion of the health-related quality of life patterns of former trauma patients. J Trauma Acute Care Surg 72: 504–512. doi: 10.1097/ta.0b013e31821a416a
[53]
Ballabeni P, Burrus C, Luthi F, Gobelet C, Dériaz O (2011) The effect of recalled previous work environment on return to work after a rehabilitation program including vocational aspects for trauma patients. J Occup Rehabil 21: 43–53. doi: 10.1007/s10926-010-9255-3
[54]
Schwartz I, Tsenter J, Shochina M, Shiri S, Kedary M, et al. (2007) Rehabilitation outcomes of terror victims with multiple traumas. Archives of Physical Medicine & Rehabilitation 88: 440–449. doi: 10.1016/j.apmr.2007.01.001
[55]
van Aswegen H, Myezwa H, Mudzi W, Becker P (2011) Health-related quality of life of survivors of penetrating trunk trauma in Johannesburg, South Africa. European Journal of Trauma and Emergency Surgery 37: 419–426. doi: 10.1007/s00068-010-0071-4
[56]
EuroQol (1990) —a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 16: 199–208. doi: 10.1016/0168-8510(90)90421-9
[57]
Teasdale GM, Pettigrew LE, Wilson JT, Murray G, Jennett B (1998) Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow Outcome Scale. J Neurotrauma 15: 587–597. doi: 10.1089/neu.1998.15.587
[58]
P？sl M, Cieza A, Stucki G (2007) Psychometric properties of the WHODASII in rehabilitation patients. Qual Life Res 16: 1521–1531. doi: 10.1007/s11136-007-9259-4
[59]
Zelle B, Stalp M, Weihs CH, Muller F, Reiter FO, et al. (2003) Hannover Score for Polytrauma Outcome (HASPOC). Validierung am Beispiel von 170 Polytrauma-Patienten und Vergleich mit dem SF-12. [Validation of the Hannover Score for Polytrauma Outcome (HASPOC) in a sample of 170 polytrauma patients and a comparison with the 12-Item Short-Form Health Survey]. Chirurg 74: 361–369. doi: 10.1007/s00104-003-0621-y
[60]
Attenberger C, Amsler F, Gross T (2012) Clinical evaluation of the Trauma Outcome Profile (TOP) in the longer-term follow-up of polytrauma patients. Injury. Netherlands: 2011 Elsevier Ltd. pp. 1566–1574.
[61]
Lyons RA, Kendrick D, Towner EM, Christie N, Macey S, et al. (2011) Measuring the population burden of injuries—implications for global and national estimates: a multi-centre prospective UK longitudinal study. PLoS Med 8: e1001140. doi: 10.1371/journal.pmed.1001140
[62]
Pirente N, Ottlik Y, Lefering R, Boullion B, Neugebauer E (2006) Quality of life in multiply injured patients. European Journal of Trauma 32: 44–63. doi: 10.1007/s00068-006-0150-8
[63]
Polinder S, Haagsma JA, Belt E, Lyons RA, Erasmus V, et al. (2010) A systematic review of studies measuring health-related quality of life of general injury populations. BMC Public Health 10: 783. doi: 10.1186/1471-2458-10-783
[64]
Cieza A, Oberhauser C, Bickenbach J, Chatterji S, Stucki G (2014) Towards a minimal generic set of domains of functioning and health. BMC Public Health 14: 218. doi: 10.1186/1471-2458-14-218
[65]
Van Beeck EF, Larsen CF, Lyons RA, Meerding WJ, Mulder S, et al. (2007) Guidelines for the conduction of follow-up studies measuring injury-related disability. J Trauma 62: 534–550. doi: 10.1097/ta.0b013e31802e70c7
[66]
Polinder S, Meerding WJ, Lyons RA, Haagsma JA, Toet H, et al. (2008) International variation in clinical injury incidence: exploring the performance of indicators based on health care, anatomical and outcome criteria. Accid Anal Prev 40: 182–191. doi: 10.1016/j.aap.2007.05.001
[67]
Valent F, Little DA, Bertollini R, Nemer LE, Barbone F, et al. (2004) Burden of disease attributable to selected environmental factors and injury among children and adolescents in Europe. The Lancet 363: 2032–2039. doi: 10.1016/s0140-6736(04)16452-0
[68]
Resnik LJ, Allen SM (2007) Using International Classification of Functioning, Disability and Health to understand challenges in community reintegration of injured veterans. Journal of Rehabilitation Research & Development 44: 991–1006. doi: 10.1682/jrrd.2007.05.0071
[69]
Krug EG, Sharma GK, Lozano R (2000) The global burden of injuries. Am J Public Health 90: 523–526. doi: 10.2105/ajph.90.4.523
[70]
Hobart JC, Cano SJ, Zajicek JP, Thompson AJ (2007) Rating scales as outcome measures for clinical trials in neurology: problems, solutions, and recommendations. Lancet Neurol 6: 1094–1105. doi: 10.1016/s1474-4422(07)70290-9
[71]
Stucki G, Ewert T, Cieza A (2002) Value and application of the ICF in rehabilitation medicine. Disabil Rehabil 24: 932–938. doi: 10.1080/09638280210148594
[72]
Turner-Stokes L (2008) Evidence for the effectiveness of multi-disciplinary rehabilitation following acquired brain injury: a synthesis of two systematic approaches. J Rehabil Med 40: 691–701. doi: 10.2340/16501977-0265
[73]
Khan F, Pallant JF (2007) Use of the International Classification of Functioning, Disability and Health (ICF) to identify preliminary comprehensive and brief core sets for multiple sclerosis. Disabil Rehabil 29: 205–213. doi: 10.1080/09638280600756141
[74]
Geyh S, Cieza A, Schouten J, Dickson H, Frommelt P, et al. (2004) ICF Core Sets for stroke. J Rehabil Med: 135–141. doi: 10.1080/16501960410016776
[75]
Bouillon B, Kreder HJ, Eypasch E, Holbrook TL, Mayou R, et al. (2002) Quality of life in patients with multiple injuries—basic issues, assessment, and recommendations. Restor Neurol Neurosci 20: 125–134.
[76]
Baker SP, O'Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14: 187–196. doi: 10.1097/00005373-197403000-00001
[77]
Copes WS, Champion HR, Sacco WJ, Lawnick MM, Gann DS, et al. (1990) Progress in characterizing anatomic injury. J Trauma 30: 1200–1207. doi: 10.1097/00005373-199010000-00003
