Seven-year excess mortality, functional outcome and health status after trauma in Hong Kong

Abstract

Purpose

The purpose was to investigate long-term health impacts of trauma and the aim was to describe the functional outcome and health status up to 7 years after trauma.

Methods

We conducted a prospective, multi-centre cohort study of adult trauma patients admitted to three regional trauma centres with moderate or major trauma (ISS ≥ 9) in Hong Kong (HK). Patients were followed up at regular time points (1, 6 months and 1, 2, 3, 4, 5, 6, and 7 years) by telephone using extended Glasgow Outcome Scale (GOSE) and the Short-Form 36 (SF36). Observed annual mortality rate was compared with the expected mortality rate estimated using the HK population cohort. Linear mixed model (LMM) analyses examined the changes in SF36 with subgroups of age ≥ 65 years, ISS > 15, and GOSE ≥ 5 over time.

Results

At 7 years, 115 patients had died and 48% (138/285) of the survivors responded. The annual mortality rate (AMR) of the trauma cohort was consistently higher than the expected mortality rate from the general population. Forty-one percent of respondents had upper good recovery (GOSE = 8) at 7 years. Seven-year mean PCS and MCS were 45.06 and 52.06, respectively. LMM showed PCS improved over time in patients aged < 65 years and with baseline GOSE ≥ 5, and the MCS improved over time with baseline GOSE ≥ 5. Higher mortality rate, limited functional recovery and worse physical health status persisted up to 7 years post-injury.

Conclusion

Long-term mortality and morbidity should be monitored for Asian trauma centre patients to understand the impact of trauma beyond hospital discharge.

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Data availability

Data may be available from the corresponding author on specific request.

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Acknowledgements

We thank all our patients and their families for their participation in the study. We are grateful for the administrative support and facilitation in patient recruitment given by colleagues in Prince of Wales, Queen Elizabeth and Tuen Mun Hospitals in the study.

Funding

This study was supported by the Health and Health Services Research Funds (HHSRF 07080261, HHSRF 10110251), Food and Health Bureau, Hong Kong SAR Government for the first 4 years of the study.

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Authors

Contributions

KH, TR, JY, and CG contributed to the conception of the study. KH, TR, JY, HH, and NC designed the study, contributes to the coordination of the study and the acquisition of the study data. KH, CC, YL, and MC analysed the data, KH, TR, LL, MC, KT, and CG interpreted data for the work. KH drafted the manuscript, and all the authors critically revised the manuscript and agreed to the final version of the manuscript. All the authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Colin Graham.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval and consent to participate

Ethical approval obtained from the Joint CUHK-NTEC Clinical Research Ethics Committee (CREC), NTWC CREC, KCC/KEC CREC. Written consent was obtained from the patient or their legal guardian.

Consent for publication

The manuscript did not contain individuals’ person detailed data in any form.

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Hung, K.K.C., Rainer, T.H., Yeung, J.H.H. et al. Seven-year excess mortality, functional outcome and health status after trauma in Hong Kong. Eur J Trauma Emerg Surg (2021). https://doi.org/10.1007/s00068-021-01714-z

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Keywords

  • Wounds and injuries
  • Glasgow Outcome Scale
  • Short-form 36
  • Trauma centre