Department of Research and Development, Division of Critical Care, Oslo University Hospital, Ulleval Hospital, PO Box 4956, Nydalen, NO-0424 Oslo, Norway. kirsti.toien@uus.no
Trauma patients have impaired health-related quality of life (HRQOL) after trauma. The aim of the study was to assess HRQOL during the first year after trauma and hospital stay in trauma patients admitted to an intensive-care unit (ICU) for >24 hours compared with non-ICU trauma patients and the general population, and to identify predictors of HRQOL.
A prospective one-year follow-up study of 242 trauma patients received by the trauma team of a trauma referral centre in Norway was performed. HRQOL was measured using the Medical Outcomes Study Short Form 36 (SF-36) at 3 and 12 months.
The mean age of the cohort was 42.3 years (95% CI, 40.4-44.3 years). The median Injury Severity Score (ISS) was 10, interquartile range 16. The HRQOL improved significantly from the 3 to the 12 months follow up in the trauma patients. However their scores were significantly lower for most subscales of SF-36 compared to the general population. Significant differences between ICU and non-ICU patients at 12 months were observed only for physical functioning and role physical subscales. Optimism was an independent predictor of good HRQOL at 12 months, in all dimensions (beta, 0.95-2.45). A higher depression score at baseline predicted lower HRQOL in four of eight dimensions (beta -1.1 to -1.70). In addition, better physical functioning was predicted by lower age (beta, -0.20), and having head injury (reference) as the most severe injury vs. spine or extremity injuries (beta, -9.49 and -10.85), and better mental health by higher age (beta, 0.21) and being employed or studying before the trauma (beta, 12.27). In addition to optimism good general health was predicted by lower score for post-traumatic stress (PTS) symptoms at baseline (beta, -0.27) and lower ISS score (beta -10.59).
The HRQOL improved significantly from the 3 to the 12 months follow up in our sample. However their scores were significantly lower for most subscales of SF-36 compared to the general population. Significant differences between ICU and non-ICU patients were observed for only two subscales. Better HRQOL at 12 months was predicted mainly by optimism, low score for depression and PTS symptoms at baseline. High ISS predicted low general health exclusively.
To study the level and predictors of posttraumatic stress, anxiety and depression symptoms in medical, surgical and trauma patients during the first year post intensive care unit (ICU) discharge.
Of 255 patients included, 194 participated at 12 months. Patients completed the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS), Life Orientation Test (LOT) at 4 to 6 weeks, 3 and 12 months and ICU memory tool at the first assessment (baseline). Case level for posttraumatic stress symptoms with high probability of a posttraumatic stress disorder (PTSD) was > or = 35. Case level of HADS-Anxiety or Depression was > or = 11. Memory of pain during ICU stay was measured at baseline on a five-point Likert-scale (0-low to 4-high). Patient demographics and clinical variables were controlled for in logistic regression analyses.
Mean IES score one year after ICU treatment was 22.5 (95%CI 20.0 to 25.1) and 27% (48/180) were above case level, IES > or = 35. No significant differences in the IES mean scores across the three time points were found (P = 0.388). In a subgroup, 27/170 (16%), patients IES score increased from 11 to 32, P
The aim of the study was to investigate the proportion of patients who return to work and predictors of return to pre-injury level of work participation the first year after trauma.
A prospective single-centre study of 188 patients aged 18-65 years with different degrees of injury severity was carried out in a trauma referral centre. All patients were working or studying full or part time before the injury. The first assessments were performed a median time of 27 days after discharge. Participation in work/education was measured 3 and 12 months after the first assessment with self-report questionnaires. The Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale (IES) were independent measures of anxiety, depression and post-traumatic stress symptoms (PTS) at baseline and 3 months. The Life Orientation Test Revised (LOT-R) measured optimism and pessimism at baseline. Predictors of return to work were identified by multiple logistic regression analysis.
After one year, 131 patients (70%) had returned to the same level of participation in work or education; 95 (50%) had returned at 3 months. Independent predictors of return to work after 3 months were low age, low Injury Severity Score (ISS) score, not needing ventilator treatment and low score for depression symptoms, adjusted for gender (Nagelkerke R square 0.38). Low ISS, absence of serious head injury, low HADS depression score and an optimistic life orientation remained significant predictors of return to work at the same level after 12 months (Nagelkerke R square 0.38). In addition, good physical function (SF-36 PF score>65) at 3 months was an independent predictor of return to work at 12 months in the 93 patients who had not returned to work at 3 months.
Independent predictors of return to work at 3 months were low age, low ISS and absence of depression symptoms. At 12 months, independent predictors of return to work were low ISS, low depression score and an optimistic life orientation. To promote early return to work, trauma patients might be screened for depression symptoms and pessimism, and intervention or treatment provided for those in need.
Acute physical injury may lead to psychological distress. The relationship between peritraumatic responses, injury severity, the personality trait of optimism/pessimism and psychological distress is not fully understood. In addition, the development of post-traumatic stress symptoms may differ in subgroups.
One hundred and eighty-one patients (18-65 years) completed questionnaires 1 (baseline), 3 and 12 months after first admission for acute physical injury. All patients were conscious on arrival. Scores on the Casualty Chain Inventory (CCI) for peritraumatic responses, the Impact of Event Scale (IES), the Hospital Anxiety and Depression Scale (HADS), the Life Orientation Test-Revised (LOT-R), trauma-related variables (ISS, Abbreviated Injury Scale [AIS], Glasgow Coma Scale [GCS]), and background variables were assessed.
Mean IES scores were 21.5 (95% CI: 19.0-24.0) at baseline and 15.8 (13.5-18.1) at 12 months (p
From the Intensive Care Unit (K.T., H.M.) and Department of Nursing Research (K.T.), Oslo University Hospital, Ulleval, Oslo, Norway; Institute of Nursing Science (K.T., I.S.B.), Faculty of Medicine, University of Oslo, Ulleval, Oslo, Norway; Unit of Breast and Endocrine surgery (I.S.B.), Oslo University Hospital, Ulleval, Oslo, Norway; Emergency Department and Department of Nursing Research (L.S.), Oslo University Hospital, Ulleval, Oslo, Norway; Section of Epidemiology and Biostatistics (L.S.), Oslo University Hospital, Ulleval, Oslo, Norway; Department of Acute Medicine (O.E.), Oslo University Hospital, Ulleval, Oslo, Norway; and Department of Behavioral Sciences in Medicine (O.E.), Faculty of Medicine, University of Oslo, Ulleval, Oslo, Norway.
BACKGROUND:: The aim of the study was to investigate the level of psychologic distress after trauma and intensive care unit (ICU) stay, memory from the ICU, and predictors for psychologic distress at 12 months. METHODS:: Prospective single center study in a trauma referral center for Eastern and Southern Norway. Participants were 150 trauma patients treated in an ICU for >24 hours. Assessments were performed after discharge, at 3 months, and at 12 months using the Impact of Event Scale, Hospital Anxiety and Depression Scale, ICU memory tool, and Life Orientation Test-Revised. RESULTS:: At baseline, the mean Impact of Event scores were 22.7 decreasing to 18.4 at 12 months (p = 0.039). At 1-year follow-up, mean anxiety scores were 5.5 (95% confidence interval [CI]: 4.6-6.4) and depression scores 3.8 (95% CI: 3.1-4.5). Factual memories from ICU (odds ratio [OR] 6.58, [95% CI: 2.01-21.52], p = 0.002), low educational level (OR 0.29, [95% CI: 0.10-0.86] p = 0.025), not having care of children (OR 0.14, [95% CI: 0.04-0.47] p = 0.002), and female gender (OR 2.95, [95% CI: 1.04-8.34] p = 0.042) predicted posttraumatic stress symptoms at 12 months. Anxiety at 12 months was predicted only by pessimism (OR 0.83, [95% CI: 0.75-0.93] p = 0.001). Depression at 12 months was predicted by being out of work before the injury (OR 3.64, [95% CI: 1.11-11.94] p = 0.033) and pessimism (OR 0.83, [95% CI: 0.73-0.93] p = 0.002). CONCLUSIONS:: Many patients suffer from posttraumatic stress symptoms, anxiety, and depression after trauma and ICU stay. The strongest predictors of psychologic distress 12 months after discharge were having factual memories from the ICU stay, being pessimistic, and being out of work before the injury.
