Development of prediction models of stress and long-term disability among claimants to injury compensation systems: a cohort study

作者：Spittal Matthew J^*; Grant Genevieve; O'Donnell Meaghan; McFarlane Alexander C; Studdert David M

来源：BMJ Open, 2018, 8(4): e020803.

DOI：10.1136/bmjopen-2017-020803

Objectives We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury.
Design Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury.
Setting Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia.
Participants 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers' compensation scheme.
Primary outcome measures 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey.
Results Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R-2=0.37) and calibration. The disability risk score had a score range of 0-180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0-220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes.
Conclusions The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions.

• 出版日期2018-4