A PROSPECTIVE-STUDY OF PREDICTORS OR DISABILITY AT 3 MONTHS AFTER NONCENTRAL NERVOUS-SYSTEM TRAUMA

Objective: To delineate which injury-related, demographic, and psychos ocial variables were predictive of severe disability (limitations in t he performance of socially defined roles and tasks) at 3 months after discharge from acute hospitalization for non-central nervous system tr aumatic injury. Patients and Methods: The study design was prospective , longitudinal, and correlational. The sample consisted of 109 injured patients at three urban trauma centers. Data were obtained from patie nt interview using the Sickness Impact Profile, the Impact of Event Sc ale, and the Social Support Questionnaire; injury-related data were ob tained from the medical record and computerized trauma registries. Res ults: The sample had a mean age of 37.4 +/- 16.8 years, a mean number of injuries per person of 4.4 +/- 2.8, and a mean Injury Severity Scor e of 15.5 +/- 9.9. Motor vehicle crashes (34.9%) and violent injuries (33%) were the predominant causes of injuries. Patients experienced se vere levels of disability (Sickness Impact Profile, mean = 26.1) and m oderate levels of psychological distress (Impact of Event Scale, mean = 30.6; intrusion mean = 14.6 and avoidance mean = 16.0). Three variab les were predictive of severe disability at 3 months: high levels of i ntrusive thoughts (odds ratio, 2.9; 95% confidence interval, 1.1-7.7); injury with a maximal Abbreviated Injury Scale score in an extremity (odds ratio, 2.9; 95% confidence interval, 1.2-6.9); and having not gr aduated from high school (odds ratio, 3.4; 95% confidence interval, 1. 2-10). Conclusion: Extremity injuries, lack of high school graduation, and high level of posttraumatic psychological distress with intrusive thoughts are risk factors for severe disability at 3 months after dis charge from the hospital.