Beyond surviving: The mental and physical impairment of health-related quality of life after polytrauma emphasizes the need for interprofessional long-term aftercare.

Abstract

Major trauma, particularly from road traffic accidents, is a leading cause of death and long-term disability in young adults worldwide. Advances in trauma center management, especially in Germany, have substantially improved survival rates to approximately 90%, which can be considered excellent. They often experience a reduced health-related quality of life (HrQoL) due to persistent physical, emotional, and mental challenges, underscoring the need for comprehensive long-term aftercare. This study focuses on the traumatic aftermath two years after polytrauma beyond the individual pattern of injury. This single-center cohort study was performed at the polytrauma outpatient center of the Department of Trauma Surgery, Orthopaedics, and Plastic Surgery of the University Medical Center Göttingen (UMG), Germany. Patients were retrospectively identified from hospital and trauma registry records, and data collection (questionnaires and interviews) was performed prospectively. Seventy patients aged 18 years or older with multiple trauma (ICD-10: T07 or related combinations) participated in the study 24 months after the initial trauma. Data on general HrQoL, depressive and anxiety symptoms, and socioeconomic consequences were collected using validated questionnaires (validated trauma-specific questionnaire, SF-36, PHQ-9 & GAD-7), trauma-specific surveys, and patient records. Statistical analyses were used to assess differences and correlations between patient factors and outcomes. Participants displayed significantly lower HrQoL scores across all SF-36 dimensions compared to the general population (p < 0.005), with pronounced deficits in physical functioning, pain, and emotional role functioning. Nearly half of the participants exhibited mild depressive symptoms, and approximately 40% showed mild to severe anxiety symptoms. Pain, particularly in the lower extremities, and difficulties in daily activities were strongly associated with reduced physical and mental health sum scores. Socioeconomic impacts included changes in social relationships and employment status, with only 51% returning to full-time work and nearly 30% losing their jobs post-injury. Rehabilitation was rated positively, but access remained limited. Polytrauma should be conceptualized as a chronic disease with complex physical, psychological, and socioeconomic sequelae that significantly impair long-term HrQoL. Effective management requires individualized interdisciplinary aftercare programs focusing on physical rehabilitation, mental health support, and socioeconomic reintegration. Coordinated care models, such as specialized outpatient centers, are essential for addressing these multifaceted needs and improving long-term outcomes for polytrauma survivors.