Prognosis of outcome in adult survivors of road accidents in France: 1-year follow-up in the ESPARR cohort

Hoang-Thy Nhac-Vu (1) , Martine Hours (1) , Laetitia Chossegros (1) , Pierrette Charnay (1) , Hélène Tardy (1) , Jean-Louis Martin (1) , Jean-Michel Mazaux (2) , Bernard Laumon (1)

1 UMRESTTE UMR T9405 - Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement
2 Service de Médecine Physique et Réadaptation

Objectives The consequences of road crashes are various, and few studies have dealt with the multidimensionality of outcomes. The aim of the present study was to assess the multidimensional nature of outcomes one year after a crash and to determine predictive factors which could help in adapting medical and social care to prevent such consequences to improve road-crash victims’ prognosis. Methods The study population was the 886 respondents to the one year follow-up from the ESPARR cohort, aged ≥16 years; the analysis was carried out only on the 616 subjects who fully completed a self-report questionnaire on health, social, emotional and financial status 1 year after a crash. Multiple correspondence analysis and hierarchical clustering was implemented to produce homogeneous groups according to differences in outcome. Groups were compared using the WHOQol-Bref (a standard instrument of quality of life, assessing physical health, psychological health, social relationships and environment) and the IIS (Injury Impairment Scale), a tool to predict road-crash sequelae. Baseline predictive factors for group attribution were analyzed by weighted multinomial logistic regression models. Results 370 of the 616 subjects (60.1%) were men. Mean age was 36.9 years (standard deviation=16.5). Five victim groups were identified in terms of consequences at 1 year: one group (206 subjects, 33.4%) with few problems, one with essentially physical sequelae, one with problems that were essentially both physical and social, and two groups with a wider range of problems (one including psychological problems but fewer environmental problems, and the last one reported negative physical, psychological, social and environmental impact; notably, all had PCS). There were significant differences between groups in terms of family status, injury severity and certain types of injury (thorax, spine, lower limbs). Comparison on the WHOQol-Bref confirmed that groups reporting more adverse outcomes had a lower quality of life. Description of the 5 groups by IIS indicators showed that IIS underestimated physical consequences 1 year after the crash. Beside the known prognostic factors such as age, initial injury severity and lesion type, socioeconomic fragility and having a relative involved in the accident emerged as predictive of poor outcome at one year. Conclusions One year after the crash, victims may still be experiencing multiple problems in terms not only of physical health but also of mental health, social life and environment. Poor outcome may be predicted from both accident-related factors and socioeconomic fragility. Our results are useful in catching the attention of both clinicians and the public administration regarding victims at risk of suffering from important consequences after an accident. If those suffering head injuries are recognized, it would be very important to better consider and treat PTSD or PCS. Furthermore, subjects from lower socioeconomic backgrounds, with or without lower limb lesions have numerous difficulties after an accident, notably for returning to work: an objective would be to provide them more specific support.

Mots clés: ACCIDENT DE LA ROUTE; PREVISION

Domaines: Santé publique et épidémiologie

Hoang-Thy Nhac-Vu, Martine Hours, Laetitia Chossegros, Pierrette Charnay, Hélène Tardy, et al.. Prognosis of outcome in adult survivors of road accidents in France: 1-year follow-up in the ESPARR cohort. Traffic Injury Prevention, 2013, 40p. ⟨10.1080/15389588.2013.804180⟩. ⟨hal-00866403⟩