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 anonymous peer review
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
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]