Systematic Review of Health-Related Quality of Life Over Time Following Major Non-Neurological Trauma

INTRODUCTION: Long-term outcomes after major injury, such as Health-related Quality of Life (HQoL), remain poorly characterized. Previous reviews have combined heterogeneous populations, limiting conclusions about recovery following major non-neurological trauma specifically. This study aims to systematically review changes in HQoL over time in adults with major non-neurological trauma. METHODS: We searched Medline and CINAHL (inception to August 8, 2025) for English-language studies examining HQoL in adults (≥16 y) with major non-neurological trauma (Injury Severity Score ≥9 or author-defined) at ≥2 postdischarge time points using standardized assessments. Two reviewers independently screened, extracted data, and assessed risk of bias using RTI Item Bank criteria. Narrative synthesis was conducted given heterogeneity precluding meta-analysis. RESULTS: Twenty-one studies (representing 12 cohorts) were included. Major trauma was consistently associated with marked immediate HQoL decline followed by gradual, incomplete recovery. Physical health showed larger initial declines but more consistent improvement, with greatest gains within 6 mo. Mental health demonstrated smaller initial declines and slower, heterogeneous recovery with minimal improvement in many patients. Subgroup analyses identified worse outcomes associated with declining social support, financial toxicity, post-traumatic stress disorder, depression, female gender, and major complications. Women reported consistently worse HQoL across contexts after adjusting for confounders. High attrition (>20% short-term, >30% long-term) and heterogeneous measures limited evidence strength. CONCLUSIONS: HQoL recovery following major non-neurological trauma is prolonged and incomplete, with physical recovery outpacing mental health. Findings underscore the need for long-term, holistic approaches to trauma care and ongoing research focused on improving quality-of-life outcomes for survivors of major injury.