Functional recovery at a minimum of 2 years after multiple injury-development of an outcome score

Early mortality of patients with multiple injuries has been reduced within the past three decades, and now restoration of functional outcome afterward has become the primary goal. The following study was conducted to examine the long-term outcome of a population of patients with multiple injuries, and to develop a score that allows quantification of the outcome.

Three hundred eighty-six patients with multiple injuries were collected in a prospectively gathered database at our institution, a Level I trauma center. Demographic data as well as injury severity, injury patterns, and mortality rates were analyzed in 192 patients who were reexamined between February and July 2003. In those patients, outcome after trauma was described using self-reports and physician examinations. One hundred ninety-two patients who were reexamined and 107 patients who died during hospital stay were used to correlate outcome data with injury severity. Furthermore, based on the outcome data, an injury outcome score was developed. Interobserver agreement was assessed using the kappa-statistic (2 level kappa).

The mean age was 30.3 (+/-29.8) years, and the mean Injury Severity Score (ISS) was 30.6 (+/-21.5). Most patients suffered injuries from motor vehicle crashes (n = 62.5%), followed by falls from heights (25.0%), and other reasons (12.5%). In the collective undergoing reexamination protocol (n = 192), 172 (89.6%) patients still had complaints about at least 1 body region. Fifty (26.0%) patients still needed medical treatment or were integrated in a rehabilitation process. The mean Injury Outcome Score (IOS) was 30.5 (+/-33.9) with a range from 0 to 75. A significant positive correlation (r = 0.598; p < 000.1) between ISS and IOS was demonstrated. Interobserver agreement was excellent with kappa = 0.92. The subscores for "head" (r = 0.725; p < 0.001; 95% CI: 0.52-0.80), "spine" (r = 0.686; p < 0.001; 95% CI: 0.32-0.82), and "extremity" (r = 0.546; p < 0.001; 95% CI: 0.24-0.68) have significant influence on the total IOS. In the subgroup of patients suffering lower extremity fractures, IOS (mean IOS, 16.3 [range, 4-24]) was significantly higher (p < 0.001) when compared with patients without lower extremity fractures (mean IOS, 10.1 [0-13]).

Our results suggest that the ISS not only be used for mortality prediction but also can be related to the long-term outcome after 2 years. In summary, the IOS seems to provide useful information for assessment of the outcome after severe blunt trauma. Especially after head, spinal, and extremity injuries, significant influence on the overall long-term outcome can be assumed.