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Impact of comorbidities on survival following major injury across different types of road users

  • C.C. Shu
    Correspondence
    Corresponding author at: The George Institute for Global Health. Level 5, 1 King St, Newtown, NSW 2042, Australia.
    Affiliations
    The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW 2042, Australia
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  • M. Dinh
    Affiliations
    NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Locked Bag 2030, St Leonards, NSW 159, Australia

    Sydney Medical School, University of Sydney, Edward Ford Building (A27) Fisher Road, University of Sydney, NSW 2006, Australia
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  • R. Mitchell
    Affiliations
    Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, North Ryde, NSW 2109, Australia
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  • Z.J. Balogh
    Affiliations
    Department of Traumatology, John Hunter Hospital and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
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  • K. Curtis
    Affiliations
    The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW 2042, Australia

    Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Susan Wakil Health Building, Western Avenue, The University of Sydney, NSW 2006, Australia
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  • P. Sarrami
    Affiliations
    NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Locked Bag 2030, St Leonards, NSW 159, Australia

    South Western Sydney Clinical School, University of New South Wales, Locked Bag 7103, Liverpool, BC, NSW 1871, Australia
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  • H. Singh
    Affiliations
    NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Locked Bag 2030, St Leonards, NSW 159, Australia
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  • J.-F. Levesque
    Affiliations
    NSW Agency for Clinical Innovation (ACI), Locked Bag 2030, St Leonards, NSW 1590, Australia

    Centre for Primary Health Care and Equity, University of New South Wales, Level 3, AGSM Building, UNSW Sydney, NSW 2052, Australia
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  • J. Brown
    Affiliations
    The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW 2042, Australia
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      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

        • World Health Organization
        Global status report on road safety 2018.
        Licence: CC BYNC-SA 3.0 IGO, Geneva2018
        • OECD
        Towards zero: ambitious road safety targets and the safe system approach.
        Paris: OECD Publishing, Paris2008
        • Milzman DP
        • Boulanger BR
        • Rodriguez A
        • Soderstrom CA
        • Mitchell KA
        • Magnant CM.
        Pre-existing disease in trauma patients: a predictor of fate independent of age and injury severity score.
        J Trauma. 1992; 32: 236-244
        • Bergeron E
        • Lavoie A
        • Moore L
        • Clas D
        • Rossignol M.
        Comorbidity and age are both independent predictors of length of hospitalization in trauma patients.
        Can J Surg. 2005; 48: 361-366
        • Frydrych LM
        • Keeney-Bonthrone TP
        • Gwinn E
        • Wakam GK
        • Anderson MS
        • Delano MJ.
        Short-term versus long-term trauma mortality: a systematic review.
        J Trauma Acute Care Surg. 2019; 87: 990-997
        • Mitchell RJ
        • Curtis K
        • Braithwaite J.
        Health outcomes and costs for injured young people hospitalised with and without chronic health conditions.
        Injury. 2017; 48: 1776-1783
        • Hong J
        • Lee W-K
        • Kim MK
        • Lee B-E
        • Shin SD
        • Park H.
        Effect of comorbidity on length of hospital stay and in-hospital mortality among unintentionally injured patients.
        Accident Anal Prevent. 2013; 52: 44-50
      1. NSW Agency for Clinical Innovation. Major trauma in NSW: 2019-2020, 2020.

        • Australian Institute of Health and Welfare
        Australia's health 2016.
        Canberra, 2016
        • Tournier C
        • Charnay P
        • Tardy H
        • Chossegros L
        • Carnis L
        • Hours M.
        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
        • Devos S
        • Wit LD
        • Buyl R
        • Hubloue I
        • Lauwaert D
        • Pien K
        • et al.
        Factors influencing hospital admission and associated hospital costs of traffic victims admitted to an emergency department.
        J Transp Health. 2015; 2: 406-413
        • Mayou R
        • Bryant B.
        Consequences of road traffic accidents for different types of road user.
        Injury. 2003; 34: 197-202
      2. 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.

        • Vaa T.
        Impairments, diseases, age and their relative risks of accident involvement: results from meta-analysis.
        The Institute of Transport Economics, Oslo, Norway2003
        • Marshall SC
        • Man-Son-Hing M.
        Multiple chronic medical conditions and associated driving risk: a systematic review.
        Traffic Inj Prev. 2011; 12: 142-148
        • Mitchell R
        • Harvey L
        • Toson B
        • Draper B
        • Brodaty H
        • Close J.
        The association of select medical conditions with road transport and other hospitalised injury among older adults.
        J Road Saf. 2020; 31: 20-29
        • Preen DB
        • Holman CDAJ
        • Spilsbury K
        • Semmens JB
        • Brameld KJ.
        Length of comorbidity look back period affected regression model performance of administrative health data.
        J Clin Epidemiol. 2006; 59: 940-946
        • Sundararajan V
        • Henderson T
        • Perry C
        • Muggivan A
        • Quan H
        • Ghali WA.
        New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality.
        J Clin Epidemiol. 2004; 57: 1288-1294
        • Baker SP
        • O'Neill B
        • Haddon WJ
        • Long WB.
        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
        • NSW Institute of Trauma and Injury Management
        Initial management of closed head injury in adults - clinical practice guidline.
        2nd ed. Health NMo, Syendy, Australia2011 (editor)
        • Curtis KA
        • Mitchell RJ
        • Chong SS
        • Balogh ZJ
        • Reed DJ
        • Clark PT
        • et al.
        Injury trends and mortality in adult patients with major trauma in New South Wales.
        Med J Aust. 2012; 197: 233-237
        • Weijermars W
        • Bos N
        • Stipdonk H.
        Health burden of serious road injuries in the Netherlands.
        Traffic Inj Prev. 2016; 17: 863-869
        • Bureau of Infrastructure Transport and Regional Econimics
        Road trauma Australia 2019 statistical summary.
        Canberra ACT, Australia2020
        • Yasin YJ
        • Grivna M
        • Abu-Zidan FM.
        Reduction of pedestrian death rates: a missed global target.
        World J Emerg Surg. 2020; 15: 35
        • Curtis K
        • Nahidi S
        • Gabbe B
        • Vallmuur K
        • Martin K
        • Shaban RZ
        • et al.
        Identifying the priority challenges in trauma care delivery for Australian and New Zealand trauma clinicians.
        Injury. 2020; 51: 2053-2058
        • Vos T
        • Lim SS
        • Abbafati C
        • Abbas KM
        • Abbasi M
        • Abbasifard M
        • et al.
        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
        • Cheung A
        • Haas B
        • Ringer TJ
        • McFarlan A
        • Wong CL.
        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
      3. CHeReL. Quality assurance. https://www.cherel.org.au/quality-assurance (accessed 2021/08/23.