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Recovery After Injury: An Individual Patient Data Meta-Analysis of General Health Status Using the EQ-5D

Black, James A. MPH, BBiomedSci; Herbison, G. Peter Dsc; Lyons, Ronan A. MPH, MD; Polinder, Suzanne PhD; Derrett, Sarah MPH, PhD

The Journal of Trauma: Injury, Infection, and Critical Care: October 2011 - Volume 71 - Issue 4 - p 1003-1010
doi: 10.1097/TA.0b013e3182238833
Original Article

Background: General information of health-related quality of life pathways to recovery after injury are largely absent from the literature. This article describes a study which: (1) collated and synthesized individual patient data of injured persons from an earlier systematic review and (2) produced general predictions of health-related quality of life for different injury groups for up to 1 year postinjury.

Methods: A systematic search of literature from January 1990 to December 2008 was completed. Researchers were approached to share their anonymous individual level data. Injuries were grouped into 39 categories based on the Eurocost injury classifications. Multilevel mixed effects models were used to produce predictions across both the five dimensions and the visual analog scale of the EQ-5D measure at 3 days, 30 days, 120 days, and 360 days postinjury.

Results: Individual patient data from 10,496 injured persons (76% of known data worldwide) was retrieved. Predictions were fitted to 27 of the 39 injury categories covering a wide spectrum of injury types. Across most injuries, pain, or discomfort, usual activities and mobility were the most commonly impaired dimensions. Recovery for pain or discomfort was generally more gradual than other health dimensions. For many injury categories, a considerable proportion of people reported residual impairment at 360 days. Regardless of the anatomic location of injury, similar patterns of recovery or persistent impairment were seen for fractures and strains/sprains. Recovery patterns differed and took much longer than estimated in the Global Burden of Disease Study.

Conclusions: This study has produced recovery patterns for 27 injury groups using most of the worldwide individual-level data. For many injury categories, recovery is incomplete and takes much longer than estimated. This study infers that the burden of injury is likely being underestimated.


From the Injury Prevention Research Unit (IPRU) (J.B.), Dunedin School of Medicine, University of Otago; Dunedin School of Medicine (G.P.H.), University of Otago; Health Information Research Unit (HIRU) (R.A.L.), Swansea University; Department of Public Health (S.P.), Erasmus MC University Medical Center; and Injury Prevention Research Unit (IPRU) (S.D.), Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand.

Submitted for publication August 10, 2010.

Accepted for publication May 9, 2011.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

Address for reprints: James Alexander Black, Jesus College, Cambridge, CB5 8BL, United Kingdom; email:

© 2011 Lippincott Williams & Wilkins, Inc.