Search

People who sustain injury in a road traffic crash (RTC) have significant risk of psychiatric morbidity, but effective screening for identifying at-risk individuals soon after the RTC is lacking. We investigated whether pre-injury vulnerability can assist as an early screen to manage this risk. We recruited 120 adults who sustained physical injury in a RTC and admitted to an emergency department (ED). They were comprehensively assessed for acute and long-term presence of psychiatric disorder/morbidity and disability over 12-months after the injury, with comparisons to a non-injury control. Propensity matching based on six pre-injury vulnerability factors (age, sex, education, socioeconomic status, prior mental health, prior physical health) with the control group was used to determine membership of high vulnerability (HV) and low vulnerability (LV) injury sub-groups. Compared to the LV sub-group and controls that had similar pre-injury vulnerability, the HV sub-group had a worrying post-RTC recovery profile, with significantly higher rates of long-term psychiatric morbidity (42.2% vs. 23.1% and 15.9% respectively, p =.002) including post-traumatic stress disorder and/or depression, and poorer psychological adjustment over the 12-months. In contrast, the HV and LV sub-groups were similar in injury-related characteristics and post-injury physical (pain, fatigue, physical functioning) and participation outcomes. Findings provide preliminary evidence that pre-injury vulnerability, primarily prior mental health status, is a promising screen for early identification of people at risk of psychiatric morbidity post-RTC. It is suggested this screen could be implemented in ED to prevent chronicity and improve recovery following a traumatic injury. Further research is warranted to enhance the screen's effectiveness. • Pre-injury vulnerability contributes to increased risk of psychiatric morbidity after a road traffic injury. • Physical recovery is less impacted by pre-injury vulnerability. • Risk of psychiatric morbidity could be screened as soon as in Emergency Department. • Screening could be improved for instance by assessment of peri-traumatic distress. [ABSTRACT FROM AUTHOR]

Background: Motor vehicle related moderate-severe orthopaedic trauma has a major impact on the burden of injury. In Australia, all states and territories provide access to financial compensation following injury in a motor vehicle crash. The aim of this study was to investigate the influence of seeking financial compensation (i.e., making a claim) on injury recovery following motor vehicle related moderate-severe orthopaedic trauma.Methods: Patients admitted with upper/lower extremity fractures after a motor vehicle crash were recruited from two trauma hospitals. Baseline data were collected in person by written questionnaire within two weeks of injury. Follow up data were collected by a mailed written questionnaire at six, 12 and 24 months. Additional (demographic/injury-related) information was collected from hospital databases, all other measures were self-reported. Outcomes were: Short Form-36 Version 2.0 (SF36v2), Physical/Mental Component Scores (PCS/MCS); Post Traumatic Stress Disorder (PTSD) Checklist Civilian Version (PCL-C); and Global Rating of Change (GRC) scale. Analysis involved descriptive statistics and linear mixed models to examine the effect of compensation status on injury recovery over time.Results: There were 452 study participants. Baseline characteristics showed: mean age 40 years (17.1 Standard Deviation [SD]); 75 % male; 74 % worked pre-injury; 67 % in excellent-very good pre-injury health; 56 % sustained serious injuries, Injury Severity Score (ISS) 9-15; 61 % had a low-middle range household income. Overall, after controlling for possible confounders, the compensable group had poorer recovery compared to the non-compensable group for PCS (-2.97 Mean Difference (MD), 95 % CI -4.73, -1.22); MCS (-3.44 MD, 95 % CI -5.62, -1.26); PCL-C (3.42MD, 95 % CI 0.87, 5.99); and GRC (-0.66MD, 95 % CI -1.15, -0.17). Injury recovery over time for all participants showed: PCS improved from 6-12 and 12-24 months; MCS and GRC improved from 6-12 months; and PCL-C did not significantly improve from 6-12 and 12-24 months. Injury recovery over time continued for compensable and non-compensable groups but compensable participants had poorer scores at each time period, especially MCS and PCL-C.Conclusions: Making a claim was associated with poor injury recovery following motor vehicle related orthopaedic trauma, mainly for mental health. Irrespective of claim status, the majority had poor injury recovery, especially for mental health. [ABSTRACT FROM AUTHOR]

Traumatic injuries can have long-term negative impacts on health, especially psychological health. A biopsychosocial approach is recommended to identify those likely to experience psychosocial stress, however large individual differences exist in stress reactivity and post-injury health that remain unexplored. Therefore, we investigated autonomic nervous system (ANS) stress responses and pre-existing psychosocial vulnerability as contributors to health in individuals who sustained a traffic-related injury. 120 adults with traffic-related injury and 112 non-injury controls underwent an integrative ANS (cardiac and skin conductance) assessment and a health-related assessment at 3–6 weeks post-injury. Propensity score matching based on six pre-injury psychosocial vulnerability factors (age, sex, education, prior mental/physical health, socioeconomic status) guided the definition of high vulnerability (HV) and low vulnerability (LV) injury subgroups, with the LV subgroup having similar propensity scores to non-injury controls. A three-group comparative analysis of ANS responsivity (baseline, reactivity, recovery/rebound) and post-injury health was performed. The HV subgroup exhibited the most negative immediate post-injury mental health profile and less adaptive ANS response patterns, indicating greater stress vulnerability/reactivity. Significant differences were found for psychological health (elevated psychological distress and catastrophizing), but not physical health (injury factors, pain, fatigue, physical wellbeing). HV participants showed sympathetic predominance at resting baseline (lower parasympathetic activity and/or elevated heart rate) compared to the LV and control groups, as well as smaller parasympathetic decrease during a cognitive task compared to controls. Despite preserved capacity for restoring initial homeostasis in both injury subgroups during recovery, there was some indication of blunted post-task sympathetic deactivation (larger sympathetic decrease) and reduced overall ANS adaptability (reduction in total power of heart rate variability spectrum), suggesting relative reduced capacity to face stressors compared to controls. Findings suggest that baseline resting ANS regulation, particularly parasympathetic activity, and pre-injury psychosocial factors are key contributors to individual psycho-biological responses following traumatic injury, and are therefore potential stress vulnerability markers. Post-stress recovery patterns may represent a novel physiological signature for a "biological intrinsic" vulnerability early after the injury. These findings provide direction for improved early identification and management of injured individuals, including innovative preventive interventions that target ANS regulation. • Resting autonomic regulation and pre-injury vulnerability were associated with psychological adjustment to traumatic injury. • Individuals with higher pre-injury vulnerability exhibited less adaptive psycho-biological responses to the injury. • Autonomic recovery patterns suggested a reduced capacity to deal with stressors immediately post-injury. [ABSTRACT FROM AUTHOR]

Background: People who sustain road traffic injuries often have poor health outcomes. While outcomes are often worse in people with a compensation claim, especially in fault-based schemes versus no-fault schemes, few studies have directly compared outcomes across scheme types.Objective: To compare health and work outcomes between people who had no compensation claim, a fault-based claim, or "no-fault" transport or workers compensation claim after hospitalisation for a road traffic injury.Methods: Participants aged >=18 years admitted to hospital in New South Wales or Victoria for >24 hours were recruited in two separate prospective cohort studies (N=1,034). People who died or sustained minor or very severe injuries were excluded. Groups included Compulsory Third Party (fault-based, n=128), no-fault Transport Accident Commission (TAC; n=454) and workers compensation claimants (n=73), or no claim (n=226). Outcomes at six, 12- and 24-months post-injury included health [SF-12 Mental Component Score (MCS) and Physical Component Score (PCS)], and return to work for people working pre-injury. Multivariable mixed effects linear and logistic regressions, adjusting for demographic and injury covariates, examined differences in health and work outcomes between claimant groups, with fixed effects of time and random effects of participant ID.Results: Health status was better in people with a no-fault TAC claim (MCS: m=50.62, 95%CI:49.62,51.62; PCS: m=40.49, 95%CI:39.46,41.52) or no claim (MCS: m=49.99, 95%CI:49.62,51.62; PCS: m=44.36, 95%CI:43.00,45.72), than people with a workers compensation (MCS: m=45.73, 95%CI:43.46,48.00; PCS: m=38.94, 95%CI:36.59,41.30) or fault-based CTP claim (MCS: m=41.34, 95%CI:39.54,43.13; PCS: m=35.64, 95%CI:33.78,37.49). Relative to fault-based CTP claimants, the odds of returning to work were higher for people with no claim (AOR=6.84, 95%CI:1.73,27.05) but did not differ for no-fault TAC (AOR=1.21, 95%CI:0.36,4.05) or workers compensation claimants (AOR=0.83,95%CI: 0.17,3.99). While people with a fault-based CTP claim had poorer mental and physical health and return to work after injury, they showed greater improvements in mental health, and similar levels of improvement in physical health and work participation over time to the other groups.Conclusion: The patterns of health and work across scheme types provide important insights against which we can contrast the effects of future scheme designs on client outcomes. [ABSTRACT FROM AUTHOR]