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Background: There is growing evidence that a range of pre-injury, injury related and post-injury factors influence social and health outcomes across the injury severity spectrum. This paper documents health related outcomes for people with mild, moderate and severe injury after motor vehicle crash (MVC) injuries in New South Wales, Australia.Methods: This inception cohort study followed 2019 people injured in MVCs, for 6 and 12 months post-injury. We categorised moderate injury as hospital length-of-stay (LOS) of 2-6 days and Injury Severity Score (ISS) of 4-11, while severe injury as LOS ≥7 days or ISS ≥ 12. We examined differences in paid work status, 12-Item Short Form Survey (SF12), EQ-5D and World Health Organisation Disability Assessment Schedule II (WHODAS) outcomes longitudinally from baseline to 12 months between levels of injury severity using linear mixed models for repeated measures. We first considered minimally sufficient adjustment factors (age, sex, crash role, perceived danger in crash, pre-injury health, pre-injury EQ-5D, recruitment source), and then more extensive adjustments including post-injury factors. The presence of mediating pathways for SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) via post-injury factors was evaluated.Results: Based on hospital length of stay (LOS), 25 and 10% of participants sustained moderate and severe injuries, respectively, while 43 and 4% had these injuries based on ISS. Twelve months post-injury LOS ≥7 days versus ≤1 day was associated with an estimated 9 units lower mean SF12 PCS using a minimally sufficient adjustment model, and LOS ≥ 7 days was associated with a 3 units lower mean SF12 MCS score. Mediation analyses (LOS ≥ 7 days vs ≤1 day) found for SF12 MCS outcomes, effects of injury severity were small and mostly indirect (direct effect - 0.03, indirect effect - 0.22). Whereas for SF12 PCS outcomes the effect of having a more severe injury rather than mild were both direct and indirect (direct effect - 0.50, indirect effect - 0.38).Conclusions: Individuals with severe injuries (those with LOS ≥ 7 days and ISS 12+) had poorer recovery 12 months after the injury. In addition, post-injury mediators have an important role in influencing long-term health outcomes.Trial Registration: Australia New Zealand Clinical trial registry identification number - ACTRN12613000889752 . [ABSTRACT FROM AUTHOR]

Background: Studies have shown that in people injured in a road traffic crash, persistent symptoms are common and can lead to significant ongoing personal impact. Hence, elucidating factors associated with the human costs are key to reducing the socio-economic burden of road traffic injuries. Therefore, in this study we aimed to track the experience and key outcomes of persons who had sustained mild/moderate injuries as they returned to health (and work, where relevant) following a road traffic crash. Results: It is an inception study cohort of adults who had sustained mild to moderate injuries (that is, except serious injuries) in motor vehicle crashes in New South Wales, Australia, who were recruited and interviewed at baseline (within 3 months of the crash) and at 6, 12 and 24 months post-injury. We found that minor injuries had major impacts on pain ratings, physical and mental well-being, health-related quality of life and return to work and preinjury participation during the 24 months post-injury phase. Further, for mild to moderately severe injuries, biopsychosocial factors appear to be prognostic indicators of recovery (not the location or type of injury). Examples of key biopsychosocial factors are: age; preinjury health; quality of life; reactions to injury (catastrophising, and pain); social support and the third party insurance compensation system. Discussion: This study highlights the considerable impact of apparently "minor" road traffic crash injuries at a population level and suggests targeted approaches to the tertiary prevention of long-term morbidity and disability. Study findings have also reiterated the importance of looking beyond the injury to the 'whole person'. [ABSTRACT FROM AUTHOR]

Objective: To develop and recalibrate an Australian 5-year cardiovascular disease (CVD) mortality risk score to produce contemporary predictions of risk.Methods: Data were pooled from six Australian cohort studies (n = 54,829), with baseline data collected between 1989 and 2003. Participants included were aged 40-74 years and free of CVD at baseline. Variables were harmonised across studies and missing data were imputed using multiple imputation. Cox proportional hazards models were used to estimate the risk of CVD mortality associated with factors mutually independently predictive (p < 0.05) and a 5-year risk prediction algorithm was constructed. This algorithm was recalibrated to reflect contemporary national levels of CVD mortality and risk factors using national statistics.Results: Over a mean 16.6 years follow-up, 1375 participants in the six studies died from CVD. The prediction model included age, sex, smoking, diabetes, systolic blood pressure, total and high-density lipoprotein cholesterol (HDLC), a social deprivation score, estimated glomerular filtration rate and its square and interactions of sex with diabetes, HDLC and deprivation score, and of age with systolic blood pressure and smoking. This model discriminated well when applied to a Scottish study population (c-statistic (95% confidence interval): 0.751 (0.709, 0.793)). Recalibration generally increased estimated risks, but well below those predicted by the European SCORE models.Conclusions: The resulting risk score, which includes markers of both chronic kidney disease and socioeconomic deprivation, is the first CVD mortality risk prediction tool for Australia to be derived using Australian data. The primary model, and the method of recalibration, is applicable elsewhere. [ABSTRACT FROM AUTHOR]

Background: It is estimated that up to 50 % of motor vehicle crash survivors develop significant psychological distress, such as depressive mood and anxiety, within 6 months of the crash. Associated impacts include loss of employment, delayed return to work, financial and familial stress, and increased medical and compensation costs. The major aim of this research is to investigate the efficacy of interventions for preventing the development of psychological distress following a motor vehicle crash. The efficacy of two brief interventions will be examined: a cognitive behaviour therapy (CBT) programme, targeting mood and anxiety, and a lifestyle programme, targeting sleep, diet and physical activity.Methods/design: This is a randomized, controlled multisite study. Participants include at least 180 adults injured in a motor vehicle crash who have entered a compensation process. Research will compare outcomes in three groups randomly assigned to: one group of 60 adults, who receive a brief email-delivered CBT programme, with one session every 2 weeks for 10 weeks and telephone contact every 2 weeks; a second group of 60 adults, who receive a brief email-delivered lifestyle intervention involving one session every 2 weeks for 10 weeks with telephone contact; and an active waiting-list control group of 60 adults who are provided claims processing-related reading material along with telephone contact every 2 weeks for 10 weeks. Participants will be recruited within 12 weeks of the motor vehicle crash, and will be comprehensively assessed before and after treatment, and 6 and 12 months post-injury. Assuming an α probability level of 0.05 and a power of 80 %, at least 180 participants will be recruited. The primary outcome measure is the presence and severity of psychological distress or disorder. Secondary outcome measures include assessment of self-efficacy, resilience employment status, social activity and support, lifestyle and physical health factors, along with process outcome measures of treatment acceptability, feasibility and generalizability.Discussion: This study will determine whether brief email-delivered interventions distributed soon after the injury and entry into the claims process can be effective in preventing the development of psychological distress.Trial Registration: ANZCTR, ACTRN12615000326594 . Registered on 9 April 2015. [ABSTRACT FROM AUTHOR]

Background: Research suggests that exposure to the compensation system (including time to case closure) could adversely influence a persons' recovery following injury. However, the long-term predictors of time to claim closure following minor road traffic injuries remain unclear. We aimed to assess a wide spectrum of factors that could influence time to claim closure (socio-demographic, compensation-related, health, psychosocial and pre-injury factors) over 24 months following a non-catastrophic injury.Methods: Prospective cohort study of 364 participants involved in a compensation scheme following a motor vehicle crash. We used a telephone-administered questionnaire to obtain information on potential explanatory variables. Information on time to claim closure was obtained from an insurance regulatory authority maintained database, and was classified as the duration between the crash date and claim settlement date, and categorized into < 12 (early), > 12-24 (medium) and > 24 months (late).Results: Just over half of claimants (54 %) had settled their claim by 12 months, while 17 % and 30 % took > 12-24 months and > 24 months for claim closure, respectively. Whiplash at baseline was associated with claim closure time of > 12-24 months versus < 12 months: multivariable-adjusted OR 2.38 (95 % CI 1.06-5.39). Claimants who were overweight/obese versus normal/underweight at the time of injury were ~3.0-fold more likely to settle their claim at > 12-24 months than < 12 months. Consulting a lawyer was associated with a 10.4- and 21.0-fold increased likelihood of settling a claim at > 12-24 months and > 24 months, respectively. Each 1-unit increase in Orebro Musculoskeletal Pain Screening Questionnaire scores at baseline was associated with greater odds of both medium (> 12-24 months) and delayed claim settlement date (> 24 months): multivariable-adjusted OR 1.04 (95 % CU 1.01-1.07) and 1.02 (95 % CI 1.00-1.05), respectively.Conclusions: Around a third of claimants with a minor injury had not settled by 24 months. Health-related factors and lawyer involvement independently influenced time to claim closure. [ABSTRACT FROM AUTHOR]

Background: We aimed to establish the frequency and characteristics (e.g. socioeconomic, pre-injury, and crash-related parameters) of injured bicyclists and other injured road users.Methods: 748 participants aged ≥17 years who had sustained a minor or non-catastrophic injury in a land-transport crash, were interviewed after presenting to a metro hospital emergency department in New South Wales, Australia. A telephone-administered questionnaire obtained information on socio-economic, pre-injury health, and crash-related characteristics. These factors were then compared between injured bicyclists and other road users (car driver/passengers, motorcyclists/pillion and pedestrians/skateboarders). Cycling injury severity was characterized by three metrics (sustaining multiple injuries; hospital admission for ≥12 h; and sustaining a head/neck and/or facial injury).Results: In this cohort of people with injuries, 238 (32 %) were bicyclists. Frequency of cycling injuries were significantly different between age-groups among men (p = 0.0002), and were more common in men aged 45-59. Bicyclists were more likely to be aged 45-59, married, have university/tertiary qualifications and have a professional occupation compared to other road users (all p <0.0001). Bicyclists compared to participants involved in other types of land transport crashes were more likely to self-report excellent general health (p = 0.01), and were less likely to report a great/overwhelming perceived danger of death or 15.0 % versus 23-41 %; p <0.0001). Frequency of upper extremity and lower extremity injuries in bicyclists were 81.9 % and 60.5 %, respectively. Explanatory variables significantly associated with injury severity metrics were age, education level, paid work status and perceived danger of death/disability in the crash.Conclusions: Minor cycling injuries were a relatively common cause of mild-moderate injury presentations to metro emergency departments. A wide spectrum of socio-demographic-, pre-injury-, and crash-related characteristics were related to cycling injuries. [ABSTRACT FROM AUTHOR]