Outcome Evaluation in Trauma Patients

Abstract

Dramatic improvements in injury prevention, prehospital and hospital care have led to decreased mortality rates from traumatic injury. Despite decreased mortality rates, trauma contributes significantly as well as increasingly to the world’s burden of disease. As a result, there is growing interest in the non-fatal injury burden, such as post-injury disability, functionality, and health-related quality of life. Traumatic injury carries the potential to result in longstanding adverse effects on patient’s health-related quality of life, functionality, return to daily activities, and return to work. Injuries that seem innocuous in comparison to life-threatening injuries, such as injuries to the hand, wrist, foot, and ankle, may be important determinants of long-term quality of life and disability. Capturing these long-term outcomes regarding the patients’ perspectives, outcomes that truly matter to patients, can be achieved by the use of patient-reported outcome measures (PROMs). To date, knowledge on patient-reported outcomes after traumatic injury is sparse. In this thesis, outcomes after a variety of traumatic injuries as well as characteristics associated with these outcomes are presented. It is shown that without taking into account injury mechanism, concomitant injuries, and general functioning, and by focusing on the available PROMs alone, outcome evaluation in trauma patients is inadequate. When the shift towards the use of PROMs as outcome measures and value-based healthcare is going to be continued, efforts towards a better understanding of outcome evaluation in the typically heterogeneous and challenging trauma population should be made. Results of this thesis may be used for guidance.