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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 3/2022

15-11-2021 | Original Article

Prediction of recovery in trauma patients using Latent Markov models

Authors: Roos Johanna Maria Havermans, Felix Johannes Clouth, Koen Willem Wouter Lansink, Jeroen Kornelis Vermunt, Mariska Adriana Cornelia de Jongh, Leonie de Munter

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2022

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Abstract

Purpose

Patients’ expectations during recovery after a trauma can affect the recovery. The aim of the present study was to identify different physical recovery trajectories based on Latent Markov Models (LMMs) and predict these recovery states based on individual patient characteristics.

Methods

The data of a cohort of adult trauma patients until the age of 75 years with a length of hospital stay of 3 days and more were derived from the Brabant Injury Outcome Surveillance (BIOS) study. The EuroQol-5D 3-level version and the Health Utilities Index were used 1 week, and 1, 3, 6, 12, and 24 months after injury. Four prediction models, for mobility, pain, self-care, and daily activity, were developed using LMMs with ordinal latent states and patient characteristics as predictors for the latent states.

Results

In total, 1107 patients were included. Four models with three ordinal latent states were developed, with different covariates in each model. The prediction of the (ordinal) latent states in the LMMs yielded pseudo-R2 values between 40 and 53% and between 21 and 41% (depending of the type R2 used) and classification errors between 24 and 40%. Most patients seem to recover fast as only about a quarter of the patients remain with severe problems after 1 month.

Conclusion

The use of LMMs to model the development of physical function post-injury is a promising way to obtain a prediction of the physical recovery. The step-by-step prediction fits well with the outpatient follow-up and it can be used to inform the patients more tailor-made to manage the expectations.
Appendix
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Metadata
Title
Prediction of recovery in trauma patients using Latent Markov models
Authors
Roos Johanna Maria Havermans
Felix Johannes Clouth
Koen Willem Wouter Lansink
Jeroen Kornelis Vermunt
Mariska Adriana Cornelia de Jongh
Leonie de Munter
Publication date
15-11-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-021-01798-7

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