Fabbri Andrea, Marchesini Giulio, Dente Massimo, Iervese Tiziana, Spada Marco, Vandelli Alberto
Dipartimento di Urgenza-Accettazione, Azienda Unità Sanitaria Locale di Forlì, Forlì, Italy.
Ann Emerg Med. 2005 Aug;46(2):161-7. doi: 10.1016/j.annemergmed.2005.04.002.
The identification of risk factors for recurrent motor vehicle crashes is the basis for prevention, but few studies have been published on predictors of recurrence. Our objective is to determine the main variables predicting recurrent crashes in subjects attending an emergency department (ED) for injuries after motor vehicle crash.
During a 5-year follow-up period, we studied 2,354 consecutive adult subjects treated in the ED after a motor vehicle crash in 1998. The variables of the original event were tested for predicting recurrence in a Cox proportional hazard model.
During follow-up, 390 of 2,325 (16.8%) survivors were treated for injury after a new crash. The overall event rate was 34 per 1,000 subject-years. Four variables (age < or =32 years, male sex, nighttime crash, and blood alcohol concentration >50 mg/dL) were identified as independent predictors of recurrent crash. After adjustment for sex, age, and nighttime, alcohol was the leading predictor (relative risk 3.73; 95% confidence interval 3.00 to 4.64). In the presence of the 4 variables, the recurrence rate was as high as 145 (117 to 175) events per 1,000 subject-years, and alcohol per se accounted for more than 75% of events. In the absence of the 4 variables, the rate was as low as 11 (7 to 17) events per 1,000 subject-years.
Alcohol was the most powerful behavioral factor predicting recurrent events in subjects treated in an ED for injury after motor vehicle crash, along with young age, male sex, and nighttime.
确定机动车碰撞事故复发的危险因素是预防的基础，但关于复发预测因素的研究报道较少。我们的目的是确定在因机动车碰撞事故受伤而前往急诊科（ED）就诊的患者中，预测复发碰撞事故的主要变量。
在5年的随访期内，我们研究了1998年在急诊科接受治疗的2354例连续成年机动车碰撞事故患者。在Cox比例风险模型中测试原始事件的变量以预测复发情况。
在随访期间，2325名幸存者中有390人（16.8%）因新的碰撞事故受伤接受治疗。总事件发生率为每1000人年34起。四个变量（年龄≤32岁、男性、夜间碰撞事故以及血液酒精浓度>50mg/dL）被确定为复发碰撞事故的独立预测因素。在对性别、年龄和夜间因素进行调整后，酒精是主要预测因素（相对风险3.73；95%置信区间3.00至4.64）。在存在这四个变量的情况下，复发率高达每1000人年145起（117至175起）事件，酒精本身占事件的75%以上。在不存在这四个变量的情况下，发生率低至每1000人年11起（7至17起）事件。
酒精是预测因机动车碰撞事故受伤而在急诊科接受治疗的患者复发事件的最有力行为因素，同时还有年轻、男性和夜间因素。
