The capacity of baseline patient, injury, treatment and outcome data to predict reduced capacity to work and accident insurer costs - a Swiss prospective 4-year longitudinal trauma centre evaluation

• Published in: Swiss medical weekly Vol. 149; no. 5152; p. w20144
• Main Authors: Gross, Thomas, Morell, Sabrina, Scholz, Stefan M, Amsler, Felix
• Format: Journal Article
• Language: English
• Published: Switzerland SMW supporting association (Trägerverein Swiss Medical Weekly SMW) 16.12.2019
• Subjects: cost data; health; insurance; outcome; Suva; trauma
• ISSN: 1424-3997; 1424-3997
• DOI: 10.4414/smw.2019.20144

Given the lack of information on the relation between baseline patient, injury and treatment data and longer-term outcomes for survivors of significant trauma, the objective of this evaluation was to examine the degree to which these characteristics might predict working constraints and expenses. 1183 significantly injured patients (New Injury Severity Score >8) of working age were treated at a Swiss trauma centre. Only patients insured by the largest national accident insurer, Suva, were included. Their sociodemographic, trauma, treatment and early clinical status data were evaluated against insurance variables for 4 years post-injury (uni- and multivariate analysis, R2). 346 out of 363 surviving Suva-insured patients were eligible for analysis, constituting a 95% complete 4-year longitudinal follow-up. Overall, 121 (35%) presented with a reduced capacity to work (RCW) 1 to 4 years after the trauma. Patients experienced a mean percentage RCW (PRCW) of 27% 1 year after injury and of 14% at 4 years. In multivariate analysis all investigated parameters together explained 40% of the adjusted variance of patients' mean PRCW over the 4-year surveillance period, with the highest association found for the block of injury-related variables (17%). Sixty percent of variance was explained for total insurance costs, found to be on average CHF 417,000 per case in patients with a RCW compared with CHF 47,000 per case without RCW (p <0.001). Four years after significant injury, every fifth patient presented with resultant RCW; half of these remained totally incapable of work. Investigated baseline parameters predicted about 40% of the variance regarding RCW. Future studies are needed to better explain and potentially minimise longer-term incapacity to work following injury. (Trial registration no. NCT02165137).