Factors Associated with Reduced Longer-Term Capacity to Work in Patients after Polytrauma: A Swiss Trauma Center Experience

• Published in: Journal of the American College of Surgeons Vol. 211; no. 1; pp. 81 - 91
• Main Authors: Gross, Thomas, MD, Attenberger, Corinna, MD, Huegli, Rolf W., MD, Amsler, Felix, MSc
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2010; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Biological and medical sciences; Chi-Square Distribution; Disability Evaluation; Educational Status; Female; General aspects; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Multiple Trauma; Prospective Studies; Quality of Life; Recovery of Function; Surgery; Surveys and Questionnaires; Switzerland; Time Factors; Trauma Centers; Trauma Severity Indices; Traumas. Diseases due to physical agents; Work; Switzerland; Europe; Nottingham Health Profile; Abbreviated Injury Severity scale; EQ-5D; Trauma and Injury Severity Score; OR; Euro Quality of Life Group health-related quality of life on five dimensions; RCW; ISS; nonreduced capacity to work; AIS; odds ratio; medical outcomes study Short Form-36; TRISS; Injury Severity Score; SF-36; Glasgow Coma Scale; GCS; EQ VAS; NHP; reduced capacity to work; NRCW; Euro Quality of Life Group Visual Analogue Scale; Human; Medicine; Center; Reduction; Treatment; Surgery; Cause; Work; Patient; Long term; Multiple injury; Trauma
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2010.02.042

Background Knowledge of the factors associated with longer-term reduced capacity to work (RCW) is lacking in patients after polytrauma. Study Design We studied a prospectively collected cohort of polytrauma survivors (n = 115; age 39.5 ± 20.6 years [mean ± SD]; 98% blunt trauma; Injury Severity Score [ISS] 27.5 ± 8.2) at a university trauma center. Uni- and multivariable analyses of patient, trauma, and treatment characteristics as well as parameters of self-reported functional outcomes were studied to determine their association with a reduced capacity to work (RCW) at least 2 years after injury. Results Postinjury quality of life was worse compared with preinjury status in univariate analysis (eg, Euro Quality of Life Group Visual Analogue Scale [EQ VAS] 66.2 ± 24.4 vs 89.7 ± 14.7; p = <0.001). In 53% of patients (n = 61), an RCW was found and functional outcomes were significantly lower than those in non-RCW patients (p < 0.001). Lower educational status (odds ratio [OR] 0.25; 95% CI 0.07 to 0.92; p = 0.036), higher ISS (OR 1.12; 95% CI 1.02 to 1.22; p = 0.017), less time in the emergency room (OR 0.92; 95% CI 0.86 to 0.97; p = 0.005), higher mean nurse labor per day and patient (OR 1.01; 95% CI 1.000 to 1.004; p = 0.033), and a reduced Nottingham Health Profile value (OR 1.10; 95% CI 1.06 to 1.15; p < 0.001) were associated with an RCW in the multiple logistic regression model (proportion of variance explained: 0.74). Conclusions In this cohort of patients surviving polytrauma, approximately 50% of patients sustained longer-term RCW. Several characteristics, such as level of education or trauma severity, showed an independent association with patients' capacity to work, which was significantly associated with patients' self-rated scorings of well-being.