B. L. Zarzaur1, T. M. Bell1, B. L. Zarzaur1 1Indiana University School Of Medicine,Surgery,Indianapolis, IN, USA
Introduction: The recent focus on patient centered outcomes highlights the need to better describe recovery trajectories in terms of patient quality of life for surgical disease. Most clinicians and patients expect an initial large decrease in physical and mental functioning after injury followed by a gradual increase in both during recovery. However there is little data regarding the existence of subtypes of recovery trajectories following non-neurologic injury. The purpose of this study was to characterize the types of recovery trajectories that exist after non-neurologic moderate to severe injury.
Methods: Adults admitted towith an injury severity score > 10 but without traumatic brain injury or spinal cord injury were eligible. A baseline quality of life survey (SF-36) was administered at the time of admission and repeated at 1, 2, 4 and 12 months after injury. To determine if distinct trajectories existed for the physical component score (PCS) and the mental component score (MCS) of the SF-36, group based trajectory modeling was used (GBTM). GBTM is a semi-parametric statistical technique that identifies homogeneous subpopulations within a heterogeneous population.
Results: 500 patients were enrolled. Follow-up was 93% at 1 month, 82% at 2 months, 70% at 4 months and 58% at 12 months. After GBTM, PCS had 3 distinct trajectories. Trajectory 1 (10.3%) is characterized by a lower baseline PCS, followed by no improvement over time. Trajectory 2 (65.6%) has a drastic decline in PCS 1 month after injury, but shows, slow consistent improvement over time. Trajectory 3 (24.1%) also has a sharp decline in PCS but has a rapid recovery and reaches near-baseline levels of health by month 12. For the MCS, 5 trajectories were identified. Trajectory 1 (9.5%), has a low MCS at baseline and continues to have low scores throughout the rest of the study. Trajectory 2 (14.4%) has a large decrease in MCS post-injury and does not recover over the next twelve months. Trajectory 3 (22.7%) has an initial decrease in MCS early after injury, followed by continuous recovery. Trajectory 4 (19.1%) has a steady decline in MCS across most of the study. Lastly, trajectory 5 (34.3%) has consistently high MCS across all phases of recovery.
Conclusion: Both physical and mental recovery trajectories are more complex than is typically realized. There is greater variation in mental health outcomes among non-neurologically injured patients compared to physical health outcomes. The existence of multiple recovery trajectories for patients has significant implications on patient centered clinical trial design and in the distribution of limited resources devoted to recovery.
