Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong SAR, China.
John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, Level 13, Kolling building, St Leonards, Sydney, NSW, Australia.
BMC Public Health. 2021 Mar 27;21(1):602. doi: 10.1186/s12889-021-10638-7.
There is growing evidence that a range of pre-injury, injury related and post-injury factors influence social and health outcomes across the injury severity spectrum. This paper documents health related outcomes for people with mild, moderate and severe injury after motor vehicle crash (MVC) injuries in New South Wales, Australia.
This inception cohort study followed 2019 people injured in MVCs, for 6 and 12 months post-injury. We categorised moderate injury as hospital length-of-stay (LOS) of 2-6 days and Injury Severity Score (ISS) of 4-11, while severe injury as LOS ≥7 days or ISS ≥ 12. We examined differences in paid work status, 12-Item Short Form Survey (SF12), EQ-5D and World Health Organisation Disability Assessment Schedule II (WHODAS) outcomes longitudinally from baseline to 12 months between levels of injury severity using linear mixed models for repeated measures. We first considered minimally sufficient adjustment factors (age, sex, crash role, perceived danger in crash, pre-injury health, pre-injury EQ-5D, recruitment source), and then more extensive adjustments including post-injury factors. The presence of mediating pathways for SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) via post-injury factors was evaluated.
Based on hospital length of stay (LOS), 25 and 10% of participants sustained moderate and severe injuries, respectively, while 43 and 4% had these injuries based on ISS. Twelve months post-injury LOS ≥7 days versus ≤1 day was associated with an estimated 9 units lower mean SF12 PCS using a minimally sufficient adjustment model, and LOS ≥ 7 days was associated with a 3 units lower mean SF12 MCS score. Mediation analyses (LOS ≥ 7 days vs ≤1 day) found for SF12 MCS outcomes, effects of injury severity were small and mostly indirect (direct effect - 0.03, indirect effect - 0.22). Whereas for SF12 PCS outcomes the effect of having a more severe injury rather than mild were both direct and indirect (direct effect - 0.50, indirect effect - 0.38).
Individuals with severe injuries (those with LOS ≥ 7 days and ISS 12+) had poorer recovery 12 months after the injury. In addition, post-injury mediators have an important role in influencing long-term health outcomes.
Australia New Zealand Clinical trial registry identification number - ACTRN12613000889752 .
越来越多的证据表明，一系列受伤前、受伤时和受伤后的因素会影响整个受伤严重程度范围内的社会和健康结果。本文记录了澳大利亚新南威尔士州机动车碰撞（MVC）损伤后轻度、中度和重度损伤人群的健康相关结果。
这项初始队列研究随访了 2019 名 MVC 受伤者，在受伤后 6 个月和 12 个月进行了研究。我们将中度损伤定义为住院时间（LOS）为 2-6 天和损伤严重程度评分（ISS）为 4-11，而严重损伤定义为 LOS≥7 天或 ISS≥12。我们使用重复测量的线性混合模型，从基线到 12 个月，纵向比较不同严重程度的损伤在有偿工作状态、12 项简短健康调查（SF12）、EQ-5D 和世界卫生组织残疾评估量表 II（WHODAS）结果方面的差异。我们首先考虑了最小充分调整因素（年龄、性别、碰撞角色、碰撞时的危险感知、受伤前健康、受伤前 EQ-5D、招募来源），然后进行了更广泛的调整，包括受伤后的因素。通过受伤后的因素评估 SF-12 生理成分综合评分（PCS）和心理成分综合评分（MCS）的中介途径的存在。
根据住院 LOS，分别有 25%和 10%的参与者发生了中度和重度损伤，而根据 ISS，分别有 43%和 4%的参与者发生了这些损伤。受伤后 12 个月 LOS≥7 天与 LOS≤1 天相比，SF12 PCS 的平均得分低 9 个单位，使用最小充分调整模型，而 LOS≥7 天与 SF12 MCS 得分低 3 个单位相关。中介分析（LOS≥7 天与 LOS≤1 天）发现，SF12 MCS 结果的损伤严重程度的影响较小且主要为间接影响（直接效应-0.03，间接效应-0.22）。而对于 SF12 PCS 结果，发生更严重损伤而不是轻度损伤的效应既有直接的也有间接的（直接效应-0.50，间接效应-0.38）。
严重损伤（LOS≥7 天和 ISS≥12+）患者在受伤后 12 个月的恢复情况较差。此外，受伤后的中介因素在影响长期健康结果方面起着重要作用。
澳大利亚新西兰临床试验注册中心注册号 - ACTRN12613000889752。
