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Citation
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Herrera-Escobar JP, Deroon-Cassini T, Brasel KJ, Nehra D, Al Rafai SS, Toppo A, Kasotakis G, Velmahos G, Salim A, Haider AH. J. Trauma Acute Care Surg. 2019; ePub(ePub): ePub. |
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Affiliation
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Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H Chan School of Public Health. Boston, MA, USA. |
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Abstract
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BACKGROUND: The National Academies of Science has called for routine collection of long-term outcomes after injury. One of the main barriers for this is the lack of practical trauma-specific tools to collect such outcomes. The only trauma-specific long-term outcomes measure that applies a biopsychosocial view of patient care, the Trauma Quality-of-Life (T-QoL), has not been adopted due to its length, lack of composite scores, and unknown validity. Our objective was to develop a shorter version of the T-QoL measure that is reliable, valid, specific, and generalizable to all trauma populations.
METHODS: We used two random samples selected from a prospective registry developed to follow long-term outcomes of adult trauma survivors (Injury Severity Score ≥9) admitted to three Level-I trauma centers. First, we validated the original T-QoL instrument using the SF-12 and Breslau PTSD-screening (B-PTSD) tools. Second, we conducted a confirmatory factor analysis (CFA) to reduce the length of the original T-QoL instrument; and using a different sample, we scored and performed internal consistency and validity assessments of the revised T-QoL (RT-QoL) components.
RESULTS: All components of the original T-QoL were significantly correlated negatively with the B-PTSD and positively with the SF-12 mental and physical composite scores. After CFA, a three-component structure using 18-items (6-items/component) most appropriately represented the data. Each component in the revised instrument demonstrated a high level of internal consistency (Cronbach's alpha ≥0.8) and correlated negatively with the B-PTSD and positively with the SF-12, demonstrating concurrent validity. Additionally, each of the RT-QoL components were able to distinguish between individuals based on their work status, with those who have returned to work reporting better health.
CONCLUSIONS: This more practical RT-QoL measure greatly increases the ability to evaluate long-term outcomes in trauma more efficiently and meaningfully, without sacrificing the validity and psychometric properties of the original instrument. LEVEL OF EVIDENCE: Level III - Prognostic and Epidemiological.
Language: en |