Impacts of injury severity on long-term outcomes following motor vehicle crashes

Abstract

Background There is growing evidence that a range of pre-injury, injury related and post-injury factors influence social and health outcomes across the injury severity spectrum. This paper documents health related outcomes for people with mild, moderate and severe injury after motor vehicle crash (MVC) injuries in New South Wales, Australia. Methods This inception cohort study followed 2019 people injured in MVCs, for 6 and 12 months post-injury. We categorised moderate injury as hospital length-of-stay (LOS) of 2–6 days and Injury Severity Score (ISS) of 4–11, while severe injury as LOS ≥7 days or ISS ≥ 12. We examined differences in paid work status, 12-Item Short Form Survey (SF12), EQ-5D and World Health Organisation Disability Assessment Schedule II (WHODAS) outcomes longitudinally from baseline to 12 months between levels of injury severity using linear mixed models for repeated measures. We first considered minimally sufficient adjustment factors (age, sex, crash role, perceived danger in crash, pre-injury health, pre-injury EQ-5D, recruitment source), and then more extensive adjustments including post-injury factors. The presence of mediating pathways for SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) via post-injury factors was evaluated. Results Based on hospital length of stay (LOS), 25 and 10% of participants sustained moderate and severe injuries, respectively, while 43 and 4% had these injuries based on ISS. Twelve months post-injury LOS ≥7 days versus ≤1 day was associated with an estimated 9 units lower mean SF12 PCS using a minimally sufficient adjustment model, and LOS ≥ 7 days was associated with a 3 units lower mean SF12 MCS score. Mediation analyses (LOS ≥ 7 days vs ≤1 day) found for SF12 MCS outcomes, effects of injury severity were small and mostly indirect (direct effect − 0.03, indirect effect − 0.22). Whereas for SF12 PCS outcomes the effect of having a more severe injury rather than mild were both direct and indirect (direct effect − 0.50, indirect effect − 0.38). Conclusions Individuals with severe injuries (those with LOS ≥ 7 days and ISS 12+) had poorer recovery 12 months after the injury. In addition, post-injury mediators have an important role in influencing long-term health outcomes. Trial registration Australia New Zealand Clinical trial registry identification number - ACTRN12613000889752.

Psychological Distress, Pain and Insurance Claims Negatively Affect Long-Term Health-Related Quality of Life After Road Traffic Injuries

“…Secondly, despite LOS being the most common indicator for injury severity used by transportation authorities worldwide ( 17 ), critics have argued that LOS will depend on comorbidity factors and also be affected by changes in healthcare delivery over time ( 40 ). However, from our previous analyses using the same dataset, it was found that the LOS and Injury Severity Score were strongly related, supporting the use of LOS in this study ( 16 ). The DASS21, IESR and Pain Catastrophizing Scale were chosen for this study because of the excellent criterion validity for detecting these psychological disorders in injured participants ( 23 ); nonetheless they are not intended for the purposes of diagnosis of psychological disorder and not comparable to clinical diagnosis by mental health professionals.…”

“…Participants were divided into 3 groups of injury severity according to their self-reported length of hospital stay (LOS), with mild injury defined as participants with LOS of 1 day or less (including participants who did not present or who were not admitted to hospital), moderate for participants with LOS 2–6 days and severe with LOS ≥ 7 days. The use of LOS as injury severity measure has been common practice ( 17 ) and this LOS cut-off has been reported previously (and is strongly correlated with Injury Severity Score) ( 16 ). Participants were assessed using a structured interview at baseline, and again at 6 and 12 months after injury.…”

“…Our previous study found increasing injury severity had a significant negative effect on the 12-Item Short Form Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores at 12 months after injury. Using mediation analyses, baseline SF-12 scores, baseline pain, baseline psychological status and compulsory third-party (CTP) insurance claimant status were all involved in indirect pathways of effect of injury severity on 12-month SF-12 PCS and SF-12 MCS ( 16 ). Based on this previous work, the current study hypothesis is that injury severity affects 12-month SF-12 PCS and MCS through several pathways, and the aim of this study is to quantify the mediating factors involved.…”

Factors associated with long term work incapacity following a non-catastrophic road traffic injury: analysis of a two-year prospective cohort study

“…Injury severity was also evaluated using the Injury Severity Scale (ISS), derived from Abbreviated Injury Scale scores of affected body regions [ 33 ]. Injury Severity Scale scores were derived by a trained coder using methods and injury data sources described by Hung et al [ 34 ]. Participant-perceived danger of death during the crash was evaluated on a 5-point Likert scale (0-none to 5-overwhelming).…”

Audit of Motor Vehicle Accidents at a Trauma Center

“…Chassé M et al showed that higher BMI in women may be a risk factor [2]. Ntundu SH et al further showed that blunt abdominal injury was commonly linked to road traffic accidents (RTAs) [3][4][5][6][7][8][9][10]. Mortality was linked to extra-abdominal injury, injury to the head or pelvis, length of stay (LOS) ≥ seven days, systolic BP < 90, and anemia.…”