Early Predictors of Functional Outcome After Trauma

Area of Science:

• Trauma care research
• Rehabilitation medicine
• Clinical outcomes assessment

Background:

• Routinely collected trauma data is underutilized in research for rehabilitation outcomes, functional evaluation, and comparative effectiveness.
• Existing models often lack predictors or adjustors from initial trauma assessment.
• This gap limits the comprehensive understanding of patient recovery trajectories.

Purpose of the Study:

• To identify pre-hospital and emergency department variables for predicting functional outcomes in trauma survivors.
• To leverage readily available trauma data for enhanced prognostic modeling.
• To improve the assessment of functional recovery post-trauma.

Main Methods:

• Prospective study conducted at a Level I academic trauma center.
• Inclusion of patients surviving spinal cord injury, traumatic brain injury, or polytrauma.
• Merging trauma and rehabilitation registries, followed by two-stage linear regression analysis to link demographic, scene, and ED data with discharge functional outcomes (Functional Independence Measure - FIM).

Main Results:

• Older patients with government insurance had poorer discharge FIM scores compared to those with commercial insurance.
• Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) scores from the accident scene significantly correlated with discharge FIM.
• Lower ISS and higher GCS scores were associated with better functional outcomes (higher FIM scores).

Conclusions:

• Routinely collected trauma data elements are valuable for assessing the continuum of patient care.
• Incorporating trauma data can enhance models of functional outcomes.
• This approach offers meaningful risk adjustors for comparing and evaluating rehabilitation care systems and treatments.