Highlights
- •Among road users with major trauma, those with higher Charlson Comorbidity Index score, cardiovascular diseases and diabetes were more likely to die, regardless of age and road user type. The association between death and cardiovascular diseases was stronger in males than females.
- •Pedestrians with severe injury (ISS ≥25) and severe impaired consciousness (GCS total score 3-8) were more likely to die, regardless of pre-existing comorbidities or age, compared to car occupants.
- •Our findings highlight the need to identify ways to enhance the management of road trauma patients with pre-existing cardiovascular diseases, diabetes, or multiple comorbidities, as well as the need to prioritize actions to prevent pedestrian crashes in strategies to reach Vision Zero.
Abstract
Background
While comorbidities and types of road users are known to influence survival in people
hospitalised with injury, few studies have examined the association between comorbidities
and survival in people injured in road traffic crashes. Further, few studies have
examined outcomes across different types of road users with different types of pre-existing
comorbidities. This study aims to examine differences in survival within 30 days of
admission among different road user types with and without different pre-existing
comorbidities.
Method
Retrospective cohort study using data for all major road trauma cases were extracted
from the NSW Trauma Registry Minimum Dataset (1 January 2013 – 31 July 2019) and linked
to the NSW Admitted Patient Data Collection, and the NSW Registry of Births, Deaths
and Marriages - death dataset. Pre-existing comorbidities and road user types were
identified by the International Statistical Classification of Diseases and Related
Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes and Charlson
Comorbidity Index in the Trauma Registry, hospital admission, and death datasets.
Logistic regression was used to assess the associations between six types of road
users (pedestrian, pedal cycle, two- and three-wheel motorcycle, car and pick-up truck,
heavy vehicle and bus, and other types of vehicle) and death within 30 days of hospital
admission while controlling for comorbidities. All models used ‘car and pick-up truck
driver/passenger’ as the road user reference group and adjusted for demographic variables,
injury severity, and level of impaired consciousness.
Results
Within 6253 traffic injury person-records (all aged ≥15 years old, ISS>12), and in
final models, injured road users with major trauma who had a history of cardiovascular
diseases (including stroke), diabetes mellitus, and higher Charlson Comorbidity Index
score, were more likely to die, than those without pre-existing comorbidities. Furthermore,
in final models, pedestrians were more likely to die than car occupants (OR: 1.68
– 1.77, 95CI%: 1.26 – 2.29 depending on comorbidity type).
Conclusions
This study highlights the need to prioritize enhanced management of trauma patients
with comorbidities, given the increasing prevalence of chronic medical conditions
globally, together with actions to prevent pedestrian crashes in strategies to reach
Vision Zero.
Keywords
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References
- Global status report on road safety 2018.Licence: CC BYNC-SA 3.0 IGO, Geneva2018
- Towards zero: ambitious road safety targets and the safe system approach.Paris: OECD Publishing, Paris2008
- Pre-existing disease in trauma patients: a predictor of fate independent of age and injury severity score.J Trauma. 1992; 32: 236-244
- Comorbidity and age are both independent predictors of length of hospitalization in trauma patients.Can J Surg. 2005; 48: 361-366
- Short-term versus long-term trauma mortality: a systematic review.J Trauma Acute Care Surg. 2019; 87: 990-997
- Health outcomes and costs for injured young people hospitalised with and without chronic health conditions.Injury. 2017; 48: 1776-1783
- Effect of comorbidity on length of hospital stay and in-hospital mortality among unintentionally injured patients.Accident Anal Prevent. 2013; 52: 44-50
NSW Agency for Clinical Innovation. Major trauma in NSW: 2019-2020, 2020.
- Australia's health 2016.Canberra, 2016
- A few seconds to have an accident, a long time to recover: consequences for road accident victims from the ESPARR cohort 2 years after the accident.Accident Anal Prevent. 2014; 72: 422-432
- Factors influencing hospital admission and associated hospital costs of traffic victims admitted to an emergency department.J Transp Health. 2015; 2: 406-413
- Consequences of road traffic accidents for different types of road user.Injury. 2003; 34: 197-202
Markogiannakis H, Sanidas E, Messaris E, Koutentakis D, Alpantaki K, Kafetzakis A, et al. Motor vehicle trauma: analysis of injury profiles by road-user category. 2006; 23(1): 27-31.
- Impairments, diseases, age and their relative risks of accident involvement: results from meta-analysis.The Institute of Transport Economics, Oslo, Norway2003
- Multiple chronic medical conditions and associated driving risk: a systematic review.Traffic Inj Prev. 2011; 12: 142-148
- The association of select medical conditions with road transport and other hospitalised injury among older adults.J Road Saf. 2020; 31: 20-29
- Length of comorbidity look back period affected regression model performance of administrative health data.J Clin Epidemiol. 2006; 59: 940-946
- New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality.J Clin Epidemiol. 2004; 57: 1288-1294
- The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.J Trauma Acute Care Surg. 1974; 14: 187-196
- Initial management of closed head injury in adults - clinical practice guidline.2nd ed. Health NMo, Syendy, Australia2011 (editor)
- Injury trends and mortality in adult patients with major trauma in New South Wales.Med J Aust. 2012; 197: 233-237
- Health burden of serious road injuries in the Netherlands.Traffic Inj Prev. 2016; 17: 863-869
- Road trauma Australia 2019 statistical summary.Canberra ACT, Australia2020
- Reduction of pedestrian death rates: a missed global target.World J Emerg Surg. 2020; 15: 35
- Identifying the priority challenges in trauma care delivery for Australian and New Zealand trauma clinicians.Injury. 2020; 51: 2053-2058
- Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet North Am Ed. 2020; 396: 1204-1222
- Canadian study of health and aging clinical frailty scale: does it predict adverse outcomes among geriatric trauma patients?.J Am Coll Surg. 2017; 225 (e3): 658-665
CHeReL. Quality assurance. https://www.cherel.org.au/quality-assurance (accessed 2021/08/23.
Article info
Publication history
Published online: July 12, 2022
Accepted:
July 3,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
