The effect of severe injury on quality of life and the incidence of psychopathology. A pilot study.

Trauma still remains the most important cause of death among people younger
than 40 years old. Often it results in some disability if patients with serious
injury survive. This has a lot of socialeconomic consequences.
In contrast to somatic sequelae, little is known about quality of life and
appearance of psychopathology as a result of such accidents and corporal
disability. The frequency and the intensity in which corporal damage can
influence quality of life (negatively) are more or less unknown. A
psychological reaction might have more effect on quality of life than somatic
disability. Besides this shocking experiences (like an accident) are knonw to
cause psychopathology (like posttraumatic stress syndrome - PTSS). It is not
clear whether type of accident, seriousness of injury or corporal sequelae
affect the appearance of PTSS.

The Dutch government assigned 11 trauma centres to improve the quality of
trauma care. The responsibility given to these trauma centres is quality
improvement for the entire chain of trauma care. One of these trauma centres is
Trauma centre Brabant in St. Elisabeth Hospital.
To improve trauma care, Dutch trauma centres implemented a nationwide trauma
registry, in which among other things, type of injury and accident, and
information about mortality and treatment are registered. The collected data is
used to investigate survival and mortality of trauma patients. Mortality is the
commonly used outcome parameter in trauma care studies. However, quality of
trauma care not only depends on lifetime and little is known about quality of
life and received psychological assistance of (multi)trauma patients.

The objective of this study is to provide understanding of the relation between
effects of accidents (cause, type injury and sequelae) and appearance of
psychopathology. It is not clear whether psychopathology that influences the
quality of life in a negative way, caused by the accident exists.
Therefore, it is also important to find out how many and what type of patients
it concerns and to distinguish the experienced quality of life of subgroups
multitrauma patients based on demographic, psychological and psychosocial
characteristics or characteristics of the accident.

After a general inventarisation, subgroup analysis will be performed to find
out which relations exist between specific injury, quality of life and
psychopathology and on the other hand to find out how many patients with a
posttraumatic psychopathology have received an adequate treatment.

The results of this retrospective study will be a starting point for other
studies and are essential for prospective observational or intervention
studies.

It is a retrospective study in which data from trauma registry,
(electronically) medical records and questionnaires will be used.

All suitable patients are asked to participate the study by a letter. If they
agree and sign the informed consent, there medical records will be studied and
they will be asked to answer some questionnaires. Trauma registration, medical
records and the questionnaires mentioned below will be used to collect the
study information.

Demographic data (age, gender, civil class, education, being in work), medical
data (seriousness and type of injury, comorbidity), characteristics of the
accident (traffic, at work, at home, sports, tentamen suicidi), destination
after leaving the hospital (home, other hospital, rehabilitation centre,
nursing home) and consultation will be extracted from the trauma registration,
medical records or questionnaires.

Dutch translations of the following international accepted and validated
questionnaires will be used to determine the quality of life and
psychopathology and or malfunctioning of the patients:
World Health Organization Quality of Life assessment instrument-Bref
(WHOQOL-Bref)
SchokVerwerkingslijst (SVL)
Hospital Anxiety and Depression Scale (HADS)
Cognitive Failures Questionnaire (CFQ)
Short Musculoskeletal Function Assessment (SMFA)

Frequencies will be used to describe the results of the study. To determine
quality of life of multitrauma patients, an unpared student t-test will be used
to compare the results with data from the reference group of WHOQOL-Bref (de
Vries & Van Heck, 2003). To investigate the relation between quality of life
and demographic, medical or injury and accident characteristics and
psychopathology of the patients and the relation between unconsciousness,
sedation or pain relieving-drug directly after the accident and quality of life
or psychopathology, multilevel linear regression will be used. To investigate
the relation between accident characteristics and psychopathology logistic
regression will be used. The study results will also be compared with a - if
possible matched - control group.

about 30 minutes to answer the questionnaires.