THE PSYCHOSOCIAL BURDEN DUE TO CAR CRASHES IN DRIVERS SURVIVING SERIOUS CRASHES: FINDINGS FROM A POPULATION-BASED COHORT STUDY

摘要

Background: Estimates of disability following car crashes are derived mainly from studies of hospitalised survivors and insurance claimants. We assessed the population-based burden of physical and non-physical disability in drivers surviving serious car crashes. Methods: Between October 1998 and July 1999, all drivers involved in car crashes in which at least one occupant was admitted to hospital in Auckland, New Zealand, and a representative sample of all driving in the region were recruited to a population-based prospective cohort study. Of 292 "crash" drivers and 368 "control" drivers recruited, 245 (84%) and 285 (75%), respectively, were interviewed at five months, and 218 (75%) and 254 (69%) interviewed at eighteen months. The study instrument included the Short Form-36. Findings: At eighteen months follow-up, 43% of hospitalised drivers, 20% of non-hospitalised "crash" drivers and 7% of "control" drivers reported their health was worse than at baseline. The risk of deteriorating health over eighteen months was fivefold greater in "crash" survivors than the general driving public (adjusted odds ratio 5.0; 95% CI: 3.5-6.5). While hospitalised drivers reported greater physical disability than non-hospitalised "crash" drivers, these indices improved from five to eighteen months. However, hospitalised and non-hospitalised drivers reported declining mental and general health throughout follow-up, with non-hospitalised drivers reporting greater reductions than those hospitalised. Interpretation: Previous estimates based primarily on survivors requiring medical attention substantially under-represent the population-based burden of long-term disability following car crashes, a significant component of which appears unrelated to physical injury.