Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 149 No. 5152 (2019)

The capacity of baseline patient, injury, treatment and outcome data to predict reduced capacity to work and accident insurer costs – a Swiss prospective 4-year longitudinal trauma centre evaluation

  • Thomas Gross
  • Sabrina Morell
  • Stefan M. Scholz
  • Felix Amsler
DOI
https://doi.org/10.4414/smw.2019.20144
Cite this as:
Swiss Med Wkly. 2019;149:w20144
Published
17.12.2019

Summary

AIMS OF THE STUDY

Given the lack of information on the relation between baseline patient, injury and treatment data and longer-term outcomes for survivors of significant trauma, the objective of this evaluation was to examine the degree to which these characteristics might predict working constraints and expenses.

METHODS

1183 significantly injured patients (New Injury Severity Score >8) of working age were treated at a Swiss trauma centre. Only patients insured by the largest national accident insurer, Suva, were included. Their sociodemographic, trauma, treatment and early clinical status data were evaluated against insurance variables for 4 years post-injury (uni- and multivariate analysis, R2).

RESULTS

346 out of 363 surviving Suva-insured patients were eligible for analysis, constituting a 95% complete 4-year longitudinal follow-up. Overall, 121 (35%) presented with a reduced capacity to work (RCW) 1 to 4 years after the trauma. Patients experienced a mean percentage RCW (PRCW) of 27% 1 year after injury and of 14% at 4 years. In multivariate analysis all investigated parameters together explained 40% of the adjusted variance of patients’ mean PRCW over the 4-year surveillance period, with the highest association found for the block of injury-related variables (17%). Sixty percent of variance was explained for total insurance costs, found to be on average CHF 417,000 per case in patients with a RCW compared with CHF 47,000 per case without RCW (p <0.001).

CONCLUSIONS

Four years after significant injury, every fifth patient presented with resultant RCW; half of these remained totally incapable of work. Investigated baseline parameters predicted about 40% of the variance regarding RCW. Future studies are needed to better explain and potentially minimise longer-term incapacity to work following injury. (Trial registration no. NCT02165137)

References

  1. Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev. 2016;22(1):3–18. doi:.https://doi.org/10.1136/injuryprev-2015-041616
  2. Moore L, Champion H, Tardif P-A, Kuimi B-L, O’Reilly G, Leppaniemi A, et al.; International Injury Care Improvement Initiative. Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis. World J Surg. 2018;42(5):1327–39. doi:.https://doi.org/10.1007/s00268-017-4292-0
  3. Gross T, Morell S, Amsler F. Longer-term quality of life following major trauma: age only significantly affects outcome after the age of 80 years. Clin Interv Aging. 2018;13:773–85. doi:.https://doi.org/10.2147/CIA.S158344
  4. Thompson L, Hill M, Davies C, Shaw G, Kiernan MD. Identifying pre-hospital factors associated with outcome for major trauma patients in a regional trauma network: an exploratory study. Scand J Trauma Resusc Emerg Med. 2017;25(1):83. doi:.https://doi.org/10.1186/s13049-017-0419-4
  5. Nemunaitis G, Roach MJ, Claridge J, Mejia M. Early Predictors of Functional Outcome After Trauma. PM R. 2016;8(4):314–20. doi:.https://doi.org/10.1016/j.pmrj.2015.08.007
  6. Hoffman K, Cole E, Playford ED, Grill E, Soberg HL, Brohi K. Health outcome after major trauma: what are we measuring? PLoS One. 2014;9(7):e103082. doi:.https://doi.org/10.1371/journal.pone.0103082
  7. Gabbe BJ, Simpson PM, Harrison JE, Lyons RA, Ameratunga S, Ponsford J, et al. Return to work and functional outcomes after major trauma: Who recovers, when, and how well? Ann Surg. 2016;263(4):623–32. doi:.https://doi.org/10.1097/SLA.0000000000001564
  8. Scaratti C, Leonardi M, Sattin D, Schiavolin S, Willems M, Raggi A. Work-related difficulties in patients with traumatic brain injury: a systematic review on predictors and associated factors. Disabil Rehabil. 2017;39(9):847–55. doi:.https://doi.org/10.3109/09638288.2016.1162854
  9. Ardolino A, Sleat G, Willett K. Outcome measurements in major trauma--results of a consensus meeting. Injury. 2012;43(10):1662–6. doi:.https://doi.org/10.1016/j.injury.2012.05.008
  10. Tøien K, Skogstad L, Ekeberg Ø, Myhren H, Schou Bredal I. Prevalence and predictors of return to work in hospitalised trauma patients during the first year after discharge: a prospective cohort study. Injury. 2012;43(9):1606–13. Published online April 15, 2011. doi:.https://doi.org/10.1016/j.injury.2011.03.038
  11. Clay FJ, Newstead SV, McClure RJ. A systematic review of early prognostic factors for return to work following acute orthopaedic trauma. Injury. 2010;41(8):787–803. doi:.https://doi.org/10.1016/j.injury.2010.04.005
  12. Clay FJ, Berecki-Gisolf J, Collie A. How well do we report on compensation systems in studies of return to work: a systematic review. J Occup Rehabil. 2014;24(1):111–24. Published online April 19, 2013. doi:.https://doi.org/10.1007/s10926-013-9435-z
  13. Haeusler JM, Tobler B, Arnet B, Huesler J, Zimmermann H. Pilot study on the comprehensive economic costs of major trauma: Consequential costs are well in excess of medical costs. J Trauma. 2006;61(3):723–31.
  14. Gross T, Amsler F. Langzeitoutcome nach Polytrauma im erwerbsfähigen Alter [Long-term outcome following multiple trauma in working age : A prospective study in a Swiss trauma center]. Unfallchirurg. 2016;119(11):921–8. Article in German. doi:.https://doi.org/10.1007/s00113-014-2720-2
  15. Gross T, Morell S, Amsler F. To What Extent Are Main Accident-Insurer Cases Representative of All Significantly Injured? A Swiss Monocenter Perspective. J Insur Med. 2019;insm-48-1-1-14.1. Published online April 25, 2019. doi:.https://doi.org/10.17849/insm-48-1-1-14.1
  16. The Swiss authorities online. Accident insurance: Who is covered? [cited 2018 28. Jan]. Available from: https://www.ch.ch/en/accident-insurance-who-covered/.
  17. Federal Office of Public Health FOPH. Accident Insurance 2018 [cited 2018 28. Jan]. Available from: https://www.bag.admin.ch/bag/en/home/themen/versicherungen/unfallversicherung.html.
  18. Annual Report 2016 full version: Schweizer Unfallversicherungsanstalt (SUVA); 2016 [cited 2018 28. Jan]. Suva_Annual_Report_2016_1278-104-16.E.pdf. Available from: https://www.suva.ch/en/material/Documentations/annual-report-2016-full-version/#uxlibrary-from-search.
  19. Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir (Wien). 1976;34(1-4):45–55. doi:.https://doi.org/10.1007/BF01405862
  20. Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoïpé M, et al. Mechanism, Glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med. 2010;38(3):831–7. doi:.https://doi.org/10.1097/CCM.0b013e3181cc4a67
  21. Gennarelli T. The Abbreviated Injury Scale - 1990 revision. Des Plaines, IL: American Association for the Advancement of Automotive Medicine (AAAM); 1990.
  22. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975; 305(7905):480–4. doi:.https://doi.org/10.1016/S0140-6736(75)92830-5
  23. Lefering R. Ein neuer Prognose-Score im TraumaRegister DGU (RISC II). Orthopädie und Unfallchirurgie Mitteilungen und Nachrichten. 2015;04(01):80–1. doi:.https://doi.org/10.1055/s-0041-100418
  24. Gross T, Braken P, Amsler F. Trauma center need: the American College of Surgeons’ definition in contrast to Swiss highly specialized medicine regulations-a Swiss trauma center perspective. Eur J Trauma Emerg Surg. 2018. doi:.https://doi.org/10.1007/s00068-018-1027-3
  25. Attenberger C, Amsler F, Gross T. Clinical evaluation of the Trauma Outcome Profile (TOP) in the longer-term follow-up of polytrauma patients. Injury. 2012;43(9):1566–74. doi:.https://doi.org/10.1016/j.injury.2011.01.002
  26. Brenneman FD, Redelmeier DA, Boulanger BR, McLellan BA, Culhane JP. Long-term outcomes in blunt trauma: who goes back to work? J Trauma. 1997;42(5):778–81. doi:.https://doi.org/10.1097/00005373-199705000-00004
  27. Vles WJ, Steyerberg EW, Essink-Bot ML, van Beeck EF, Meeuwis JD, Leenen LPH. Prevalence and determinants of disabilities and return to work after major trauma. J Trauma. 2005;58(1):126–35. doi:.https://doi.org/10.1097/01.TA.0000112342.40296.1F
  28. Soberg HL, Roise O, Bautz-Holter E, Finset A. Returning to work after severe multiple injuries: multidimensional functioning and the trajectory from injury to work at 5 years. J Trauma. 2011;71(2):425–34. doi:.https://doi.org/10.1097/TA.0b013e3181eff54f
  29. Collie A, Simpson PM, Cameron PA, Ameratunga S, Ponsford J, Lyons RA, et al. Patterns and Predictors of Return to Work After Major Trauma: A Prospective, Population-based Registry Study. Ann Surg. 2019;269(5):972–8. doi:.https://doi.org/10.1097/SLA.0000000000002666
  30. Overgaard M, Høyer CB, Christensen EF. Long-term survival and health-related quality of life 6 to 9 years after trauma. J Trauma. 2011;71(2):435–41. doi:.https://doi.org/10.1097/TA.0b013e31820e7ec3
  31. Redmill DA, McIlwee A, McNicholl B, Templeton C. Long term outcomes 12 years after major trauma. Injury. 2006;37(3):243–6. doi:.https://doi.org/10.1016/j.injury.2005.11.014
  32. Prada SI, Salkever D, Mackenzie EJ. Level-I trauma center effects on return-to-work outcomes. Eval Rev. 2012;36(2):133–64. doi:.https://doi.org/10.1177/0193841X12442674
  33. Prada SI, Salkever D, MacKenzie EJ. Level-I trauma centre treatment effects on return to work in teaching hospitals. Injury. 2014;45(9):1465–9. doi:.https://doi.org/10.1016/j.injury.2014.02.025
  34. Larsen P, Goethgen CB, Rasmussen S, Iyer AB, Elsoe R. One-year development of QOL following orthopaedic polytrauma: a prospective observational cohort study of 53 patients. Arch Orthop Trauma Surg. 2016;136(11):1539–46. doi:.https://doi.org/10.1007/s00402-016-2550-5
  35. van Delft-Schreurs CCHM, van Bergen JJM, de Jongh MAC, van de Sande P, Verhofstad MHJ, de Vries J. Quality of life in severely injured patients depends on psychosocial factors rather than on severity or type of injury. Injury. 2014;45(1):320–6. doi:.https://doi.org/10.1016/j.injury.2013.02.025
  36. von Rüden C, Woltmann A, Röse M, Wurm S, Rüger M, Hierholzer C, et al. Outcome after severe multiple trauma: a retrospective analysis. J Trauma Manag Outcomes. 2013;7(1):4. doi:.https://doi.org/10.1186/1752-2897-7-4
  37. Kuhlman MB, Lohse N, Sørensen AM, Larsen CF, Christensen KB, Steinmetz J. Impact of the severity of trauma on early retirement. Injury. 2014;45(3):618–23. doi:.https://doi.org/10.1016/j.injury.2013.09.007
  38. Knowlton LM, Harris AHS, Tennakoon L, Hawn MT, Spain DA, Staudenmayer KL. Interhospital variability in time to discharge to rehabilitation among insured trauma patients. J Trauma Acute Care Surg. 2019;86(3):406–14. doi:.https://doi.org/10.1097/TA.0000000000002163
  39. Krause N, Dasinger LK, Neuhauser F. Modified Work and Return to Work: A Review of the Literature. J Occup Rehabil. 1998;8(2):113–39. doi:.https://doi.org/10.1023/A:1023015622987
  40. MacEachen E, Kosny A, Ferrier S, Chambers L. The “toxic dose” of system problems: why some injured workers don’t return to work as expected. J Occup Rehabil. 2010;20(3):349–66. Published online February 09, 2010. doi:.https://doi.org/10.1007/s10926-010-9229-5
  41. Corso P, Finkelstein E, Miller T, Fiebelkorn I, Zaloshnja E. Incidence and lifetime costs of injuries in the United States. Inj Prev. 2015;21(6):434–40. doi:.https://doi.org/10.1136/ip.2005.010983rep
  42. Etuknwa A, Daniels K, Eib C. Sustainable Return to Work: A Systematic Review Focusing on Personal and Social Factors. J Occup Rehabil. 2019. doi:.https://doi.org/10.1007/s10926-019-09832-7
  43. Gross T, Morell S, Amsler F. To what extent are main accident-insurer cases representative of all significantly injured? A Swiss monocenter perspective. J Insur Med. 2019;insm-48-1-1-14.1. doi:.https://doi.org/10.17849/insm-48-1-1-14.1
  44. Murgatroyd DF, Casey PP, Cameron ID, Harris IA. The effect of financial compensation on health outcomes following musculoskeletal injury: systematic review. PLoS One. 2015;10(2):e0117597. doi:.https://doi.org/10.1371/journal.pone.0117597
  45. Spearing NM, Connelly LB. Is compensation “bad for health”? A systematic meta-review. Injury. 2011;42(1):15–24. doi:.https://doi.org/10.1016/j.injury.2009.12.009
  46. Gross T, Attenberger C, Huegli RW, Amsler F. Factors associated with reduced longer-term capacity to work in patients after polytrauma: a Swiss trauma center experience. J Am Coll Surg. 2010;211(1):81–91. doi:.https://doi.org/10.1016/j.jamcollsurg.2010.02.042
  47. Keune JD. Disability and the contemporary surgical gestalt. Disabil Stud Q. 2018;38(1).
  48. Hou WH, Chi CC, Lo HL, Chou YY, Kuo KN, Chuang HY. Vocational rehabilitation for enhancing return-to-work in workers with traumatic upper limb injuries. Cochrane Database Syst Rev. 2017;12:CD010002. doi:.https://doi.org/10.1002/14651858.CD010002.pub3
  49. Mason ST, Esselman P, Fraser R, Schomer K, Truitt A, Johnson K. Return to work after burn injury: a systematic review. J Burn Care Res. 2012;33(1):101–9. Published online December 06, 2011. doi:.https://doi.org/10.1097/BCR.0b013e3182374439
  50. Hilton G, Unsworth C, Murphy G. The experience of attempting to return to work following spinal cord injury: a systematic review of the qualitative literature. Disabil Rehabil. 2018;40(15):1745–53. doi:.https://doi.org/10.1080/09638288.2017.1312566