Fleischhacker Evi, Trentzsch Heiko, Kuppinger David, Meigel Franziska, Beyer Felix, Hartl Wolfgang H
Department of General, Trauma and Reconstructive Surgery with Integrated Fracture Liaison Service, University School of Medicine, Grosshadern Campus, Ludwig-Maximilian University, Munich, Germany.
Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, Ludwig-Maximilians-Universität Munich, Germany.
Injury. 2018 Feb;49(2):195-202. doi: 10.1016/j.injury.2017.10.020. Epub 2017 Oct 12.
Numerous studies have identified various risk factors for a poor health-related quality of life (HRQOL) after severe trauma. The relative importance of the time elapsed after injury, however, is unknown and results of clinical studies have been conflicting.
A cross-sectional study was performed in two trauma centres using data from the German TraumaRegister DGU, which contained prospectively collected information on the type and severity of the injury, on critical care, and on outcome. To evaluate HRQOL in patients surviving more than 500days after the injury, we used a self-rating instrument, the EQ-5D which contains a visual analogue scale (EQ-VAS), and which allows the calculation of a global outcome indicator, the EQ-D5 index value. Complex statistical models were used to evaluate independent associations between the time elapsed after injury and a poor HRQOL.
Of 380 contacted patients, follow-up assessments could be obtained in 168 patients (44.2%) 3.6±1.6 (SD) years after the injury. There was a linear association between the time elapsed after the injury and the% of contacted patients not participating in the study (p=0.013). In participating subjects, average EQ-5D index value was 0.599±0.299, and average EQ-VAS rating 67.8±22.0. A very poor quality of life (EQ-5D index value<0.6, EQ-VAS rating≤50) could be found in 43.5% and 28.0% of the patients, respectively. After adjusting for multiple confounders, the number of days elapsed after injury showed a complex non-linear and independent association with a poor HRQOL (low EQ-5D index value: p=0.027; low EQ-VAS rating: p=0.008). Frequencies of a poor HRQOL reached their minimum about four to five years after the injury and increased thereafter.
There is an independent, U-shaped association between the frequency of extreme values of HRQOL and the time elapsed after injury. Time patterns of HRQOL may be sensitive to increasing rates of attrition since patients with a good outcome are less likely to respond to questionnaires. Time from injury should be incorporated into all future cross sectional studies trying to identify predictors of HRQOL.
众多研究已确定了严重创伤后健康相关生活质量（HRQOL）较差的各种风险因素。然而，受伤后经过的时间的相对重要性尚不清楚，临床研究结果也相互矛盾。
在两个创伤中心进行了一项横断面研究，使用来自德国创伤登记处DGU的数据，其中包含前瞻性收集的有关损伤类型和严重程度、重症监护和结局的信息。为了评估受伤后存活超过500天的患者的HRQOL，我们使用了一种自评工具EQ-5D，它包含一个视觉模拟量表（EQ-VAS），并允许计算一个总体结局指标EQ-D5指数值。使用复杂的统计模型来评估受伤后经过的时间与较差的HRQOL之间的独立关联。
在380名联系的患者中，受伤后3.6±1.6（标准差）年，168名患者（44.2%）获得了随访评估。受伤后经过的时间与未参与研究的联系患者的百分比之间存在线性关联（p=0.013）。在参与研究的受试者中，平均EQ-5D指数值为0.599±0.299，平均EQ-VAS评分为67.8±22.0。分别有43.5%和28.0%的患者生活质量非常差（EQ-5D指数值<0.6，EQ-VAS评分≤50）。在调整了多个混杂因素后，受伤后经过的天数与较差的HRQOL（低EQ-5D指数值：p=0.027；低EQ-VAS评分：p=0.008）呈现复杂的非线性独立关联。HRQOL较差的频率在受伤后约四到五年达到最低，此后增加。
HRQOL极值频率与受伤后经过的时间之间存在独立的U型关联。由于预后良好的患者对问卷调查的反应可能性较小，HRQOL的时间模式可能对失访率的增加敏感。受伤时间应纳入所有未来试图确定HRQOL预测因素的横断面研究中。
