The road to recovery for vulnerable road users hospitalised for orthopaedic injury following an on-road crash
Introduction
Pedestrians, cyclists and motorcyclists are considered vulnerable road users, and according to the World Health Organization comprise more than half of all global road transport fatalities (World Health Organization, 2018). Vulnerable road users have limited external devices to protect them from mechanical force during a crash and are therefore more susceptible to sustaining serious trauma. The effects of road trauma on vulnerable road users extend well beyond the physical injuries. Traumatic road injuries can cause psychological distress, which may become prolonged in the form of mental illnesses such as post-traumatic stress disorder, and generalised anxiety disorder (Holbrook et al., 2005; Vincent et al., 2015). Involvement in a road transport crash also increases vulnerability to experiencing problems with social and physical functioning, and can negatively impact on health-related quality of life (Gabbe et al., 2017; Papadakaki et al., 2017). Furthermore, a proportion of people involved in a traumatic road-transport injury will go on to develop chronic pain that persists for greater than six months, which can significantly impact upon performing daily activities and working capacity (Rosenbloom et al., 2013). The societal burden of orthopaedic transport injury is borne through the high costs of hospitalisation and treatment (Beck et al., 2017a), loss of work productivity (Gabbe et al., 2007), involvement in adversarial aspects of compensation schemes (Ioannou et al., 2016) and misuse of prescription opioids to name a few (Hahn et al., 2018).
Previous studies have examined injury outcomes for vulnerable road users in the hospital setting, with a focus on length of stay and injury characteristics (Brockamp et al., 2017; Cevik et al., 2013; O’Hern et al., 2015). Others have investigated long-term outcomes such as return to work, function and quality of life (Dinh et al., 2016; Gabbe et al., 2017; Kenardy et al., 2017). Of the longitudinal studies conducted, the prevalence of people reporting problems up to two and three years post-injury from road trauma in Australia remains high, indicating that further research in this area is warranted to attenuate the burden of road trauma for our most vulnerable road users (Gabbe et al., 2017; Kenardy et al., 2017). Vulnerable road user groups included in studies to date are rarely considered separately, and pedestrians are often combined with cyclists (Gabbe et al., 2017; Heron-Delaney et al., 2017; Kenardy et al., 2017). Consequently, the rate of recovery and improvements in health-related quality of life for different types of vulnerable road users after orthopaedic injury remains unclear. Prior research has demonstrated that pedestrians sustain higher rates of severe head injury compared to motor vehicle drivers (Reith et al., 2015), and when compared to other vulnerable road users, comprise a larger proportion of older adults (Vanlaar et al., 2016). Unlike pedestrians and motorcyclists, cyclists generally have the best improvements in health status over time (Tournier et al., 2014; Vanlaar et al., 2016). The group most commonly admitted to hospital after a motorcycle-related injury comprise young males with low education (Papadakaki et al., 2018). Few longitudinal studies have investigated health outcomes of motorcyclists compared to other road users (Hours et al., 2010), however it has been reported that compared to other vulnerable road user groups a larger proportion of motorcyclists experience pain six months after the injury (Hours et al., 2010). There is a need for longitudinal studies to explore health outcomes of injured motorcyclists over longer periods of time.
Understanding and improving mental and physical health recovery specific to each vulnerable road user group after orthopaedic transport injury is an important step towards improving care post-discharge from hospital. Identifying factors that place an individual at risk of experiencing poor quality of life outcomes could assist with the delivery of targeted interventions and detection of financial resources to specific individuals at an appropriate time along the journey to recovery. The aim of the present study was to characterise and describe patient reported outcomes of vulnerable road users at 6 and 12 months post-injury for pedestrians, cyclists and motorcyclists who sustained an orthopaedic injury following an on-road collision.
Section snippets
Victorian Orthopaedic Trauma Outcomes Registry (VOTOR)
The VOTOR includes patients admitted with orthopaedic injury to four hospitals in Victoria, including two major trauma centres, one metropolitan trauma centre and one regional trauma centre. Patients are included in the registry if they are aged > 16 years, and have a length of hospital stay >24 h following orthopaedic trauma. Patients are excluded if they have a pathological fracture related to metastatic disease or an isolated soft tissue injury managed non-operatively. Patient outcomes are
Results
There were 8528 injury pedestrians, motorcyclists and cyclists during the study period of which 6186 (72.5%) were injured on a road, street or highway, and therefore met the inclusion criteria for the study (Table 1). One hundred and thirty-three patients (2.2%) died during their hospital stay including 27 motorcyclists, 16 cyclists and 90 pedestrians. A further 48 patients died post-discharge prior to the 12-month follow up time point (Fig. 1).
The follow-up rates at 12 months post-injury were
Discussion
We explored the demographic and injury characteristics, and longer term outcomes, of vulnerable road users who sustained orthopaedic injuries. To our knowledge, this is the first longitudinal study that has compared health-related quality of life, function and work outcomes between vulnerable road user groups. We found no differences in health-related quality of life between motorcyclists and pedestrians (with the exception of anxiety/depression). In contrast, the longer term outcomes of
Conclusion
This study demonstrated that health-related quality of life and return to work outcomes differed between vulnerable road user groups. In particular, pedestrians and motorcyclists experienced poorer health-related quality of life, function and return to work outcomes when compared to cyclists. Primary prevention efforts are the preferred method for reducing the burden of road trauma. Additional and targeted investment to protect these vulnerable road users is needed. Further, this study
Acknowledgements
The Victorian Orthopaedic Trauma Outcomes Registry is funded by the Transport Accident Commission. Ben Beck and Melita Giummarra were supported by Australian Research Council Discovery Early Career Researcher Award Fellowships (DE180100825; DE170100726). Belinda Gabbe was supported by an Australian Research Council Future Fellowship (FT170100048). CE was supported by a National Health and Medical Research Council of Australia (NHMRC) Early Career Fellowship (1106633).
References (37)
- et al.
Predictors of recovery in cyclists hospitalised for orthopaedic trauma following an on-road crash
Accid. Anal. Prev.
(2017) - et al.
Evaluation of geriatric patients with trauma scores after motor vehicle trauma
Am. J. Emerg. Med.
(2013) - et al.
Functional declines as predictors of risky street-crossing decisions in older pedestrians
Accid. Anal. Prev.
(2013) - et al.
Inter-rater agreement on assessment of outcome within a trauma registry
Injury
(2016) - et al.
The impact of opioid analgesic prescription uptake on the costs of recovery from injury: evidence from compensable orthopaedic road trauma patients
Accid. Anal. Prev.
(2018) - et al.
Predictors of non-return to work 2 years post-injury in road traffic crash survivors: results from the UQ SuPPORT study
Injury
(2017) - et al.
Functional outcome after road-crash injury: Description of the ESPARR victims cohort and 6-month follow-up results
Accid. Anal. Prev.
(2010) - et al.
Recovery trajectories for long-term health-related quality of life following a road traffic crash injury: results from the UQ SuPPORT study
J. Affect. Disord.
(2017) - et al.
Consequences of road traffic accidents for different types of road user
Injury
(2003) - et al.
Older adults at increased risk as pedestrians in Victoria, Australia: an examination of crash characteristics and injury outcomes
Traffic Inj. Prev.
(2015)
Defining major trauma using the 2008 abbreviated injury scale
Injury
Psychological distress and physical disability in patients sustaining severe injuries in road traffic crashes: results from a one-year cohort study from three European countries
Injury
Physical, psychological and economic burden of two-wheel users after a road traffic injury: evidence from intensive care units of three EU countries
J. Safety Res.
A few seconds to have an accident, a long time to recover: consequences for road accident victims from the ESPARR cohort 2 years after the accident
Accid. Anal. Prev.
Fatal and serious injuries related to vulnerable road users in Canada
J. Safety Res.
Psychological distress after orthopedic trauma: prevalence in patients and implications for rehabilitation
PM&R
Road safety: serious injuries remain a major unsolved problem
Med. J. Aust.
Comparison of transportation related injury mechanisms and outcome of young road users and adult road users, a retrospective analysis on 24,373 patients derived from the TraumaRegister DGU®
Scand. J. Trauma Resusc. Emerg. Med.
Cited by (12)
An evaluation of the association between fault attribution and healthcare costs and trajectories in the first three years after transport injury
2021, InjuryCitation Excerpt :Road traffic injury is a global public health problem [1] and leads to a significant economic impact exceeding A$33 billion per year in Australia [2]. Transport-related injuries lead to long-term disability and premature mortality for many people, especially for people with serious injuries that require treatment in hospital [3,4]. Common disabling problems after injury include reduced health-related quality of life and the development of persistent pain, mental health concerns, and other functional impairments [3,5,6].
Twelve-month health outcomes for bicyclists and car occupants after a non-catastrophic traffic crash injury
2021, Annals of Physical and Rehabilitation MedicineCitation Excerpt :Cyclists who had collisions with motor vehicles generally had poorer outcomes than cyclists with other crash counterparts or non-collision events, whereas non-compensable patients had greater odds of complete functional recovery and return to work than compensable patients. More recently, Devlin et al. [8] found that pedestrians and motorcyclists involved in on-road collisions experienced poorer recovery and more pain or discomfort at 6 and 12 months post-injury as compared with cyclists. Recently, we compared 6-month outcomes of cycling injuries for cyclists versus vehicle drivers and passengers [4,9].
Health and return to work in the first two years following road traffic injury: a comparison of outcomes between compensation claimants in Victoria and New South Wales, Australia
2020, InjuryCitation Excerpt :Firstly, people without a claim consistently better mental and physical health outcomes than the claimant groups, with the exception of the no-fault claimants who reported similar high levels of mental health over time. It may be that these effects were driven by the fact that people without a claim were predominantly motorcyclists and pedal cyclists, who differ quite substantially from other road user groups with higher levels of pre-injury health, demographics (i.e., predominantly younger males), higher occupation skill, education, and neighbourhood socioeconomic position [59]. While pedal cyclists in particular are typically found to have better health and work outcomes than people with other injury causes [66], the present outcomes may also partly have been driven by the pre-injury health and socioeconomic differences rather than a lack of compensation scheme exposure per se [59,67].
Contributing factors on the level of delay caused by crashes: a hybrid method of latent class analysis and XGBoost based SHAP algorithm
2024, Journal of Transportation Safety and SecurityLong-term opioid use following bicycle trauma: a register-based cohort study
2023, European Journal of Trauma and Emergency Surgery