Impact of the severity of trauma on early retirement.
OBJECTIVE
To assess the association between Injury Severity Score (ISS) and subsequent risk of early retirement.


DESIGN
Observational cohort study with follow-up based on prospectively collected data. Hospital-based data were linked to national register data on pension reception and vital status.


SETTING
Level-one urban trauma centre.


PARTICIPANTS
Patients aged 18-64 years entering the trauma centre in Copenhagen during 1999-2007 who were alive after three days were followed until early retirement, death or emigration.


MAIN OUTCOME MEASURES
Primary outcome was early retirement, defined as receiving disability pension (unintentional) or voluntary early retirement pension (intentional) before the regular age of retirement (65 years). Relative risk of early retirement according to ISS (low, ISS 1-15 vs. high, ISS 16-75) was assessed using Cox proportional hazards regression, adjusted for age and gender.


RESULTS
Of all 6687 patients admitted to the trauma centre, a total of 1722 trauma patients were included and followed for a median of 6.2 years (interquartile range (IQR) 3.7-9.1). Of these, 1305 (75.8%) were males, median age was 35.0 years (IQR 25.4-46.5), and median ISS was 16 (IQR 9-25). Three hundred and twenty-two patients retired during follow-up. Patients with high ISS, compared to patients with low ISS, had an increased risk of early retirement, adjusted hazard ratio 2.60 (95% confidence interval (CI) 2.05-3.30; p<0.001). Relative increase in retirement risk was 1.04 (95% CI 1.03-1.05) per ISS point and 1.03 (95% CI 1.03-1.04) per year older. Gender was not found to be a significant risk factor (p=0.69). Five-year absolute risks of early retirement were 9.9% (95% CI 7.8-12.0%) for the low ISS group and 24.6% (95% CI 21.6-27.5%) for the high ISS group.


CONCLUSIONS
The risk of early retirement is 2.6 times higher in severely injured patients (ISS 16-75) than the risk in low to moderately injured patients (ISS 1-15) and they have a high absolute 5-year risk as well. Early, targeted interventions to assist with return to work might be able to reduce this risk.
['Kuhlman|Michael Bilde|MB|', 'Lohse|Nicolai|N|', 'Sørensen|Anne Marie|AM|', 'Larsen|Claus Falck|CF|', 'Christensen|Karl Bang|KB|', 'Steinmetz|Jacob|J|']
D000293:Adolescent D000328:Adult D003718:Denmark D004185:Disability Evaluation D006233:Disabled Persons D005260:Female D005500:Follow-Up Studies D006801:Humans D015601:Injury Severity Score D008297:Male D008875:Middle Aged D017063:Outcome Assessment, Health Care D011336:Probability D011446:Prospective Studies D011788:Quality of Life D012179:Retirement D062707:Return to Work D012307:Risk Factors D014193:Trauma Centers D014505:Urban Population D014947:Wounds and Injuries
Trauma Injury Severity Score Cohort study Early retirement pension