Health outcomes of adults 3 months after injury
Introduction
Injury represents one of the major contributors to the public health burden in Australia. According to the Australian Institute of Health and Welfare, 6.8% of all separations from public, private and psychiatric hospitals in Australia in the 2001/2002 financial year were due to injury (including poisonings).2 This burden remains similar to that reported several years earlier in relation to the 1999/2000 financial year.14 In terms of expenditure, health care costs related to injury and poisoning accounted for 8.2% of the total allocated health expenditure in Australia in 2001/2002.2 Despite this burden, there is limited literature on the long-term outcomes of injury, including health related quality of life (HRQoL).
HRQoL has a variety of descriptions, but generally it includes ‘the dimensions of physical functioning, social functioning, role functioning, mental health and general health perceptions’.40 These dimensions are effectively measured using the SF-36 instrument.8, 38 HRQoL represents one aspect of the broader concept of quality of life. The measurement of HRQoL provides a useful method of assessing the outcomes of health interventions. It can also assist health workers in the identification of key areas to target in planning and monitoring different treatment options.
Given that injury is a leading cause of preventable mortality and morbidity in Australia and the world and a major cost to the health system,3, 5, 25, 31 the lack of research in this field is surprising. There has been minimal research in Australia examining the HRQoL of adults following injury, however there has been two series of work from the USA, one in general trauma patients and one in specific subgroups of trauma patients. Holbrook et al. identified reduced function up to 18 months post-injury, with function being worse in women when compared to men.15, 16, 17, 18 Similarly, MacKenzie et al. identified poorer health across most dimensions measured by the SF-36 1 year post-head injury and poor functional outcomes up to 7 years post-severe lower limb trauma.22, 24
This study was consequently developed to determine the HRQoL of adults 3 months post-injury. These HRQoL scores were then compared to non-injured Australian adults of the same age to determine whether the reported HRQoL was similar to the general population, suggesting the impact of injury was experienced for less than 3 months, or whether HRQoL was lower than the general population, suggesting the impact of injury persisted beyond 3 months. This study is making the assumption that the injured population did not differ from the general population prior to their injury.
Section snippets
Materials and methods
A prospective cohort design was used to study people who were admitted to 1 of the 12 adult Queensland Trauma Registry (QTR) hospitals for the treatment of injury and who granted consent for follow-up post-discharge. The sample reported in this manuscript was limited to those people who met the following criteria:
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aged 14 years or older at the time of injury;
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coded in a category between S00 and S99 or T00 and T78 (injuries and poisonings) using the International Classification of Diseases,
Results
Initially 843 potential participants consented to be contacted regarding participation in the study (Fig. 1). Of the 843 consenting patients, 286 (33.9%) patients did not respond, while a further 58 (6.9%) questionnaires were returned as ‘unknown at that address’. Eleven potential participants were ineligible including seven patients who had died since hospital admission, one patient who had left the country, four patients who declined to participate and three patients who were unable to
Discussion
This study is one of the first in Australia using the short form 36 to assess the HRQoL of individuals hospitalised as a result of injury. The short form 36, a measure of adult health and well being that has been tested and standardised for Australian use, was chosen to obtain follow-up data from a cohort of adults admitted to 1 of the 12 Queensland Trauma Registry hospitals throughout the state. Results for the present study of HRQoL of adults following an injury, show support for the
Conclusions
In the majority of age groups the participants in this study reported lower HRQoL in the majority of subscales measured on the SF-36 approximately 3 months post-injury. The lowest scores, when compared to Australian norms, were reported in the physical, rather than psychosocial subscales. People who were injured and were admitted to hospital for less than 24 h reported similarly reduced scores on the SF-36 when compared with Australian norms.
It is evident that significant reductions in HRQoL are
Conflict of interest
There are no conflicts of interest by any authors in relation to this article.
Acknowledgements
The authors wish to thank Ms. Joan Hendrikz for her assistance with statistical analysis during the preparation of this manuscript. The authors also wish to thank the Motor Accident Insurance Commission (Qld) for the funding provided to support this research as a component of the Queensland Trauma Plan Project.
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