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Hossain S, Moeller H, Sharpe P, Campbell M, Kimlin R, Porykali B, Shannon B, Gray J, Afzali H, Harrison JE, Ivers RQ, Ryder C. Characterising the Aboriginal and Torres Strait Islander patient journey after a serious road traffic injury and barriers to access to compensation: a protocol. Inj Prev 2024; 30:75-80. [PMID: 37923356 DOI: 10.1136/ip-2023-044997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Road safety has been a long-enduring policy concern in Australia, with significant financial burden of road trauma and evident socioeconomic disparities. Transport injuries disproportionately impact individuals in remote areas, those in lower socioeconomic situations, and Aboriginal and Torres Strait Islander populations. There is a lack of insight into transport injuries in Aboriginal and Torres Strait Islander communities, absence of Indigenous perspective in published research and limited utilisation of linked data assets to address the inequity. Aim 1 is to determine the breadth, cost and causal factors of serious injury from road traffic crashes in South Australia (SA) and New South Wales (NSW) with a focus on injury prevention. Aim 2 is to identify enablers and barriers to compensation schemes for Aboriginal and Torres Strait Islander patients in SA and NSW. METHODS AND ANALYSIS This study will be guided by an Aboriginal and Torres Strait Islander Governance Group, applying Knowledge Interface Methodology and Indigenous research principles to ensure Indigenous Data Sovereignty and incorporation of informed perspectives. A mixed-method approach will be undertaken to explore study aims including using big data assets and mapping patient journey. CONCLUSION The results of this study will provide valuable insights for the development of focused injury prevention strategies and policies tailored to Aboriginal and Torres Strait Islander communities. By addressing the specific needs and challenges faced by these communities, the study aims to enhance road safety outcomes and promote equitable access to healthcare and compensation for affected individuals and their families.
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Affiliation(s)
- Sadia Hossain
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Holger Moeller
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Patrick Sharpe
- Far West Community Partnerships, Far West Region, South Australia, Australia
| | - Marnie Campbell
- Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Rebecca Kimlin
- Barossa Hills Fleurieu Local Health Network, Mount Barker, South Australia, Australia
| | - Bobby Porykali
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Brett Shannon
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jodi Gray
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Hossein Afzali
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - James E Harrison
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Q Ivers
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Courtney Ryder
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Hennessy S, Berlin JA. Real-World Trends in the Evaluation of Medical Products. Am J Epidemiol 2023; 192:1-5. [PMID: 36217921 DOI: 10.1093/aje/kwac172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/15/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023] Open
Abstract
There is a compelling need to evaluate the real-world health effects of medical products outside of tightly controlled preapproval clinical trials. This is done through pharmacoepidemiology, which is the study of the health effects of medical products (including drugs, biologicals, and medical devices and diagnostics) in populations, often using nonrandomized designs. Recent developments in pharmacoepidemiology span changes in the focus of research questions, research designs, data used, and statistical analysis methods. Developments in these areas are thought to improve the value of the evidence produced by such studies, and are prompting greater use of real-world evidence to inform clinical, regulatory, and reimbursement decisions.
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Melita J G, Joanna F D, Alex C, Jennie P, Shanthi A, Belinda J G. An evaluation of the association between fault attribution and healthcare costs and trajectories in the first three years after transport injury. Injury 2021; 52:3309-3319. [PMID: 34593247 DOI: 10.1016/j.injury.2021.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND People with complex medical and psychosocial issues have high healthcare needs. This registry-based cohort study sought to quantify the association between external fault attribution, recorded during compensation claim lodgement, and the cost and patterns of healthcare utilisation. METHODS 6,144 survivors of transport-related major trauma between 1 July 2010 and 30 June 2016 were extracted from the Victorian State Trauma Registry (VSTR) and linked to treatment payments from the Transport Accident Commission (TAC). Associations between fault and healthcare costs were examined with Generalised Linear Regression. Healthcare trajectories were identified using Group-Based Multi-Trajectory Modelling and included medical treatments from a physician, or pain, mental health and physical therapy treatments for the first three years post-injury. Trajectories were validated against the EQ-5D-3L health status summary score using mixed linear regression. RESULTS While injury severity had the strongest association with healthcare use, people who attributed fault to another had 9% higher healthcare costs. Six multi-trajectory groups were identified: 36% had low treatments over time; 25% had a rapid decline from high medical and physical therapy by 12-months; 12% had moderate to high medical and physical therapy that declined by 2-3 years; 11% had a gradual decline in medical treatment, an early increase in physical therapy but low pain and mental health treatment; 8% had high or increasing medical and physical therapy, moderate mental health therapy and low pain treatment; and 7% had moderate-high treatment across all domains. All groups had poorer health status compared with the group with low treatment levels, and people who attributed fault to another had higher risk of following trajectories with higher levels of treatment versus the low treatment group (beta=0.34, SE=0.12, p=0.01). CONCLUSION These findings highlight the need to provide pro-active multidisciplinary care coordination for people with complex needs after injury to better optimise recovery.
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Affiliation(s)
- Giummarra Melita J
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, VIC, Australia.
| | - Dipnall Joanna F
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Collie Alex
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ponsford Jennie
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, VIC, Australia
| | - Ameratunga Shanthi
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Section of Epidemiology & Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand; Population Health Directorate, Counties Manukau District Health Board, South Auckland, New Zealand
| | - Gabbe Belinda J
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea University, Swansea, Wales, UK, SA2 8PP
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Cancelliere C, Boyle E, Côté P, Holm LW, Salmi LR, Cassidy JD. Predicting nonrecovery in adults with incident traffic injuries including post-traumatic headache. ACCIDENT; ANALYSIS AND PREVENTION 2021; 159:106265. [PMID: 34182320 DOI: 10.1016/j.aap.2021.106265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/07/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
IMPORTANCE The management of traffic injuries is challenging for clinicians. Knowledge about predictors of nonrecovery from traffic injuries may help to improve patient care. OBJECTIVE To develop a prediction model for self-reported overall nonrecovery from traffic injuries six months post-collision in adults with incident traffic injuries including post-traumatic headache (PTH). DESIGN Inception cohort studies of adults with incident traffic injuries (including PTH) injured in traffic collisions between November 1997 and December 1999 in Saskatchewan, Canada; and between January 2004 and January 2005 in Sweden. METHODS Prediction model development and geographical external validation. SETTING The Saskatchewan cohort (development) was population-based (N = 4,162). The Swedish cohort (validation) (N = 379) were claimants from two insurance companies covering 20% of cars driven in Sweden in 2004. PARTICIPANTS All adults injured in traffic collisions who completed a baseline questionnaire within 30 days of collision. Excluded were those hospitalized > 2 days, lost consciousness > 30 min, or reported headache < 3/10 on the numerical rating scale. Follow-up rates for both cohorts were approximately 80%. PREDICTORS Baseline sociodemographic, pre-injury, and injury factors. OUTCOME Self-reported nonrecovery from all injuries (not "all better (cured)" on the self-perceived recovery scale) six months after traffic collision. RESULTS Both cohorts were predominantly female (69.8% in Saskatchewan, 65.2% in Sweden), with median ages 35.9 years (Saskatchewan), and 38.0 years (Sweden). Predictors were age, low back pain, symptoms in arms or hands, hearing problems, sleeping problems, pre-existing headache, and lower recovery expectations. With a positive score (i.e., ≥0.85 probability), the model can rule in the presence of self-reported nonrecovery from all injuries at six months (development: specificity = 91.3%, 95% CI 89.2%-93.0%; sensitivity = 27.8%, 95% CI 26.0%-29.7%; positive likelihood ratio (LR + ) = 3.2, 95% CI 2.5-4.0; negative likelihood ratio (LR-) = 0.79, 95% CI 0.76-0.82; validation: specificity = 72.6%, 95% CI 61.4%-81.5%; sensitivity = 60.5%, 95% CI 53.9%-66.7%); LR+ = 2.2, 95% CI 1.5-3.3; LR- = 0.5, 95% CI 0.4-0.7). CONCLUSIONS AND RELEVANCE In adults with incident traffic injuries including PTH, predictors other than those related to baseline head and neck pain drive overall nonrecovery. Developing and testing interventions targeted at the modifiable predictors may help to improve outcomes for adults after traffic collision.
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Affiliation(s)
- Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Science Building, Room 3000, Oshawa, Ontario L1H 7K4, Canada; Centre for Disability Prevention and Rehabilitation at Ontario Tech Universtiy and the Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
| | - Eleanor Boyle
- Department of Sport Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Science Building, Room 3000, Oshawa, Ontario L1H 7K4, Canada; Centre for Disability Prevention and Rehabilitation at Ontario Tech Universtiy and the Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Canada Research Chair in Disability Prevention and Rehabilitation, Ontario Tech University, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada
| | - Lena W Holm
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Louis-Rachid Salmi
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Science Building, Room 3000, Oshawa, Ontario L1H 7K4, Canada; ISPED/Bordeaux School of Public Health, University of Bordeaux, F-33000 Bordeaux, France; Centre INSERM U-1219 Bordeaux Population Health, F-33000 Bordeaux, France; CHU de Bordeaux, Pole de sante Publique, Service d'information médicale, F-33000 Bordeaux, France
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Chowdhary K, Enam N. Post-traumatic Headaches After Traumatic Brain Injury: Current Clinical Approaches. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00314-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Alharbi RJ, Lewis V, Mosley I, Miller C. Current trauma care system in Saudi Arabia: A scoping literature review. ACCIDENT; ANALYSIS AND PREVENTION 2020; 144:105653. [PMID: 32629227 DOI: 10.1016/j.aap.2020.105653] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 05/04/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Trauma is one of the leading causes of death worldwide with millions of people dying each year, particularly in low or middle-income countries. This paper describes and evaluates the current trauma system (TS) in Saudi Arabia (SA). METHODS A scoping literature review was performed, incorporating an extensive search of Medline and Embase databases for refereed literature, as well as a search of grey literature to locate unpublished articles or reports in English or Arabic. All publications were assessed against the World Health Organization (WHO) Trauma System Maturity Index (TSMI) and American College of Surgeon's (ACS) criteria. RESULTS Despite local injury prevention efforts, Motor Vehicle Crashes (MVC) remain the primary cause of injuries in SA. Prehospital trauma care in SA aligns with level III care as described in the WHO TSMI classification system, based on the presence of formal emergency medical services and universal access to care. With respect to the ACS classification, no clear written guidelines, either for field triage or trauma destination protocols such as trauma bypass, were identified in prehospital trauma care. The role of secondary and tertiary facilities in treating trauma patients is unclear, with no clear referral linkages, suggesting a level I to III grading of SA's trauma care facilities. Currently, there is no national or regional electronic trauma registry, no quality assurance program, and active involvement in research projects related to injuries is limited. CONCLUSION The current SA TS has strengths but there are key features missing in comparison to other systems globally. As MVCs remain a leading cause of death/ disability, efforts to reduce the prevalence and impact of MVC burden in SA through development of a stronger national TS are warranted.
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Affiliation(s)
- Rayan Jafnan Alharbi
- Alfred Health Clinical School, La Trobe University, Prahran, Victoria, Australia; Department of Emergency Medical Service, Jazan University, Jazan, Saudi Arabia.
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Ian Mosley
- School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Charne Miller
- Alfred Health Clinical School, La Trobe University, Prahran, Victoria, Australia
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Cancelliere C, Boyle E, Côté P, Holm LW, Salmi LR, Cassidy JD. Development and validation of a model predicting post-traumatic headache six months after a motor vehicle collision in adults. ACCIDENT; ANALYSIS AND PREVENTION 2020; 142:105580. [PMID: 32445970 DOI: 10.1016/j.aap.2020.105580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/20/2019] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
IMPORTANCE The prognosis of post-traumatic headache is poorly understood. OBJECTIVE To develop and validate a prognostic model to predict the presence of post-traumatic headache six months after a traffic collision in adults with incident post-traumatic headache. DESIGN Secondary analyses of adults with incident post-traumatic headache injured in traffic collisions between November 1997 and December 1999 in Saskatchewan, Canada (development cohort); and between January 2004 and January 2005 in Sweden (validation cohort). SETTING The Saskatchewan cohort (development) was population-based (N = 4162). The Swedish cohort (validation) (N = 379) were claimants from two insurance companies covering 20 % of cars driven in Sweden in 2004. PARTICIPANTS All adults injured in traffic collisions who completed a baseline questionnaire within 30 days of collision. Excluded were those hospitalized >2 days, lost consciousness >30 min, or reported headache <3/10 on the numerical rating scale. Follow-up rates for both cohorts were approximately 80 %. PREDICTORS Baseline sociodemographic, pre-injury, and injury factors. OUTCOME Self-reported headache pain intensity ≥3 (numerical rating scale) six months after injury. RESULTS Both cohorts were predominantly female (69.7 % in Saskatchewan, 65.2 % in Sweden), with median ages 35.9 years (Saskatchewan), and 38.0 years (Sweden). Predictors were age, work status, headache pain intensity, symptoms in arms or hands, dizziness or unsteadiness, stiffness in neck, pre-existing headache, and lower recovery expectations. With a positive score (i.e., ≥0.75 probability), the model can rule in the presence of post-traumatic headache at six months (development: specificity = 99.8 %, 95 % CI 99.5 %-99.9 %; sensitivity = 1.6 %, 95 % CI 1.0 %-2.6 %; positive likelihood ratio (LR+) = 8.0, 95 % CI 2.7-24.1; negative likelihood ratio (LR-) = 1.0, 95 % CI 1.0-1.0; validation: specificity = 95.5 %, 95 % CI 91.1 %-97.8 %; sensitivity = 27.2 %, 95 % CI 20.4 %-35.2 %); LR+ = 6.0, 95 % CI 2.8-13.2; LR- = 0.8, 95 % CI 0.7-0.8). CONCLUSIONS AND RELEVANCE Clinicians can collect patient information on the eight predictors of our model to identify patients that will report ongoing post-traumatic headache six months after a traffic collision. Future research should focus on selecting patients at high risk of poor outcomes (using our model) for inclusion in intervention studies, and determining effective interventions for these patients.
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Affiliation(s)
- Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Centre for Disability Prevention and Rehabilitation, Ontario Tech Universty and Canadian Memorial Chiropractic College, Oshawa, Ontario, Canada.
| | - Eleanor Boyle
- Department of Sport Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Centre for Disability Prevention and Rehabilitation, Ontario Tech Universty and Canadian Memorial Chiropractic College, Oshawa, Ontario, Canada; Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Canada Research Chair in Disability Prevention and Rehabilitation, Ontario Tech University, Faculty of Health Sciences, Oshawa, Ontario, Canada; Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Lena W Holm
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Louis-Rachid Salmi
- ISPED/Bordeaux School of Public Health, University of Bordeaux, F-33000 Bordeaux, France; Centre INSERM U-1219 Bordeaux Population Health, F-33000 Bordeaux, France; CHU de Bordeaux, Pole de sante Publique, Service d'information médicale, F-33000 Bordeaux, France
| | - J David Cassidy
- Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Gelaw AY, Gabbe BJ, Simpson PM, Ekegren CL. Pre-injury health status of major trauma patients with orthopaedic injuries. Injury 2020; 51:243-251. [PMID: 31848017 DOI: 10.1016/j.injury.2019.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pre-injury health status is an important determining factor of long-term outcomes after orthopaedic major trauma. Determining pre-injury health status of major trauma patients with orthopaedic injuries is also important for evaluating the change from pre to post-injury health status. OBJECTIVES Describe pre-injury health statuses reported at three different time points (6, 12 and 24 months) after injury and compare these with Australian normative values; determine the agreement between pre-injury health status collected at multiple time points post-injury; and identify factors associated with reporting better pre-injury health status. MATERIALS AND METHODS A registry-based cohort study was conducted. Major trauma patients with orthopaedic injuries captured by the Victorian State Trauma Registry with a date of injury from January 2009 to December 2016 were included. Pre-injury health status (measured using the EuroQol-Visual Analogue Scale (EQ-VAS)), reported 6, 12 and 24 months post-injury, was compared against Australian population normative values. The Bland-Altman method of comparison was used to determine the agreement between pre-injury EQ-VAS scores reported 6 to 12 and 6 to 24 months post-injury. Mixed effects ordinal logistic regression was used to determine factors associated with reporting better pre-injury health status. RESULTS A total of 3,371 patients were eligible for the study. The median (IQR) pre-injury EQ-VAS score reported 6, 12 and 24 months post-injury was 90 (85-100) out of 100. Participants' pre-injury EQ-VAS scores reported 6, 12 and 24 months post-injury were significantly higher than Australian population normative values. Pre-injury EQ-VAS scores reported 6 months post-injury agreed with pre-injury EQ-VAS scores reported 12 and 24 months post-injury. A significant association exists between pre-injury health status and age, comorbidities, injury characteristics, socioeconomic status and pre-injury work status. CONCLUSIONS People with orthopaedic major trauma have better pre-injury health compared to the general Australian population. Therefore, population-specific values should be used as baseline measures to evaluate orthopaedic trauma outcomes. Pre-injury health status values reported at three different post-injury time points were comparable. If conducting a retrospective pre-injury health evaluation, researchers need be aware of factors that influence self-reporting of pre-injury health status and the response shift that may happen due to encountering injury.
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Affiliation(s)
- Asmare Yitayeh Gelaw
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, United Kingdom
| | - Pamela M Simpson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Christina L Ekegren
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Alfred Emergency and Trauma Centre, Melbourne, Australia.
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The Incremental Hospitalization Cost of Significant Transport-Related Traumatic Brain Injury. J Head Trauma Rehabil 2019; 35:E144-E155. [PMID: 31479077 DOI: 10.1097/htr.0000000000000522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This study aims to determine the incremental cost of acute hospitalization for traumatic brain injury (TBI) compared with matched controls. A second purpose is to identify the factors contributing to this hospital costs. METHODOLOGY Analyses were performed on administrative data for injured patients, hospitalized in Belgium between 2009 and 2011 following a road traffic accident. Cases were matched to a control with similar injuries but without TBI. The incremental hospitalization cost of TBI and the factors contributing to the hospital costs were determined using multivariable regression modeling with gamma distribution and log link. RESULTS A descriptive comparison of cases and controls shows clear differences in healthcare utilization and costs. The presence of a TBI increases the cost by a factor between 1.66 (95% confidence interval: 1.52-1.82) and 2.08 (95% confidence interval: 1.72-2.51). Regarding healthcare utilization, the most important determinants of hospital costs are surgical complexity, use of magnetic resonance imaging, intensive care unit admission, and mechanical ventilation. DISCUSSION To our knowledge, this is the first matched-control study calculating the incremental hospitalization cost of TBI. The insights provided by this study are relevant in the context of prospective payments and can be an incentive for investments in prevention policies and extramural care.
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Eden L, Kühn A, Gilbert F, Meffert RH, Lefering R. Increased Mortality Among Critically Injured Motorcyclists Over 65 Years of Age. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:479-485. [PMID: 31431237 DOI: 10.3238/arztebl.2019.0479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Motorcycle accidents account for a large fraction of the patients with polytrauma treated in German hospitals. Clinical experience indicates that an in- creasing number of older motorcyclists are having accidents. We studied whether such individuals are subject to higher mortality and longer hospital stays. METHODS We retrospectively evaluated data from the Traumaregister DGU® (TR- DGU) concerning all patients (n = 13 850) who were registered in the TR-DGU as having sustained trauma in a motorcycle accident from 2002 to 2015 and who had an Injury Severity Score (ISS) greater than 8. The patients were divided into four age groups for further study. RESULTS Despite a nearly identical severity of anatomical injury according to the ISS, persons sustaining trauma in motorcycle accidents who were over 65 years of age (n = 892) needed longer and more intensive treatment than their younger counter- parts. They were invasively ventilated for a longer time (+ 1.2 days), kept for a longer time on the intensive care unit (+ 1.7 days), and stayed in the hospital three days longer. These older persons injured in motorcycle accidents had a disproportionate mortality in comparison to other polytrauma patients and a significantly elevated mor- tality in comparison to their younger counterparts-15.8%, compared to 7.2% among patients aged 45 to 64. Older trauma patients are more likely than younger ones to develop lethal complications in the later course of their hospitalization, while younger trauma patients who die generally do so as a direct result of the traumatic injury. CONCLUSION Patients over age 65 who sustain trauma in motorcycle accidents have a higher mortality, a longer duration of ventilation, and longer stays in the intensive care unit and in the hospital overall than their younger counterparts. These patients present a special challenge to the treating medical team.
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Affiliation(s)
- Lars Eden
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius Maximilians University Würzburg; Department of Orthopedics and Trauma Surgery, Robert-Bosch-Krankenhaus Stuttgart; Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU)
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Samoborec S, Simpson P, Hassani-Mahmooei B, Ruseckaite R, Giummarra M, Ayton D, Evans S. Impact of comorbidity on health outcome after a transport-related injury. Inj Prev 2019; 26:254-261. [PMID: 31004008 DOI: 10.1136/injuryprev-2019-043195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/26/2019] [Accepted: 03/30/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Understanding the impact of comorbidity on health outcomes is important given that comorbidities can affect survival, morbidity, service delivery costs and healthcare utilisation. However, little is known about the types of comorbidities affecting specific health outcomes after minor to moderate road trauma. METHODS This study involved 1574 participants who claimed injury compensation following transport-related injury. Cross sectional data were collected. Health outcomes were assessed using the EQ-5D-3L specific domains and summary score. Twelve self-reported pre-existing chronic conditions were assessed using a multivariate logistic regression, adjusting for demographic and injury characteristics. RESULTS Out of 1574 participants, only 17 (1%) participants reported no pre-existing comorbidities, 72% reported one, 13% reported two and 14% reported three or more comorbidities. Hypertension (15%), depression (14%) and anxiety (14%) were the most commonly reported comorbidities, followed by arthritis (13%), chronic pain (11%) and asthma (11%). Participants with a history of arthritis (adjusted odds ratio [AOR] 1.90, 95% CI 1.24 to 2.91); chronic back pain (AOR 1.59, 95% CI, 1.04 to 2.43); other chronic pain (AOR 2.73, 95% CI 1.42 to 4.24); depression (AOR 2.55, 95% CI 1.60 to 4.05) and anxiety (AOR 2.08, 95% CI 1.32 to 3.26) were at increased risk of poorer health outcomes, after controlling for age, gender, type of injury and time since injury. CONCLUSION This study found that comorbidities such as arthritis, chronic back pain, other chronic pain, depression and anxiety significantly increase the odds of poorer health postinjury, regardless of the time since injury. Regular screening of comorbid conditions may help identify people likely to have poorer outcomes, thereby enabling the implementation of interventions to optimise health despite the presence of comorbidities.
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Affiliation(s)
- Stella Samoborec
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pamela Simpson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melita Giummarra
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Wang L, Yu C, Zhang Y, Luo L, Zhang G. An analysis of the characteristics of road traffic injuries and a prediction of fatalities in China from 1996 to 2015. TRAFFIC INJURY PREVENTION 2018; 19:749-754. [PMID: 29969283 DOI: 10.1080/15389588.2018.1487061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/29/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study analyzed the characteristics and burdens of road traffic injuries (RTIs) from the 3 perspectives of time, space, and population in China and predicted traffic fatalities using 2 models. METHODS By extracting data from the China Statistical Yearbooks and GBD 2015 (Global Health Data Exchange), we described the change in the time trend of traffic crashes and economic losses associated with the rate of motorization in China from 1996 to 2015; analyzed the geographical distribution of these events by geographic information system; and evaluated the age-, sex-, and cause-specific death rate, disability-adjusted life year (DALY) rate, years of life lost (YLL) rate, and years lost due to disability (YLD) rate lost from RTIs from 1990 to 2015. In addition, we predicted the traffic fatality (per population or vehicles) trend using the log-linear model derived from Smeed's and Borsos' models. RESULTS From 1996 to 2015, the motorization rate showed rapid growth, increasing from 0.023 to 0.188. With the growth in the motorization rate, the time trends of traffic crashes and economic losses in China changed, showing a tendency to first increase and then later decrease. The crashes and losses were closely correlated and mainly distributed in some of the economically developed provinces, including Zhejiang, Jiangsu, Anhui, Sichuan, and Guangdong provinces. The health burden of RTIs presented a time trend similar to that of the economic burden, and it was higher among males than females. The death rate among older pedestrians was higher. The DALY rate and YLL rate among young and middle-aged pedestrians were higher. The YLD rate among older motor vehicle drivers was higher. In addition, the fatalities per 10,000 vehicles continued to decline, and Borsos's model was better fitted to the reported traffic fatalities than Smeed's model. CONCLUSIONS Although the burden of RTIs in China has declined, the burden of RTIs is still heavy. Hence, RTIs remain a universal problem of great public health concern in China, and we need to work hard to reduce them.
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Affiliation(s)
- Lu Wang
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
| | - Chuanhua Yu
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
- b Global Health Institute, Wuhan University, Wuchang District , Wuhan , China
| | - Yunquan Zhang
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
| | - Lisha Luo
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
| | - Ganshen Zhang
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
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