Risk of disability due to car crashes: a review of the literature and methodological issues
Introduction
Despite well-publicised declines in traffic fatality rates in many industrialised countries, the impact of crashes on the loss of healthy years of life remains largely speculative.41 This reflects a lack of reliable data on non-fatal outcomes following crashes even in countries where detailed mortality statistics are assembled annually.62 In much of the world, routinely collected data on crash-related disability are non-existent or inaccessible.47
Assessors of the research evidence concur that a significant proportion of crash survivors experience long-term morbidity, but there is little agreement about the magnitude of this risk.7., 8., 32., 35., 38., 43., 44., 50. Furthermore, previous commentaries have primarily focused on psychiatric sequelae, whiplash-associated disorders, or injuries to the head and extremities.
With the global burden of road traffic injuries projected to rank as the third leading cause of disability-adjusted life years by 2020,41 it is vital to review the epidemiological evidence and identify gaps in knowledge regarding the magnitude and determinants of post-crash disability. This should help inform public policy, preventive interventions and health services. It may also change our perception of priorities.41
We conducted a systematic review of the epidemiological literature investigating the risk of disability due to car crashes. The review was restricted to car occupants as the patterns and consequences of injuries vary by the road user group.26., 36., 59. In addition to constituting the commonest road casualty group in most industrialised countries, injured car occupants are of increasing concern in many rapidly motorising low- and middle-income countries. Furthermore, an initial scan of the literature revealed car occupants to be the focus of much of the published literature on road crash-related disability. The specific objectives of the review were to critically appraise the evidence quantifying the risk of disability to crashes in this road user group, examine the methodological strengths and weaknesses of relevant studies, and determine the implications for future research into road traffic crash-related disability more generally.
Section snippets
Methods
We sought studies published between January 1980 and December 2002 that examined the risk of disability following involvement in a car crash. Pre-1980 publications were excluded due to important changes in crash-related injury since the introduction of seat-belt legislation. In the absence of a universally accepted objectively defined measure, outcomes related to current concepts of disability (e.g. functional limitations, psychosocial consequences, reduced quality of life) were considered
Results
Of the approximately 750 studies identified from the combined search strategy, 68 were considered potentially relevant based on the title or abstract and the full-text retrieved for detailed evaluation.
Discussion
Of the 19 studies reviewed, only one investigated the extent to which involvement in crashes increased the risk of disability among car occupants, independent of other causes.30 Most studies focused on the prevalence of disability following crashes but not the association between them. Period effects (e.g. seat-belt legislation, changes in the vehicle fleet such as age and presence of airbags, and characteristics of road networks), selection biases, idiosyncratic outcome measures, residual
Acknowledgements
We gratefully acknowledge the assistance of information specialists at the Ministry of Transport, Ministry of Health, Land Transport Safety Authority and Accident Compensation Corporation of New Zealand in searching institutional bibliographic databases. We also acknowledge the valuable feedback from the anonymous reviewers. This work was funded by a project grant from the Health Research Council of New Zealand.
References (62)
- et al.
The timing of disability measurement following injury
Injury
(2000) - et al.
The association between exposure to a rear-end collision and future health complaints
J. Clin. Epidemiol
(2001) - et al.
Psychiatric morbidity following motor vehicle accidents: a review of methodological issues
Compre. Psychiatr
(1998) - et al.
A systematic and critical review of the process of translation and adaptation of generic health-related quality of life measures in Africa, Asia, Eastern Europe, the Middle East, South America
Soc. Sci. Med
(2003) Disabilities caused by road traffic accidents and their relation to severity scores
Accid. Anal. Prev
(1985)Return to work of road accident victims claiming compensation for personal injury
Injury
(1992)- et al.
Disabilities resulting from traffic injuries in Barcelona, Spain: 1-year incidence by age, gender and type of user
Accid. Anal. Prev
(1998) - et al.
Life-threatening and disabling injuries in car-to-car side impacts: implications for development of protective systems
Accid. Anal. Prev
(1993) - et al.
Whiplash disorders: a review
Injury
(2002) Medico-legal aspects of road traffic accidents
J. Psychosom. Res
(1995)
Consequences of road traffic accidents for different types of road user
Injury
Epidemiology of transport-related injuries in Ghana
Accid. Anal. Prev
Injury severity assessment for car occupants in frontal impacts, using disability scaling
J. Clin. Epidemiol
Emergency department and hospital admissions and deaths from traffic injuries in Barcelona, Spain. A one-year population-based study
Accid. Anal. Prev
Psychosocial sequelae of motor vehicle collisions: a follow-up study
Accid. Anal. Prev
Characteristics, hospital charges and effects of road transport injuries in Vermont
Accid. Anal. Prev
Should journals publish systematic reviews that find no evidence to guide practice? Examples from injury research
Br. Med. J
Systematic reviews of evaluations of prognostic variables
Br. Med. J
Letter
Int. J. Epidemiol
Prevalence of impairments, disabilities, handicaps and quality of life in the general population: a review of recent literature
Bull World Health Organization
Quality of life in patients with multiple injuries: basic issues, assessment, and recommendations
Restorative Neurol. Neurosci
Sick leave and disability pension among passenger car occupants injured in urban traffic
Spine
Injury and disability effects of motor car accidents
Int. Disabil. Stud
Systematic reviews in epidemiology: why are we so far behind?
Int. J. Epidemiol
Meta-analysis: bias in location and selection of studies
Br. Med. J
Spurious precision? Meta-analysis of observational studies
Br. Med. J
Cited by (51)
Twelve-month recovery following road trauma: Results from an inception cohort in Vancouver, Canada
2024, Annals of Physical and Rehabilitation MedicineRisk of permanent medical impairment after road traffic crashes: A systematic review
2023, Chinese Journal of Traumatology - English EditionCitation Excerpt :This reflects a lack of reliable data on non-fatal outcomes especially permanent disabilities after RTIs even in the countries where mortality statistics are assembled annually.2 Globally, routinely collected data on crash-related disability are non-existent or inaccessible.3 World Health Organization reports about 1.24 million annual traffic-related fatalities, and 20–50 million sustained non-fatal injuries.4,5
Minor Injury Crashes: Prevalence of Driver-Related Risk Factors and Outcome
2017, Journal of Emergency MedicineCitation Excerpt :In a 2004 systematic review, Ameratunga et al. found six studies reporting outcomes in injured drivers recruited from the ED or outpatient settings. The prevalence of disability in this group ranged from 5% to 39% (15). Since that review, only a few researchers have studied the outcome after MVC and most focused on severe crashes.
A comprehensive conceptual framework for road safety strategies
2016, Accident Analysis and PreventionCopula-based regression modeling of bivariate severity of temporary disability and permanent motor injuries
2016, Accident Analysis and PreventionDisability related to road traffic crashes among adults in Spain
2015, Gaceta Sanitaria