Long-Term Multidimensional Functional Consequences of Severe Multiple Injuries Two Years After Trauma: A Prospective Longitudinal Cohort Study

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Abstract
The assessment of outcome after multiple injuries in a rehabilitation perspective is increasingly important in trauma research. The purpose of this study was to assess functioning and quality of life after severe injuries using a prospective cohort design. One hundred and five patients with a New Injury Severity Score >15, aged 18 to 67 years, and admitted to a Level I trauma center were included consecutively starting January 2002 through June 2003. Outcomes were assessed 6 weeks after discharge and 1 and 2 years after injury. Self-reported functioning and quality of life was measured by Short Form (SF)-36, World Health Organization Disability Assessment Schedule II (WHODAS II) and a cognitive function scale (COG). Mean age was 35.3 years (standard deviation [SD], 14.0), 83% were male. Mean New Injury Severity Score was 34.6 (SD, 12.6). Disease burden measured by SF-36 showed scores below the general population. Effect sizes showed that the largest difference was for physical functioning, social functioning, and physical and emotional role functioning. The WHODAS II disability score showed substantially worse functioning compared with general population data. Profession, injury severity, pain, and physical, cognitive, and social functioning made independent contributions to WHODAS II 2 years after injury and explained 69% of the variance of the model. Long-lasting functional problems after multiple injuries affect most life domains. Knowledge about the reduced physical, mental, cognitive, social, and role functioning should impact the rehabilitation services provided for severely injured patients, from primary care to community rehabilitation.