Traffic Crash Injuries Research Articles

Exploring Risk Factors with Crash Severity on China Two-Lane Rural Roads Using a Random-Parameter Ordered Probit Model

Understanding the factors that contribute to traffic crashes can help provide a fundamental basis to plan and develop appropriate countermeasures for road safety issues emerging in particular on two-lane rural roads. However, most of the studies have focused on urban roadways and freeway systems, and few studies have investigated the issue of heterogeneity on two-lane rural roads. The purpose of this study is to uncover the risk factors influencing crash severity on two-lane rural roads in China. A sample of 1490 traffic crashes occurring on two-lane rural roads between 2012 and 2017 was collected from the Mouding County Highway Bureau in Yunnan, China. A random-parameter ordered probit model was estimated using these data to capture underlying unobserved characteristics in personal traits, vehicle attributes, roadway conditions, environmental factors, and crash attribute. To better understand the effect of critical factors on crash severity outcome probability, an elasticity analysis was then introduced. The results show that six factors such as driver’s attribution, illegal driving behaviour, access segment, day of week, vehicle type, and crash form have a significant impact on the injury severity, and the impacts of driving behaviours, access segment, and vehicle-fixed object crashes had significant variation across observations. Besides, the correlations between critical factors and the probability of serious injury sustained in traffic crashes are identified and discussed. The local driver indicator has more positive impact on the crash severity than nonlocal driver, and nonaccess segment appears a higher probability of serious or vicious collisions. It is worth mentioning that motorcycle-involved crashes do show an obvious correlation with crash injury severity. As for crash forms, vehicle-vehicle crashes are more likely to lead to severe crash injury. Besides, high-risk driving behaviour (e.g., fatigue driving, speeding, and converse driving), weekends, and holidays are found to have significant contribution to increasing the probability of traffic crash injuries and fatalities on two-lane rural roads.

Impacts of augmenting heliports with school playgrounds on air medical transport time

Air ambulance has a huge advantage over the ground transport in providing rapid medical access to remote areas, shortening transport time, and improving survival rate. However, one of the hurdles to expanding air service coverage is the limited heliports for landing. This study aims to quantitatively assess the impact of adding school playgrounds as sub-heliports to reduce air medical transport time. To achieve this goal, the existing air medical transport infrastructure and traffic crash injury data were collected and analyzed to establish the relationship between transport time and injury severities. Then, air medical transport time with and without the augmentation of school playgrounds were estimated, respectively. Additionally, air medical service coverage maps were created to show the impact of fatal injury reduction and the estimated transport times. The findings have shown promising results of using school playgrounds to reduce air medical transport time, which is an encouraging sign for converting school playgrounds to potential heliports. Our research provides the quantitative evidence to the policy makers on expanding air medical capacity with existing infrastructure to improve the emergency medical services in South Korea.

Factors influencing duration of compensation following road traffic crash injury in older vs younger adults.

To identify factors independently associated with late claim closure, a proxy for recovery, in older (65+years) compared to younger (17-64years) adults following road traffic crash injury (RTI). Multivariable analysis of statewide compensation data from New South Wales (NSW), Australia, for NSW residents aged ≥17years injured in a non-catastrophic RTI between July 2010 and June 2013 with finalised claims (n=16687). Legal representation was the dominant factor independently associated with late claim closure in both age groups. However, the odds were doubly high for the younger group (younger: AOR 8.46, 95% CI 7.7-9.4; older: AOR 3.95, 95% CI 3.1-5.0). Median time to claim closure was shorter for older people. Older (and younger) claimants with legal representation are at increased risk of late claim closure and can be readily identified within routinely collected compensation data, enabling delivery of targeted strategies or supports early in the claims process.

Adult ADHD screening scores and hospitalization due to pedestrian injuries: a case-control study.

sBackgroundThe aim of this study was to investigate the association between adult ADHD screening scores and hospitalization due to pedestrian injuries in a sample of Iranian pedestrians.MethodsThrough a case-control study, a case population of 177 pedestrians injured by the vehicles in road traffic crashes were compared with 177 controls who lacked a record of intentional or unintentional injuries enrolled from various wards of Imam Reza University Hospital which is a specialty teaching hospital located in the same city with similar referral level. The cases and controls had an age range of 18–65 years and were matched on gender and age. ADHD symptom profile was assessed using the Persian Self-report Screening Version of the Conner’s Adult ADHD Rating Scales (CAARS-S:SV). The association of ADHD screening score and pedestrian injuries was investigated using multiple binary logistic regression to investigate the independent effect of ADHD index score on belonging to case group. Both crude and adjusted odds ratios were reported.ResultsMen comprised 86.4% of the study subjects. The crude odds ratios for all the four ADHD subscales to be associated with pedestrian injuries were 1.05, 1.08, and 1.04 for the subscales A (attention deficit), B (hyperactivity/impulsiveness) and ADHD index respectively. However, the association for subscale A was not statistically significant with a borderline p-value. The final multivariate analysis showed that variables associated with pedestrian injuries in the road traffic crashes were ADHD Index score (OR = 1.06, 95% CI: 1.01–1.12); economic status (including household income and expenditure capacity); educational level and total walking time per 24 h.ConclusionsAdult ADHD screening score can predict pedestrian injuries leading to hospitalization independently from sex, age, economic status, educational level and pedestrian exposure to traffic environment (average walking time).

Unsafe bicyclist overtaking behavior in a simulated driving task: The role of implicit and explicit attitudes

There is extensive literature into the mechanisms of injury in traffic crashes involving vulnerable road users (VRUs), but little research into the social or psychological factors in causation in these crash types. Attitudes and emotional associations can affect how people attend to objects in their visual environment and physical approach/avoidance responses, but few studies have extended these approaches into the road safety domain. Existing driving simulator studies of driver-bicyclist interactions have focused on driver behavior but not underlying attitudes and their effect on safety-related behaviors.This research explored the impact of implicit and explicit attitudes on drivers' behavior in interactions with bicyclists. In a driving simulator, various objective measures of safety (e.g., speed, passing distance, crash occurrence) were collected in an overtaking scenario. Participants' self-reported attitudes about driving and bicyclists were collected via survey instrument, along with an online test of subconscious attitudes called an Implicit Association Test, developed to examine preference between drivers and bicyclists.Importantly, this study examined not only distance, but duration and speed during overtaking. Results demonstrate that conscious attitudes affect how quickly and closely drivers overtake bicyclists. Participants who hold negative attitudes about bicyclists as a legitimate road user group passed significantly faster, while people with concerns about their knowledge or judgment about overtaking a bicyclist passed further and more slowly. Drivers self-identification as a bicyclist predicted higher passing speeds, while respondents who bicycle weekly drove closer but more slowly to the simulated bicyclist. These behaviors did not significantly differ based on the measure of implicit attitudes. The results of this study provide potential avenues for infrastructure and education interventions to improve pedestrian and bicyclist safety. Additionally, pairing driving simulator behavior with attitudinal measures represents a significant methodological contribution.

Twelve-month health outcomes for bicyclists and car occupants after a non-catastrophic traffic crash injury.

In this inception cohort study, we investigated differences in health outcomes for bicyclists (cyclists) and car occupants (car driver and passengers) at 12months after a non-catastrophic traffic injury. We also aimed to determine the independent predictors of key health outcomes among cyclists. Of the 2019 participants at baseline, 299 were cyclists and 927 were car occupants; 229 cyclists and 489 car occupants were followed up 12months after the injury. A telephone-administered questionnaire was used to obtain information on socio-economic, pre-injury health and injury-related characteristics. The survey also included tools on health outcomes: quality of life (SF-36 and EQ-5D-3L scales), pain severity, general psychological distress, trauma-related distress and pain catastrophizing. After adjusting for all potential confounders, general psychological distress scores and trauma-related distress scores were 2.05 and 0.60 units lower for cyclists than car occupants (P=0.01 and P<0.0001, respectively) at 12-month follow-up. Cyclists showed greater improvement than car occupants over 12months in mean pain severity ratings and SF-12 physical component summary (PCS) score (both P<0.0001) but had lower mean pain severity and similar PCS scores at baseline. However, cyclists showed less improvement in SF-12 mental component summary (MCS) scores (P=0.03) than car occupants but had higher mean MCS scores at baseline. Pre-injury and baseline quality-of-life scores and pain catastrophizing as well as injury involving the head or face were significant predictors of overall psychological functioning, general psychological distress and trauma-related distress in cyclists at 12months. Cyclists demonstrated better recovery than car occupants at 12months after sustaining a traffic crash injury. Prognostic indicators of long-term physical functioning and psychological well-being in cyclists were related to pre-injury and baseline quality of life and pain factors and injury location.

PROTOCOL: Effectiveness of road safety interventions: An evidence and gap map.

The Decade of Action for Road Safety 2011-2020, officially proclaimed by the UN General Assembly in March 2010, sought to reduce morbidity and mortality due to road traffic injuries (RTI) significantly. While there is reasonable agreement internationally on safer designs of motor vehicles (except locally produced vehicles like three-wheeled scooter taxis, tuk-tuks, jeepneys, etc.), there is a lack of evidence based interventions in road and infrastructure design, police enforcement and post-crash care. Researchers in the field of traffic safety have been aware of the existence of counterintuitive results in their area of work for more than four decades. The fact that many interventions do not result in reductions in RTI is mainly because a large number of studies only measure intermediate outcomes like change in behaviour or knowledge and not the actual results in the field. The scope of this evidence and gap map (EGM) is to cover relevant studies in road safety sector from all countries and present the effectiveness of interventions in terms of mainly traffic crash injuries as its outcome. The interventions adopted in this EGM are classified into five broad categories: Human factors, vehicle factors and protective devices, road design, infrastructure and traffic control, post-crash pre-hospital care and legal and institutional framework. In order to come closer to accomplishing targets for road safety, it is important to allocate resources to promote interventions that are effective in achieving outcomes in the context of road safety. A mapping will provide a comprehensive overview of existing knowledge in the area of road safety and its effectiveness across the world. The map will guide programme managers to high quality evidence and inform targeted commissioning of future research.

Estimate of safety impact of lane keeping assistant system on fatalities and injuries reduction for China: Scenarios through 2030

Objective: The objective of this research is to assess the number of casualties in China's road traffic accidents that can be reduced by lane keeping assistant (LKA) through 2030, based on the historical data on the number of fatalities and injuries in China and the proportion of LKA planed in China policy.Methods: The analysis was divided into 4 main parts: (1) Predict injuries and fatalities caused by traffic accident in China without LKA through 2030; (2) Apply the methodology to estimate the percentage reduction in injuries and fatalities assuming 100% penetration rate of LKA; (3) Predict the penetration rate of intelligent vehicles with LKA system through 2030 under Chinese government policy planning; (4) Calculate the specific number for the reduction in injuries and fatalities with LKA through 2030.Results: According to the historical accident data, the fatalities caused by traffic accidents without LKA are predicted to be 55,686 in 2020, 51,420 in 2025, and 47,484 in 2030, while the injuries are 188,285, 164,135, and 143,163. The percentage reduction with 100% penetration rate was calculated to be 14.8% for fatalities and 10.1% for injuries. Based on the China policy, the market penetration rate of intelligent vehicle with LKA was predicted to be 44.2% in 2025 and 77.7% in 2030. With the great increase of market penetration rate, the maximum reduction in injuries and fatalities from 2018 to 2030 was calculated. Compared to the previsions without LKA, 3370 fatalities and 7359 injuries will be reduced in 2025, while the specific number is 5465 fatalities and 11,270 injuries in 2030. Considering the three main limitations of LKA, the adjusted result would become approximately 1/9 of the original ideal result to be 375 fatalities and 818 injuries in 2025, while the specific number is 608 fatalities and 1253 injuries in 2030.Conclusions: The safety impact of LKA system on traffic crash fatalities and injuries reduction in China has been estimated. The results indicate that LKA system has considerable potential benefit in China. Interaction design with the driver, setting of the minimum travel speed and adaptability of the harsh conditions of the camera are the breakthrough points for maximizing safety benefits. The safety system of the intelligent vehicle has different benefits in different countries.

Functional and employment outcomes following road traffic crashes in Queensland, Australia: Protocol for a prospective cohort study.

IntroductionMost road traffic crash injuries are minor to moderate in severity, but can still lead to persistent disability. One aspect of this disability is being unable to return to paid employment. Being unable to work has follow-on effects for personal financial stability, health and quality of life, as well as increasing costs for employers and society more broadly. In order to better understand the trajectory of returning to work in individuals injured in road traffic crashes, a prospective inception cohort study will be conducted across multiple sites in Queensland, Australia that will assess work and health outcomes in the first year after injury. This study protocol describes the process undertaken by the research team to design the methodology of this study. MethodsParticipants aged between 18 and 64 years, injured in a crash involving a motorised vehicle, will be recruited from public hospitals in Queensland. Participants will be excluded if their injuries are severe, including severe traumatic brain injury or spinal cord injury. Baseline data collection will occur within 28 days of the injury, with major follow up assessments occurring at 6 and 12 months post-baseline. Outcome measures include return to work status, health-related quality of life, musculoskeletal pain, disability, psychosocial well-being, and physical activity. Ethics and disseminationThis study has been approved by Townsville Hospital and Health Service Human Research Ethics Committee, and The University of Queensland Human Research Ethics Committee. RegistrationAustralian New Zealand Clinical Trials Registry reference number ACTRN12618001684213.

Predictors of health-related quality of life after non-catastrophic injury sustained in a road traffic crash.

Health-related quality of life (HRQoL) is an important patient-reported outcome that warrants greater attention in individuals who sustained a non-catastrophic injury in a road traffic crash. Additional robust data on HRQoL outcomes after a non-catastrophic injury are needed to effectively identify potential targets for studies of tertiary prevention of poor recovery after a crash. We assessed the association between non-catastrophic road traffic crash injuries and HRQoL and factors that independently affect long-term HRQoL. In this inception cohort study, injured participants (≥17years old) were identified from various sources including hospital emergency departments by a medical examination by a registered healthcare professional in New South Wales (Australia) and followed up after 12months. HRQoL was measured by the European Quality of Life-5 Dimensions (EQ-5D-3L) and Medical Outcomes Survey Short Form 12 items (SF-12). A range of socio-demographic, pre-injury health, psychological, and injury-related factors were considered potential predictors of HRQoL in regression analyses. Among 2019individuals identified, 1201 (59.5%) were followed up after 12months. HRQoL significantly improved between baseline and 12-month follow-up: EQ-5D-3L summary score (0.41-unit difference); SF-12 physical component summary score (PCS; 13.6-unit difference) and mental component summary score (MCS; 3.5-unit difference). Over 12months, HRQoL score was lower for people claiming compensation than others (P<0.0001). Key predictors of better 12-month EQ-5D-3L summary score and visual analogue scale score for pain were age, not claiming compensation, reduced body mass index, less pain severity, less pain-related disability, and less general psychological distress. Significant predictors of SF-12 PCS score were injury to the neck (P=0.02) or head or face (P=0.01), being a driver or passenger at the time of the crash (P<0.0001), hospital admission (P<0.0001) and pain severity (P<0.0001). Baseline variables associated with 12-month SF-12 MCS scores were head or face injury (P=0.02), pre-injury health (P=0.04), pre-injury psychological conditions (P=0.04), trauma-related distress (P=0.0002) and general psychological distress (P<0.0001). A wide spectrum of biopsychosocial factors contribute to HRQoL after a road traffic crash injury. These epidemiological data are potentially important because they could identify potential targets for studies of tertiary prevention of persistently poor HRQoL after such an injury.

Effects of ethyl alcohol on injuries severity according to injury severity scales in pedestrian fatal injury in traffic crashes

Introduction: The dominant cause of injuries in traffic crashes. A significant portion of them affects victims under the influence of ethyl alcohol. The goal of the studies was to assess the correlation between the state of sobriety and the severity of injuries expressed by injury severity scales in fatal pedestrian victims of traffic crashes. Research Material and Method: The data were obtained from the Warsaw Medical University's Department of Forensic Medicine. The analysis covered the data for 2009–2013 and included 200 fatal pedestrian victims hit by passenger cars. The assessment of the effect of risk factors on injury severity expressed in terms of injury severity scales such as Life Threat Indicator (LTI), International Classification based Injury Severity Score (ICISS), Injury Severity Score (ISS) and New Injury Severity Score (NISS), was made using adequately selected methods of statistical analysis. Results: As alcohol concentration increases in women, the values of LTI, ICISS-10 and ICISS-15 decrease, which denotes more severe injuries. In the ISS and NISS, the effect of alcohol concentration on the severity of injuries turned out to be negligible. However, these injuries are significantly heavier in women than in men. According to all the scales used, the older the victims, the milder injuries cause their death. Conclusions: The studies show that ethyl alcohol concentration may harm injury severity, especially in the case of women. The assessment of the severity of injuries in traffic crash victims is significantly influenced by their age and gender. The more risk factors the scale takes into consideration, the more precise is the assessment.

Analysis of Factors Affecting Injury Severity in Traffic Crashes on Arizona Tribal Lands

Reducing fatal and serious injuries sustained in traffic crashes on tribal lands is a priority of federal, state, and local agencies in the United States. In the state of Arizona, the proportion of fatal and severe injury crashes on several areas of tribal land are 4.0% higher compared with statewide statistics. There is a need to investigate why higher proportions of fatal and severe injuries are occurring on tribal lands to plan effective countermeasures aimed at improving traffic safety in these areas. This study presents an analysis of factors affecting injury severity in crashes occurring within five tribal reservations in the state of Arizona. Crash data were obtained from the Arizona Department of Transportation, and the analysis included data for 9,597 persons involved in traffic crashes on these tribal lands for the years 2010–2016. An ordered logit model with random parameters was estimated using this data to identify factors significantly associated with severe injury outcomes in the event of a crash on tribal lands. Several person-, vehicle-, roadway-, and environmental-related variables were found to impact injury severity. For instance, alcohol and safety device usage were significantly associated with severity outcomes. The results of this study have the potential to aid transportation agencies effectively plan strategies to reduce traffic crash injuries and fatalities on tribal lands, and potential countermeasures considering the 4Es of traffic safety (engineering, education, enforcement, and emergency medical services) are discussed.

Differential Predictors of Pain Severity Over 12 Months Following Noncatastrophic Injury Sustained in a Road Traffic Crash

There is paucity of prospective studies that have examined rates and prognostic indicators of pain severity after a road traffic crash injury. This cohort study involved 1,854 participants aged ≥17 years with a noncatastrophic injury. Primary analyses of pain severity involved 1604 individuals who reported any pain since the injury at baseline Of these, 1,188 and 972 participants were reexamined at the 6- and 12-month follow-up, respectively. The mean pain severity (primary study outcome) was assessed using a numeric rating scale (NRS), and a range of possible pain predictors were assessed. A mean pain NRS score of 4.9 was observed at baseline, and the mean NRS score was 2.1 at the 12-month follow-up. At the 6- and 12-month follow-up, 21% and 17.5% reported clinically significant pain (NRS score of ≥5), respectively. After multivariable adjustment, key predictors of pain severity ratings over the 12 months included the following, which were measured at baseline: age, sex, education, claim compensation, spine/back injury, being a bicyclist, physical well-being, pain-related catastrophizing, pain-related disability, and trauma-related and general psychological distress. Clinically significant pain was experienced by just >1 in 6 participants 12 months after injury. Several independent contributors to chronic pain identified in this study are modifiable, reinforcing their inclusion as targets in pain management programs. PerspectiveThis cohort study involving participants who sustained a noncatastrophic injury in a road traffic crash established the predictors of pain severity over 12 months. Study findings reiterate and reinforce the importance of being cognizant of a wide spectrum of biopsychosocial predictors both in the management and rehabilitation of injured persons.

Injury prevalence and safety habits of boda boda drivers in Moshi, Tanzania: A mixed methods study.

BackgroundTraffic crashes are a major cause of global morbidity and mortality disproportionately affecting low- and middle-income countries (LMICs). Motorcycle taxi (boda boda) drivers are particularly vulnerable because they are exposed to traffic risks with limited safety equipment. This study aims to characterize injury prevalence and safety habits among boda boda drivers, as well as ways to improve road traffic safety in LMICs.MethodsA cross-sectional mixed methods study was conducted with 300 boda boda drivers between 24 March and 3 April 2014 in urban Moshi, Tanzania. A convenience sample of participants was drawn from 25 of 58 registered boda boda stands and 2 of 31 unregistered stands. Data were analyzed using R, and content thematic analysis was performed and agreed upon by three investigators. Logistic regression models were used to evaluate the association between boda boda characteristics and injury risk.ResultsIn total, 300 drivers participated, of whom 148 (49.3%) had experienced a crash during their lifetime, and 114 (77.0%) sustained at least one injury. Only 27 of those injured (23.4%) were hospitalized. Of all participants, 220 (73.3%) reported consistent helmet usage, despite 285 participants (95.0%) agreeing that helmet usage reduces injury severity. From the 280 helmets observed, 231 (82.5%) were either damaged or fit improperly. Having a cracked helmet was associated with higher risk of being involved in a traffic crash. Owning a helmet with a proper fit was associated with reduced risk for a traffic crash (OR = 0.06) and road traffic injuries (OR = 0.07). A thematic analysis of boda boda drivers’ suggestions to increase road safety identified four intervention areas: 1) roadway infrastructure and traffic regulation, 2) road user attitudes and safe driving behaviors, 3) education and training, and 4) law enforcement.ConclusionOur study demonstrates boda boda drivers’ safety behaviors and identifies four intervention areas that can be leveraged to increase overall road traffic safety. Unfortunately, while boda boda drivers are aware of ways to improve safety, adherence to safety habits remains low. Successful multi-sectoral interventions are needed to improve road safety for boda boda drivers in Tanzania.

Occupants’ seatbelt use are related to vehicle type and usage on a Ghanaian university campus

Seat belt use does not only save lives but prevents the severity of injuries in road traffic crashes (RTCs). Vehicle type and usage have been found to influence the use of seat belt in cities like Kumasi, the host of Kwame Nkrumah University of Science and Technology (KNUST) campus. This paper presents a study on an un-obstructive survey of seat belt use by vehicle occupants entering and leaving KNUST campus through the four entrances from 7 to 9 am and 3 to 5 pm on five weekdays. A total of 5489 vehicles with 9542 occupants comprising 5489 drivers, front-right and first back seat and second back seat passengers were observed. The majority of the private and SUV drivers used seat belts. Meanwhile, almost all the commercial drivers did not use seat belts. There is a statistically significant relationship between vehicle type and use and the use of seat belt in KNUST.

Morbidity and mortality from road traffic crashes in children in Metro West, City of Cape Town – 2014

The road traffic crash injury burden significantly impacts the lives of South African children. This study aimed to assess the fatal and non-fatal pattern of road traffic crash injury of children under 13 years old from Metro West, City of Cape Town, from 1 January until 31 December 2014. The data were stratified by age, sex and mechanism of road traffic crash. The overall mortality rate was 8.7 per 100 000 population and pedestrians contributed the most to this burden (72.5%). There were more male children involved in a road traffic crash (p = 0.0001). The greatest proportion of fatal and non-fatal road traffic crash injuries was observed in children aged 5–9 years. Fractures contributed to the greatest rate of years lived with disability (3.0 years of life lived with disability per 100 000). Our study found that the burden of road traffic crashes primarily affects male pedestrians aged 5–9 years old.

Promote buckling up and save a child’s life

Road traffic crash (RTC) injuries are the leading cause of child mortality and morbidity in South Africa for children between the ages of 1 and 18 years. The World Health Organization’s Global Status Report on Road Safety 2015 rated the African continent’s roads the world’s most dangerous. After pedestrian injuries, passenger injuries are the most lethal. There is no doubt that a seat belt is the single most effective feature in a vehicle to reduce the severity of injury to the vehicle’s occupants; wearing a seat belt reduces the risk of fatal injury by up to 50% and 75% for front seat and rear seat occupants, respectively. Children have specific anatomical and physiological limitations that render them more vulnerable to serious injury, but the prevention of childhood RTC injuries has unfortunately not received the deserved attention by the medical fraternity. There is currently ample evidence that the use of seat belts and appropriate child restraint seats has led to a significant reduction in RTC fatalities and injuries. It is, therefore, the duty of every healthcare worker to lead by example by using child restraints correctly, and actively encouraging the use of these devices for all their clients and patients.

Recovery trajectories for long-term health-related quality of life following a road traffic crash injury: Results from the UQ SuPPORT study

BackgroundDiminished physical and mental health-related quality of life (HRQoL) is a common consequence of road traffic crash (RTC) injury. This study aimed to (a) determine the probable recovery trajectories in physical and mental HRQoL; (b) examine the impact of posttraumatic stress disorder (PTSD) on HRQoL scores within these trajectory groups; and (c) examine the influence of predictor covariates on trajectory group membership. Methods336 (63% female, Mage =44.72; SD =14.77) injured RTC survivors completed the SF-36v2 at approximately 6, 12, and 24 months after sustaining a RTC injury. Participants also completed telephone interviews to assess prior history of psychological disorder and current PTSD at each wave. ResultsThree trajectories were identified for SF-36v2 Physical Component Score (PCS): ”gradual recovery” (27.3%);”low but improving” (54.7%); and”severe and chronic” (17.9%). Four trajectories were defined for SF36v2 Mental Component Score (MCS): “unaffected” (19.1%);”severe but improving” (24.1%);”severe and declining” (17.3%); and”low but improving” (39.5%). A PTSD diagnosis significantly reduced SF36v2 component scores only in trajectories associated with poorer outcome. Age was predictive of trajectory group membership for PCS, whereas injury severity was predictive of trajectory group membership for MCS. LimitationsUse of a compensation seeking sample affects generalizability to the general RTC population. ConclusionsThis study identified a concerning subgroup of individuals who have chronic and/or declining physical and mental HRQoL that can be impacted by a diagnosis of PTSD. The development of interventions with a special focus on associated psychological injury is needed to improve the HRQoL of at-risk individuals following RTC injury.

Health-related quality of life 24 months after sustaining a minor musculoskeletal injury in a road traffic crash: A prospective cohort study

ABSTRACTObjectives: A better understanding of the long-term factors that independently predict poorer quality of life following mild to moderate musculoskeletal injuries is needed. We aimed to establish the predictors of quality of life (including sociodemographic, health, psychosocial, and pre-injury factors) 24 months after a noncatastrophic road traffic injury.Methods: In a prospective cohort study of 252 participants with mild/moderate injury sustained in a road traffic crash, quality of life was measured 24 months following the baseline survey. A telephone-administered questionnaire obtained information on various potential explanatory variables. Health-related quality of life was measured using the European Quality of Life–5 Dimensions (EQ-5D) and Medical Outcomes Survey Short Form–12 (SF-12). Multivariable linear regression analyses determined the associations between explanatory variables and quality of life measures.Results: Mean SF-12 physical component summary (PCS) and mental component summary (MCS) scores increased by 7.3 and 2.5 units, respectively, from baseline to 24-month follow-up. Each 10-year increase in baseline age was independently associated with 3.1-unit (P < .001) and 1.5-unit (P = .001) decrease in EQ Visual Analogue Scale (VAS) and SF-12 PCS scores at follow-up, respectively. Poor/fair compared to excellent pre-injury health was associated with a 0.16-, 21.3-, and 11.5-unit decrease in EQ-5D summary (P = .03), VAS scores (P = .001), and SF-12 PCS scores (P < .001), respectively. Baseline pain severity ratings and pain catastrophizing scores were inversely associated with 24-month EQ VAS scores (both P < .001). Each unit increase in baseline pain score (P = .001) and pain catastrophizing score (P = .02) was associated with a 1.0- and 4.6-unit decrease in SF-12 MCS scores at 24 months, respectively. Other observed predictors of quality of life measures (EQ-5D summary and/or VAS scores and/ or SF-12 MCS) included marital status, smoking, hospital admission, pre-injury health (anxiety/depression and chronic illness), and whiplash injury.Conclusion: Sociodemographic indicators, pre-injury health, and biopsychosocial correlates were independently associated with health-related quality of life 24 months following a noncatastrophic road traffic crash injury.

Risk factors affecting injury severity determined by the MAIS score

ABSTRACTObjective: Traffic crashes result in a loss of life but also impact the quality of life and productivity of crash survivors. Given the importance of traffic crash outcomes, the issue has received attention from researchers and practitioners as well as government institutions, such as the European Commission (EC). Thus, to obtain detailed information on the injury type and severity of crash victims, hospital data have been proposed for use alongside police crash records. A new injury severity classification based on hospital data, called the maximum abbreviated injury scale (MAIS), was developed and recently adopted by the EC. This study provides an in-depth analysis of the factors that affect injury severity as classified by the MAIS score.Method: In this study, the MAIS score was derived from the International Classification of Diseases. The European Union adopted an MAIS score equal to or greater than 3 as the definition for a serious traffic crash injury. Gains are expected from using both police and hospital data because the injury severities of the victims are detailed by medical staff and the characteristics of the crash and the site of its occurrence are also provided. The data were obtained by linking police and hospital data sets from the Porto metropolitan area of Portugal over a 6-year period (2006–2011). A mixed logit model was used to understand the factors that contribute to the injury severity of traffic victims and to explore the impact of these factors on injury severity. A random parameter approach offers methodological flexibility to capture individual-specific heterogeneity. Additionally, to understand the importance of using a reliable injury severity scale, we compared MAIS with length of hospital stay (LHS), a classification used by several countries, including Portugal, to officially report injury severity. To do so, the same statistical technique was applied using the same variables to analyze their impact on the injury severity classified according to LHS.Results: This study showed the impact of variables, such as the presence of blood alcohol, the use of protection devices, the type of crash, and the site characteristics, on the injury severity classified according to the MAIS score. Additionally, the sex and age of the victims were analyzed as risk factors, showing that elderly and male road users are highly associated with MAIS 3+ injuries. The comparison between the marginal effects of the variables estimated by the MAIS and LHS models showed significant differences. In addition to the differences in the magnitude of impact of each variable, we found that the impact of the road environment variable was dependent on the injury severity classification.Conclusions: The differences in the effects of risk factors between the classifications highlight the importance of using a reliable classification of injury severity. Additionally, the relationship between LHS and MAIS levels is quite different among countries, supporting the previous conclusion that bias is expected in the assessment of risk factors if an injury severity classification other than MAIS is used.