Quality of Life in Multiply Injured Patients

Abstract

Background:

Health-related Quality of Life (QoL) has gained increased attention in medicine but a specific QoL instrument for trauma patients does not yet exist. Following the recommendations of a recent international consensus conference, the Polytrauma Outcome (POLO) Chart, a modular (generic plus disease-specific) instrument was developed for systematic outcome assessment of multiply injured patients as part of the German Trauma Registry. The development of the disease- specific module, the Trauma Outcome Profile (TOP), is described.

Methods:

Phase I—item collection, including a pilot study; phase II—item reduction; phase III—pre-testing in 70 polytraumatized patients and 70 controls with minor injuries. The instrument covers the four domains of QoL: physical, psychological, social, and functional capacity. Factor analysis and inter-item correlation was used to investigate relationships between items.

Results:

The initial phase generated 175 questions. In phase II the number of items was reduced to 64 by statistical analysis and clinical experts. Pre-testing with factor analysis generated a final instrument with eight dimensions: depression, anxiousness, post-traumatic stress disorder, social interactions, daily activities, mental functioning, pain and physical functioning. Two questions on body image and satisfaction were added. The TOP is currently being validated (phase IV).

Conclusions:

Together with the Glasgow Outcome Scale (GOS), the EuroQoL, and the SF-36, the TOP module is part of the POLO-Chart. It is the first disease-specific instrument for QoL assessment in patients with multiple injuries. The extended development process has enabled all relevant aspects of a patient’s status after trauma to be considered. This instrument will be used by the German Trauma Registry for systematic follow-up investigations. The TOP can also be used as a standardized stand-alone screening measurement in followup investigations for individual trauma patients.