Abstract
BackgroundThere 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.MethodsThis 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.ResultsBased 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).ConclusionsIndividuals 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 registrationAustralia New Zealand Clinical trial registry identification number - ACTRN12613000889752.
Highlights
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
Since post-injury factors including baseline 12-Item short form survey (SF12) scores, baseline pain, baseline psychological status and compulsory third party insurance (CTP) claimant status are possible mediators of the impact of more severe injury on long-term outcomes, we evaluated the presence of these mediating pathways for SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) using MPLUS Version 7.3 (Step 4)
Of the 2019 participants recruited at baseline, the overall follow up rate was 73.5% for 6 months and 59.5% for 12 months
Summary
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. The World Health Organization Global Status Report on Road Safety 2018 highlighted the rising numbers of road traffic deaths reaching 1.35 million in 2016, and RTI were the leading cause of death among those aged 5–29 years worldwide [2]. Injury severity measures for motor vehicle crashes (MVC) vary with the source of data from different jurisdictions [4]. Common data sources include police crash reports, hospital records, and insurance agencies. Due to the lack of established linkage with hospital data and the availability of timely access to other data sources, admission to hospital and the length of hospital stay are often used in police and transportation authority official reports [4]. Multiple studies have considered hospital length of stay (LOS) reliability compared to specific injury severity measures such as the Abbreviated Injury Scale (AIS) [5], Injury Severity Score (ISS) [6] and hospital resource use (major surgery, transfusion, or prolonged ventilation) [6], and found that it to be a reasonable proxy measure with moderate to high discriminatory value in identifying serious injury
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