Trajectory of functional outcome and health status after moderate-to-major trauma in Hong Kong: A prospective 5 year cohort study

Background Trauma care systems in Asia have been developing in recent years, but there has been little long-term outcome data from injured survivors. This study aims to evaluate the trajectory of functional outcome and health status up to five years after moderate to major trauma in Hong Kong. Methods We report the five year follow up results of a multicentre, prospective cohort from the trauma registries of three regional trauma centres in Hong Kong. The original cohort recruited 400 adult trauma patients with ISS ≥ 9. Telephone follow up was conducted longitudinally at seven time points, and the extended Glasgow Outcome Scale (GOSE) and Short-Form 36 (SF36) were tracked. Results 119 out of 309 surviving patients (39%) completed follow up after 5 years. The trajectory of GOSE, PCS and MCS showed gradual improvements over the seven time points. 56/119 (47.1%) patients reported a GOSE = 8 (upper good recovery), and the mean PCS and MCS was 47.8 (95% CI 45.8, 49.9) and 55.8 (95% CI 54.1, 57.5) respectively at five years. Univariate logistic regression showed change in PCS - baseline to 1 year and 1 year to 2 years, and change in MCS - baseline to 1 year were associated with GOSE = 8 at 5 years. Linear mixed effects model showed differences in PCS and MCS were greatest between 1-month and 6-month follow up. Conclusions After injury, the most rapid improvement in PCS and MCS occurred in the first six to 12 months, but further recovery was still evident for MCS in patients aged under 65 years for up to five years

Protection from traumatic brain injury in hormonally active women vs men of a similar age: A retrospective international study

BACKGROUND: It has been suggested that women with traumatic brain injury have more favorable outcomes than do men because of higher levels of circulating estrogen and progesterone that may reduce brain edema. OBJECTIVES: To determine whether there is any association between sex and mortality in TBI patients and whether there is any association between sex and brain edema. DESIGN: Retrospective cohort study using data from 2001 to 2007 collected from a trauma registry in Hong Kong and the Victorian State Trauma Registry. SETTING: Two regional trauma centers in Hong Kong and 2 adult major trauma centers and 1 pediatric trauma center in Victoria, Australia. MAIN OUTCOME MEASURES: Mortality and brain edema. PATIENTS: Trauma patients with an Abbreviated Injury Scale score (head) of at least 3 who were aged 12 to 45 years were included. Patients with minor head injury and undisplaced closed skull fracture were excluded. RESULTS: Both the Hong Kong and Victorian data showed no significant difference in sex-related mortality. Increased mortality was associated with decreased systolic blood pressure and Glasgow Coma Scale score and with increased New Injury Severity Score or Injury Severity Score. In Hong Kong, brain edema was associated with female sex (P = .02), and the odds of brain edema in females were greater than for males. However, this association was not found in Victorian patients. CONCLUSION: This study found no significant association between sex and mortality in either Victoria or Hong Kong and does not support the concept that females have better outcomes after traumatic brain injury

Assessment of quality of life and functional outcome in patients sustaining moderate and major trauma: A multicentre, prospective cohort study

Trauma care systems aim to reduce both death and disability, yet there is little data on post-trauma health status and functional outcome. Objectives To evaluate baseline, discharge, six month and 12 month post-trauma quality of life, functional outcome and predictors of quality of life in Hong Kong. Methods Multicentre, prospective cohort study using data from the trauma registries of three regional trauma centres in Hong Kong. Trauma patients with an ISS ≥ 9 and aged ≥ 18 years were included. The main outcome measures were the physical component summary (PCS) score and mental component summary (MCS) scores of the Short-Form 36 (SF36) for health status, and the extended Glasgow Outcome Scale (GOSE) for functional outcome. Results Between 1 January 2010 and 31 September 2010, 400 patients (mean age 53.3 years; range 18–106; 69.5% male) were recruited to the study. There were no statistically significant differences in baseline characteristics between responders (N = 177) and surviving non-responders (N = 163). However, there were significant differences between these groups and the group of patients who died (N = 60). Only 16/400 (4%) cases reported a GOSE ≥ 7. 62/400 (15.5%) responders reached the HK population norm for PCS. 125/400 (31%) responders reached the HK population norm for MCS. If non-responders had similar outcomes to responders, then the percentages for GOSE ≥ 7 would rise from 4% to 8%, for PCS from 15.5% to 30%, and for MCS from 31% to 60%. Univariate analysis showed that 12-month poor quality of life was significantly associated with age > 65 years (OR 4.77), male gender (OR 0.44), pre-injury health problems (OR 2.30), admission to ICU (OR 2.15), ISS score 26–40 (OR 3.72), baseline PCS (OR 0.89), one-month PCS (OR 0.89), one-month MCS (OR 0.97), 6-month PCS (OR 0.76) and 6-month MCS (OR 0.97). Conclusion For patients sustaining moderate or major trauma in Hong Kong at 12 months after injury < 1 in 10 patients had an excellent recovery, ≤3 in 10 reached a physical health status score ≥ Hong Kong norm, although as many as 6 in 10 patients had a mental health status score which is ≥ Hong Kong norm