A new global health outcome score after trauma (GHOST) for disability, cognitive impairment, and health-related quality of life: data from a prospective cross-sectional observational study

ABSTRACT

Background:Trauma patients experience morbidity related to disability and cognitive impairment that negatively impact their health-related quality of life (HRQoL). We assessed the impact of trauma on disability, cognitive impairment and HRQoL after intensive care in patients with and without traumatic brain injury (TBI) and created a predictive score to identify patients with worse outcome.

Methods:We identified 262 patients with severe trauma (ISS>15) admitted to the emergency room of a level 1 trauma center. Patients above 13 years were included. After 6 months, patients were assessed for disability, cognitive impairment, and HRQoL. A global health outcome score after trauma (GHOST) was obtained through the combination of these domains. Logistic regression analysis was considered for the effect of demographic, trauma and hospital factors on global outcome. p > 0.05. Statistics performed with SPSS 23.0.

Results:Patients with the worst outcomes were older and had a longer length of Intensive Care Unit (ICU) stay. The effect of gender was found in all “GHOST dimensions”. TBI was not significantly associated with worse outcome.

Conclusions:No significant differences were seen on disability, cognitive impairment and decreased HRQoL in patients with or without TBI. Our GHOST score showed that female gender, older age, and longer ICU stay were significantly associated with the worst outcome.

Abbreviations: AIS: Abbreviated Injury Scale; EQ-5D: EuroQol 5-dimensions; EQ-5D-3L: EuroQol 5-dimensions 3-levels; GCS: Glasgow Coma Scale; GOSE: Glasgow Outcome Scale Extended; HRQoL: Health-Related Quality of Life; ICU: Intensive Care Unit; ISS: Injury Severity Score; MMS: Mini Mental State; NICE: National Institute for Health and Care Excellence; RTS: Revised Trauma Score; TBI: Traumatic brain injury; TRISS: Trauma Injury Severity Score; VAS: Visual Analogue Scale

KEYWORDS:

• EQ-5D
• GOSE
• MMS
• cognitive dysfunction
• TBI
• follow-up

Key message

Disability, mild or severe cognitive impairment, and decreased HRQoL are all highly prevalent in trauma survivors. Female sex, older age and longer ICU length of stay, even when adjusted for trauma and other hospital variables, are significantly associated with worse outcome. A new Global Health Outcome Score after Trauma (GHOST), obtained through the combination of GOSE, MMS, and EQ-5D-3L, may enable clinicians to identify patients who independently show worse outcome after severe trauma.

Declarations

The authors report that they have no conflict of interest.

Clinical Trials Registry

ISRCTN42639959

Ethics approval and consent to participate

The institutional review board (Comissao de Etica para a Saude-CES) of the Hospital Geral de Santo Antonio approved the study on the 26^th of March 2006 (08/CES/06).

Consent

Written informed consent was obtained from all patients. Patients also acknowledged that they cannot be identified via the paper and that they have been fully anonymized.

Health and Safety

Not applicable

Availability of data and material

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Authors’ contributions

JBE designed the study, interpreted results and drafted the manuscript. CG designed the study, interpreted results, and drafted the manuscript. HG performed data analyses and drafted the manuscript. CCD performed data analyses. IA designed the study and interpreted the results. ACP designed the study, interpreted results and provided a critical revision of the article. LO designed the study, interpreted results and drafted the manuscript. All authors have read and approved the final manuscript.

Additional information

Funding

This work was supported by the Fundacao para a Ciencia e Tecnologia [PIC/IC/83120/2007].