THE SICKNESS IMPACT PROFILE AS A TOOL TO EVALUATE FUNCTIONAL OUTCOME IN TRAUMA PATIENTS

Because the ultimate goal of trauma care is to restore injured patient s to their former functional status, reliable evaluation of functional status is needed to assess fully the effectiveness of trauma care. We hypothesized that the Sickness Impact Profile (SIP), a widely used me asure of general health status, would be a useful tool to evaluate the long-term functional outcome of trauma patients and that the SIP woul d identify unexpected problems in the recovery process and groups of p atients at high risk for long-term disability. A prospective cohort of 329 patients with lower extremity fractures admitted to three level I trauma centers were interviewed using SIP at 6 and 12 months postinju ry. Patients with major neurologic injuries were excluded. Overall SIP scores and each of the component subscores may range from 0 (no disab ility) to 100. In this series, the mean overall SIP was 9.5 at 6 month s and 6.8 at 12 months, compared with a preinjury baseline of 2.5. At 12 months, 52% of patients had no disability (SIP 0 to 3), 23% mild di sability (4 to 9), 16% moderate disability (10 to 19), and 9% severe d isability (greater than or equal to 20). Disability was widely distrib uted across the spectrum of activities of daily living, including phys ical functioning (mean score of 5.5), psychosocial health (mean score of 5.5), sleeping (mean score of 10.0), and work (mean score of 21.0). The SIP scores did not correlate with Injury Severity Score. Higher S IP scores were associated with multiple fractures, higher extremity Ab breviated Injury Scale (AIS), and head injuries (p < 0.05), even thoug h the head injuries in this series were minor (mean head AIS score of 2.1). In conclusion, SIP is a useful tool to evaluate overall function al outcome of trauma patients, Disability in psychosocial functioning was prominent even in this group of patients whose primary injury was a lower extremity fracture. Patients with even minor-associated head i njuries were identified as a group at especially high risk for prolong ed generalized disability.