Injury severity and quality of life: whose perspective is important?

BACKGROUND: Ambiguity exists regarding factors that predict postinjury quality of life (QOL). We hypothesized that patient-perceived injury severity, not Injury Severity Score (ISS), would be correlated with QOL in a model that included severity of post-traumatic stress disorder (PTSD) symptoms.
METHODS: Four hundred twenty-six trauma patients admitted to a Level I trauma center completed a questionnaire during inpatient stay and 6 months after injury. The questionnaire assessed physical component score and mental component score QOL with the SF-36, PTSD severity using the PTSD checklist, and used a four-point rating of perceived injury severity. ISS and demographic information were obtained from the trauma registry. Statistical analysis was done with Pearson's correlation and multiple regressions.
RESULTS: ISS was not significantly correlated with perceived injury severity, PTSD symptom severity, physical component score, or mental component score. The majority of patients overestimated injury severity when compared with ISS. An increase in PTSD symptom severity and perceived injury severity significantly predicted both decreased physical and mental QOL at 6 months.
CONCLUSIONS: ISS does not give the full picture of the severity of injury. Surgeons should consider early screening of patients for perception of injury severity and PTSD symptoms to determine which patients may need psychologic intervention to improve long-term QOL.