Analysis of quality of life in polytraumatized patients two years after discharge from an intensive care unit

Abstract

Objective: Analysis of quality of life of polytraumatized critical care patients.

Design: Prospective study.

Material and methods: Patients admitted in a 2-year period in a traumatologic intensive care unit (ICU) were evaluated. A quality of life questionnaire was completed on admission (N = 351), 1 year and 2 years after discharge from the ICU. The three questionnaires evaluated patients' ability to function and communicate over the previous 2 months. A quality of life score of 0 corresponded to no limitations. Quality of life was also evaluated by the Glasgow Outcome Scale. Information was collected on the severity of illness and the diagnosis prompting ICU admission.

Results: The mean quality of life score of survivors worsened from 0.46 +/- 0.11 points on ICU admission to 6.68 +/- 0.41 1 year after discharge, and then improved to 4.86 +/- 0.38 2 years after discharge, although the quality of life score continued to be worse than on admission (p < 0.001). On admission, 93.2% of patients had normal quality of life (0 points), after 1 year 36.5% were normal, and after 2 years 51.6% were normal. Three patients (0.9%) remained in vegetative state. On admission, 96.6% were working, while after 2 years, only 57.5% had returned to employment, although the high levels of unemployment in our country during this study may have been a particular factor in this result. All age groups except pediatric patients showed a worsened quality of life after 2 years, and patients over 60 years had worst scores on admission and after 1 and 2 years. Patients with least severity by Acute Physiology and Chronic Health Evaluation (APACHE) II score (< 10 points) had a better quality of life score after 1 and 2 years. Severity by Injury Severity Score showed patients with > 25 points having the greatest deterioration in quality of life. A multivariate study showed that quality of life after 2 years is influenced by age, severity of injury, and previous quality of life.

Conclusions: Polytraumatized patients admitted into ICU showed a worsening of their quality of life 1 and 2 years after ICU discharge, with an improvement between 1 and 2 years. Quality of life after 2 years is influenced by age, severity of illness, and previous quality of life.