The impact of major in-hospital complications on functional outcome and quality of life after trauma

Background: Little is known about the impact of major in-hospital complicat ions on functional outcome in the short-and long-term period after serious injury. The Trauma Recovery Project (TRP) is a large, prospective, epidemio logic study designed to examine multiple outcomes after major tramna. inclu ding quality of life and functional limitation. Patient outcomes were asses sed at discharge and at 6, 12, and 18 months after discharge. The specific objectives of the present report are to examine the effect of postinjury co mplications on functional outcomes at discharge and at 6-, 12-, and 18-mont h follow-up time points in the TRP population. Methods: Between December 1, 1993, and September 1, 1996, 1,048 eligible tr auma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enroll ment criteria for the study included age 18 Sears or older; admission Glasg ow Coma Scale score of 13 or greater; and length of stay greater than 24 ho urs. Quality of life was measured after injury using the Quality of Well-be ing (QWB) scale, a sensitive index to the well end of the functioning conti nuum (range, 0 [death] to 1.000 [optimum functioning]), Major in-hospital c omplications were assessed for 820 patients and were coded as pulmonary, ca rdiovascular, gastrointestinal, hepatic, hematologic, infections, renal, mu sculoskeletal, neuro-logic, and vascular, on the basis of standardized code s used in the Trauma registry. Results: Major in-hospital complications were present in 83 (10.1%) patient s. Discharge QWB scores were significantly lower in patients with major com plications (0.394 vs. 0.402, p < 0.05), QWB scores were also significantly lower at 6-month follow-up in patients,vith major complications (0.575 vs. 0.637, p < 0.0001), Types of major complications with significantly lower 6 -month follow-up QWB scores were pulmonary, gastrointestinal, infections, a nd musculoskeletal, Patients with major complications also had significantl y lower 12-month (0.626 vs. 0.674, p < 0.01) and 18-month (0.646 vs. 0.681, p < 0.05) follow-up QWB scores. Pulmonary major complications and infectio ns were associated with significantly lower QWB scores at 12-monthfollow-up . Conclusions: These results provide new evidence that major in-hospital comp lications may have an important impact on functional outcomes after major t rauma.