School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia; Caulfield Pain Management and Research Centre, Caulfield Hospital, 260 Kooyong Road, Caulfield, VIC, 3162, Australia.
Accid Anal Prev. 2019 Nov;132:105279. doi: 10.1016/j.aap.2019.105279. Epub 2019 Sep 3.
Pedestrians, cyclists and motorcyclists are vulnerable to serious injury due to limited external protective devices. Understanding the level of recovery, and differences between these road user groups, is an important step towards improved understanding of the burden of road trauma, and prioritisation of prevention efforts. This study aimed to characterise and describe patient-reported outcomes of vulnerable road users at 6 and 12 months following orthopaedic trauma.
A registry-based cohort study was conducted using data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and included pedestrians, cyclists and motorcyclists who were hospitalised for an orthopaedic injury following an on-road collision that occurred between January 2009 and December 2016. Outcomes were measured using the 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3 L), Glasgow Outcome Scale - Extended (GOS-E) and return to work questions. Outcomes were collected at 6 and 12 months post-injury. Multivariable generalized estimating equations (GEE), adjusted for confounders, were used to compare outcomes between the road user groups over time.
6186 orthopaedic trauma patients met the inclusion criteria during the 8-year period. Most patients were motorcyclists (42.8%) followed by cyclists (32.6%) and pedestrians (24.6%). Problems were most prevalent on the usual activities item of the EQ-5D-3 L at 6-months post-injury, and the pain/discomfort item of the EQ-5D-3 L at 12 months. The adjusted odds of reporting problems on all EQ-5D-3 L items were lower for cyclists when compared to pedestrians. Moreover, an average cyclist had a greater odds of a good recovery on the GOS-E, (AOR 2.75, 95% CI 2.33, 3.25) and a greater odds of returning to work (AOR = 3.13, 95% CI 2.46, 3.99) compared to an average pedestrian.
Pedestrians and motorcyclists involved in on-road collisions experienced poorer patient-reported outcomes at 6 and 12 months post-injury when compared to cyclists. A focus on both primary injury prevention strategies, and investment in ongoing support and treatment to maximise recovery, is necessary to reduce the burden of road trauma for vulnerable road users.
行人、骑自行车的人和骑摩托车的人由于外部保护装置有限，容易受到严重伤害。了解这些道路使用者群体的恢复程度和差异是提高对道路创伤负担的认识以及优先考虑预防工作的重要步骤。本研究旨在描述和描述骨科创伤后 6 个月和 12 个月时弱势道路使用者的患者报告结局。
这是一项基于登记的队列研究，使用维多利亚州骨科创伤结局登记处（VOTOR）的数据进行，包括 2009 年 1 月至 2016 年 12 月期间因道路碰撞而发生的骨科损伤住院的行人、骑自行车的人和骑摩托车的人。使用 3 级欧洲五维健康量表（EQ-5D-3L）、格拉斯哥结局量表-扩展版（GOS-E）和重返工作岗位问题来衡量结局。在受伤后 6 个月和 12 个月收集结局。使用调整混杂因素的多变量广义估计方程（GEE）比较不同时间段不同道路使用者群体的结局。
在 8 年期间，6186 名骨科创伤患者符合纳入标准。大多数患者是骑摩托车的人（42.8%），其次是骑自行车的人（32.6%）和行人（24.6%）。受伤后 6 个月时，EQ-5D-3L 的日常活动项目中问题最为普遍，12 个月时 EQ-5D-3L 的疼痛/不适项目中问题最为普遍。与行人相比，骑自行车的人报告所有 EQ-5D-3L 项目存在问题的可能性更低。此外，与普通行人相比，普通骑自行车的人在 GOS-E 上有更好的恢复机会（OR 2.75，95%CI 2.33，3.25），重返工作岗位的可能性更大（OR=3.13，95%CI 2.46，3.99）。
与骑自行车的人相比，在道路碰撞中受伤的行人及骑摩托车的人在受伤后 6 个月和 12 个月时的患者报告结局较差。有必要同时关注初级伤害预防策略，以及投资于持续的支持和治疗，以最大限度地恢复，从而减少弱势道路使用者的道路创伤负担。
