Early Predictors of Functional Outcome After Trauma

Abstract

Background: Despite the availability of routinely collected trauma data, researchers who investigate rehabilitation outcomes, functional evaluation, and comparative effectiveness have not incorporated this potentially clinically meaningful information in their modeling as predictors or adjustors.

Objective: The purpose of this study was to identify variables from the scene of a traumatic accident and from the emergency department that can be used in assessing functional outcomes of persons who survive trauma.

Design: Prospective study.

Setting: Level I academic trauma center.

Patients: Persons who sustained and survived a spinal cord injury, a traumatic brain injury, or polytrauma.

Methods: Trauma and rehabilitation registries were merged by matching the 2 data files for each patient by medical record number, and the files were verified by gender and date of birth. Analysis consisted of standard descriptive statistics (frequencies and averages). A 2-staged linear regression was used to investigate the relationship between the demographic, scene, and ED data elements and discharge functional outcome.

Main outcome measure: Discharge Functional Independence Measure (FIM).

Results: Older patients with government insurance had poorer discharge FIM scores compared with patients who had commercial insurance. The Injury Severity Score (ISS) and Glasgow Coma Scale score from the scene of the accident were significantly associated with the discharge FIM. Persons with a lower ISS had significantly higher discharge FIM scores than did persons with a higher ISS (P < .001). For every unit change in Glasgow Coma Scale score, FIM scores increased by 0.488 points (P = .030).

Conclusion: The use of routinely collected trauma data elements can be useful in assessing the continuum of patient care. Incorporating trauma data into research has the potential to improve our models of functional outcomes and provide meaningful risk adjustors when comparing and evaluating rehabilitation care systems and treatments.