从交通违法者到严重道路创伤受害者的转变：是命运使然还是预防契机？
The journey from traffic offender to severe road trauma victim: destiny or preventive opportunity?
作者信息
Ho Kwok M, Rao Sudhakar, Burrell Maxine, Weeramanthri Tarun S
机构信息
Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Australia; School of Population Health, University of Western Australia, Perth, Australia; Murdoch University, Perth, Australia.
State Trauma Unit, Royal Perth Hospital, Perth, Australia.
出版信息
PLoS One. 2015 Apr 22;10(4):e0122652. doi: 10.1371/journal.pone.0122652. eCollection 2015.
BACKGROUND
Road trauma is a leading cause of death and injury in young people. Traffic offences are common, but their importance as a risk indicator for subsequent road trauma is unknown. This cohort study assessed whether severe road trauma could be predicted by a history of prior traffic offences.
METHODOLOGY AND PRINCIPAL FINDINGS
Clinical data of all adult road trauma patients admitted to the Western Australia (WA) State Trauma Centre between 1998 and 2013 were linked to traffic offences records at the WA Department of Transport. The primary outcomes were alcohol exposure prior to road trauma, severe trauma (defined by Injury Severity Score >15), and intensive care admission (ICU) or death, analyzed by logistic regression. Traffic offences directly leading to the road trauma admissions were excluded. Of the 10,330 patients included (median age 34 years-old, 78% male), 1955 (18.9%) had alcohol-exposure before road trauma, 2415 (23.4%) had severe trauma, 1360 (13.2%) required ICU admission, and 267 (2.6%) died. Prior traffic offences were recorded in 6269 (60.7%) patients. The number of prior traffic offences was significantly associated with alcohol-related road trauma (odds ratio [OR] per offence 1.03, 95% confidence interval [CI] 1.02-1.05), severe trauma (OR 1.13, 95%CI 1.14-1.15), and ICU admission or death (OR 1.10, 95%CI 1.08-1.11). Drink-drinking, seat-belt, and use of handheld electronic device offences were specific offences strongly associated with road trauma leading to ICU admission or death--all in a 'dose-related' fashion. For those who recovered from road trauma after an ICU admission, there was a significant reduction in subsequent traffic offences (mean difference 1.8, 95%CI 1.5 to 2.0) and demerit points (mean difference 7.0, 95%CI 6.5 to 7.6) compared to before the trauma event.
SIGNIFICANCE
Previous traffic offences were a significant risk factor for alcohol-related road trauma and severe road trauma leading to ICU admission or death.
背景
道路创伤是年轻人死亡和受伤的主要原因。交通违法很常见，但其作为后续道路创伤风险指标的重要性尚不清楚。这项队列研究评估了既往交通违法史是否能预测严重道路创伤。
方法与主要发现
1998年至2013年间入住西澳大利亚州创伤中心的所有成年道路创伤患者的临床数据与西澳大利亚州运输部的交通违法记录相关联。主要结局为道路创伤前的酒精暴露、严重创伤（定义为损伤严重度评分>15）以及重症监护病房（ICU）收治或死亡，通过逻辑回归分析。排除直接导致道路创伤入院的交通违法。纳入的10330例患者（中位年龄34岁，78%为男性）中，1955例（18.9%）在道路创伤前有酒精暴露，2415例（23.4%）有严重创伤，1360例（13.2%）需要入住ICU，267例（2.6%）死亡。6269例（60.7%）患者有既往交通违法记录。既往交通违法次数与酒精相关道路创伤（每次违法的比值比[OR]为1.03，95%置信区间[CI]为1.02 - 1.05）、严重创伤（OR 1.13，95%CI 1.14 - 1.15）以及ICU收治或死亡（OR 1.10，95%CI 1.08 - 1.11）显著相关。酒后驾车、不系安全带以及使用手持电子设备违法是与导致ICU收治或死亡的道路创伤密切相关的特定违法行为——均呈“剂量相关”方式。对于入住ICU后从道路创伤中康复的患者，与创伤事件前相比，后续交通违法（平均差值1.8，95%CI 1.5至2.0）和扣分（平均差值7.0，95%CI 6.5至7.6）显著减少。
意义
既往交通违法是酒精相关道路创伤以及导致ICU收治或死亡的严重道路创伤的重要风险因素。
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