Consequences of road traffic accidents for different types of road user
Introduction
There are many studies which describe and compare patterns of severity of injuries for the various types of road users; for example a previous Oxford study [20]. Other research has concentrated on more limited comparisons, for example the patterns of physical injury associated with being a vehicle driver or passenger [22], motorcyclist [3], [22], cyclist [7], [8], [18], [20], [22] or pedestrian [2], [9], [10], [17], [20], [21], [22] and on particular issues such as the use of seat belts and cycle helmets [7]. Allowing for differences in case selection, these provide a consistent picture of differences in demographic, accident and injury characteristics. There is very little information on associated disability and psychological outcome although such consequences are known to be large for less serious injuries such as whiplash [19] and for severe injuries [6]. It might be expected that there would be marked differences between road user groups in both early and late outcomes.
This paper reports findings from a prospective study of consecutive adult attenders at an emergency department over a 1-year period following all types of road traffic accident. Previously published papers have already described physical, psychological and social outcome for the whole group [11], [12], [13], [14], [15], [16]. Psychiatric complications were frequent, occurring in a third of subjects, and often persistent. Although the small proportion of the most severely injured victims had poorer long-term outcomes there was, overall, little relationship between the nature or severity of injuries and any aspect of outcome. The main predictors of later pain, disability and of psychiatric disorder were the perception of the accident as being frightening, initial distress, history of previous psychological problems and negative beliefs during convalescence [4], [16].
Section snippets
Patients and methods
A prospective study of a 1 year cohort (n=1441) of consecutive adult attenders aged 17–69 years at the Accident and Emergency Department of a teaching district general hospital following a road traffic accident. We excluded 31 suffering major head injury, 2 who were too ill to take part, 32 who did not speak English and 1 of no fixed abode. All suitable subjects were asked to complete a questionnaire whilst in the Accident and Emergency Department or sent a questionnaire to complete at home
Medical information
Data relating to the accident, injuries and management was extracted from medical notes and entered on a standard data sheet. The Injury Severity Score (ISS) of the Abbreviated Injury Scale (AIS) [1] was used to rate information about injuries from the hospital case notes. On the AIS each of 10 body areas of injury is coded on a six-point scale from 1 ‘minor’ to 6 ‘maximum’. The ISS is the sum of the squares of the highest AIS score in each of the three most injured ISS body regions (head or
Results
Demographic and medical data was available for a cohort of consecutive subjects (n=1441), of whom 56% were men. Nearly three-quarters were vehicle occupants (52% were drivers, 21% were passengers). Over two-thirds (87%) of patients had homes in the South Central region; 77% had an Oxfordshire post-code. Table 1 shows differences in injuries and other medical characteristics. Pedestrians and motorcyclists were the most severely injured.
Baseline questionnaires were completed by 1148 (80%). There
Discussion
We have been able to describe the characteristics of a large sample of consecutive road traffic accident attenders. There were satisfactory rates of completion of questionnaires for this mobile population which is known to be difficult to identify and follow-up. The size and representative nature of the sample was an advantage. There were limitations associated with self-report assessment and with the declining response rate, especially at 3 years. However, our findings are consistent with our
Acknowledgements
The research was funded by the Welcome Trust. We would like to thank Mrs. Gail Stockford and Mrs. Ann Day for help with data collection and analysis.
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