Abstract
Background
The NHS Outcomes Framework for England has identified recovery from major injury as
an important clinical area. At present, there are no established outcome indicators.
As more patients survive major trauma, outcomes will need to be measured in terms
of morbidity and not mortality alone.
Objective
To make recommendations for a selection of outcome measures that could be integrated
into National Clinical Audit data collection and form part of clinical governance
requirements for Regional Trauma Networks (RTNs) and measures by which RTNs are held
to account by government. Specific focus was given to acute care and rehabilitation
for both adults and children.
Method
A Multiprofessional, multidisciplinary expert group reviewed the current evidence
on outcome measures for major trauma in the adult and children's populations, informed
by a systematic review carried out jointly by the Trauma Audit and Research Network
(TARN) and the Cochrane Injuries Group. A structured discussion covered functional
and quality of life outcome measures as well as patient experience and indicators
such as return to work, education and social dependency.
Results
For the adult population the group agreed with the in-hospital performance and hospital
discharge measures recommended in the TARN and Cochrane systematic review. Concerning
longer-term outcome indicators, the group suggested the use of the Glasgow Outcome
Scale – Extended (GOS-E) and European Quality of Life 5D (EQ-5D) with consideration
to be given to the World Health Organisation Quality of Life survey (WHO-QoL). For
patients who had ongoing inpatient rehabilitation needs the group thought the measurement
of the Rehabilitation Complexity Scale (RCS) and Functional Independence Measure (FIM)
were important in total brain injury and, the American Spinal Injury Association Impairment
Scale (ASIA) and Spinal Cord Independence Measure (SCIM) in spinal cord injury. For
children the group recommended the use of the King's Outcome Scale for Childhood Head
Injury (KOSCHI) and Paediatric Quality of Life measure (Peds-QL) preferably at multiple
intervals following injury to take into account effects on development.
Conclusion
Specific recommendations were made for the use of outcome measures in adults and children
with major trauma and those with complex rehabilitation needs following injury. More
work on outcome measures in major trauma is needed especially for children. There
are currently no robust measures of patient experience for use in major trauma. The
importance of data linkage to allow measurement of non-clinical outcomes such as return
to work, maintainence of education and societal dependency was emphasised by the group.
A system for recording outcomes should be piloted post injury and at 6 and 12 months,
with those still requiring inpatient rehabilitation after this time having longer
follow up.
Keywords
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Article info
Publication history
Accepted:
May 7,
2012
Identification
Copyright
© 2012 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
