Using the EuroQol-5D to measure changes in quality of life 12 months after discharge from an intensive care unit

Objective: To compare changes in the health-related quality of life (HRQOL) of critical care patients by diagnostic category. Design: Prospective, cohort study. HRQOL assessed 3 months before admission and 1 year after discharge from the intensive care unit (ICU). Patients were classified as: trauma injury (TI), scheduled surgery (SS), unscheduled surgery (US), and other medical conditions (MC). Setting: Department of Intensive Medicine, University Hospital of Bellvitge, Barcelona, Spain. Patients: Three hundred and thirty-four patients admitted to ICU from October 1994 to June 1995 (62 TI patients, 181 SS patients, 19 US patients, and 72 MC patients). Interventions: Surgical and medical procedures. Measurements and results: Changes in HRQOL varied considerably between diagnostic categories, with TI patients having significantly worse HRQOL one year after discharge from the ICU compared to 3 months prior to admission [change in median EQ Visual Analogue Scale (EQ-VAS) score from 100 to 65, P < 0.001], and SS patients reporting improved HRQOL (change in median EQ-VAS scores from 60 to 75, P < 0.001). Slight deterioration was observed in the other two diagnostic categories. Twelve months after discharge, the EQ dimension in which the largest proportion of patients in all groups reported problems was usual activities (47 % of SS and US patients; 69 % of TI patients). Using proxy scores at baseline or follow-up had little effect on results. Conclusions: The degree and direction of change in ICU patients' HRQOL 1 year after discharge depends considerably on diagnostic category. Proxy responses can be reliably used with the EQ-5D when measuring change in HRQOL.