Longer-term quality of life following major trauma: age only significantly affects outcome after the age of 80 years
Received 28 November 2017
Accepted for publication 1 March 2018
Published 30 April 2018 Volume 2018:13 Pages 773—785
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Justinn Cochran
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
Thomas Gross,1 Sabrina Morell,1 Felix Amsler2
1Trauma Unit, Department of Surgery, Kantonsspital Aarau, Aarau, Switzerland; 2Amsler Consulting, Basel, Switzerland
Aim: Against the background of conflicting data on the topic, this study aimed to determine the differences in longer-term patient outcomes following major trauma with regard to age.
Materials and methods: A prospective trauma center survey of survivors of trauma (≥16 years) was carried out employing a New Injury Severity Score (NISS) ≥8 to investigate the influence of age on working capacity and several outcome scores, such as the trauma medical outcomes study Short Form-36 (physical component [PCS] and mental component [MCS]), the Euro Quality of Life (EuroQoL), or the Trauma Outcome Profile (TOP) at least 1 year following injury. Chi square tests, t-tests, and Pearson correlations were used as univariate; stepwise regression as multivariate analysis. Significance was set at p<0.05.
Results: In all, 718 major trauma patients (53.4±19.4 years; NISS 18.4±9.2) participated in the study. Multivariate analysis showed only low associations of patient or trauma characteristics with longer-term outcome scores, highest for the Injury Severity Score of the extremities with the PCS (R2=0.08) or the working capacity of employed patients (n=383; R2=0.04). For age, overall associations were even lower (best with the PCS, R2=0.04) or could not be revealed at all (TOP or MCS). Subgroup analysis with regard to decennia revealed the age effect to be mainly attributable to patients aged ≥80, who presented with a significantly worse outcome compared to younger people in all overall and physical component scores ( p<0.001). In patients under 80 years an association of age was only found for EuroQoL (R2=0.01) and the PCS (R2=0.03).
Conclusion: Given the small impact of age on the longer-term outcomes of major trauma patients, at least up to the age of 80 years, resuscitation as well as rehabilitation strategies should be adapted accordingly.
Keywords: major trauma, longer term, outcome, quality of life, working capacity, age
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