Evaluation of disability and handicap following injury

Abstract

Disability and handicap outcome measures are fundamental components of trauma system evaluation. These outcomes are described for survivors of major trauma, attended by the HEMS, London system. Together with measures of injury severity, three functional instruments (Functional Independence Measure (FIM), Glasgow Outcome Scale (GOS) and return to pre-injury work status (RTW)) were used to measure outcome in 201 trauma patients. By 12 months post injury 84.1% of cases were independent in Motor FIM, 88.1% in Cognitive FIM, 79.1% had good outcomes in GOS (grades 4 and 5) and 69.2% had returned to work. The functional measures showed a statistically significant relationship with minor and major and trauma (ISS < 16 and > or = 16): FIM (motor p < 0.002; cognitive p < 0.0003), GOS (p < 0.002) and RTW (p < 0.002). Division according to severity of principal injury confirmed the greatest disability and handicap resulted from the severest injuries (AIS 4-5): 68.9% achieved independence in Motor FIM, 73% in Cognitive FIM and only 40% returned to work. When grouped according to body region of principal injury, neurological injury, particularly severe injury (AIS 4-5) to head and spinal cord regions showed the poorest outcomes. FIM, GOS and RTW are recommended as standard indicators of disability and handicap for trauma registries and outcome studies.