Prospective observational study to examine health-related quality of life and develop models to predict long-term patient-reported outcomes 6 months after hospital discharge with blunt thoracic injuries

Edward Baker; Ceri Battle; Abishek Banjeri; Edward Carlton; Christine Dixon; Jennifer Ferry; Philip Hopkins; Robert Jones; Trevor Murrells; Christine Norton; Lee Patient; Ashraf Rasheed; Imogen Skene; Andrew Tabner; Malcolm Tunnicliff; Louise  Young; Andreas Xyrichis; Gerry Lee

doi:10.1136/bmjopen-2021-049292

Edward Baker, Ceri Battle, Abishek Banjeri, Edward Carlton, Christine Dixon, Jennifer Ferry, Philip Hopkins, Robert Jones, Trevor Murrells, Christine Norton, Lee Patient, Ashraf Rasheed, Imogen Skene, Andrew Tabner, Malcolm Tunnicliff , Louise Young, Andreas Xyrichis, Gerry Lee

Original language	English
Article number	e049292
Number of pages	14
Journal	BMJ Open
Volume	11
Issue number	7
Early online date	8 Jul 2021
DOIs	https://doi.org/10.1136/bmjopen-2021-049292
Accepted/In press	24 Jun 2021
E-pub ahead of print	8 Jul 2021
Additional links	Link to publication in Scopus

Funding Information: Funding EB is funded by a National Institute for Health Research (NIHR), Clinical Doctoral Research Fellowship for this research project (ICA-CDRF-2016-02-006). The publication presents independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care. Publisher Copyright: © Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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OBJECTIVE: This study aimed to examine the long-term outcomes and health-related quality of life in patients with blunt thoracic injuries over 6 months from hospital discharge and develop models to predict long-term patient-reported outcomes.

DESIGN: A prospective observational study using longitudinal survey design.

SETTING: The study recruitment was undertaken at 12 UK hospitals which represented diverse geographical locations and covered urban, suburban and rural areas across England and Wales.

PARTICIPANTS: 337 patients admitted to hospital with blunt thoracic injuries were recruited between June 2018-October 2020.

METHODS: Participants completed a bank of two quality of life surveys (Short Form-12 (SF-12) and EuroQol 5-Dimensions 5-Levels) and two pain questionnaires (Brief Pain Inventory and painDETECT Questionnaire) at four time points over the first 6 months after discharge from hospital. A total of 211 (63%) participants completed the outcomes data at 6 months after hospital discharge.

OUTCOMES MEASURES: Three outcomes were measured using pre-existing and validated patient-reported outcome measures. Outcomes included: Poor physical function (SF-12 Physical Component Score); chronic pain (Brief Pain Inventory Pain Severity Score); and neuropathic pain (painDETECT Questionnaire).

RESULTS: Despite a trend towards improving physical functional and pain at 6 months, outcomes did not return to participants perceived baseline level of function. At 6 months after hospital discharge, 37% (n=77) of participants reported poor physical function; 36.5% (n=77) reported a chronic pain state; and 22% (n=47) reported pain with a neuropathic component. Predictive models were developed for each outcome highlighting important data collection requirements for predicting long-term outcomes in this population. Model diagnostics including calibration and discrimination statistics suggested good model fit in this development cohort.

CONCLUSIONS: This study identified the recovery trajectories for patients with blunt thoracic injuries over the first 6 months after hospital discharge and present prognostic models for three important outcomes which after external validation could be used as clinical risk stratification scores.

King's College London

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