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Momenyan S, Chan H, Erdelyi S, Pei LX, Shum LK, Jae L, Taylor J, Staples JA, Bryan S, Brubacher JR. Trajectories of health-related quality of life following road trauma: Latent growth mixture modeling across a 12-month cohort study. Accid Anal Prev 2024; 202:107574. [PMID: 38663274 DOI: 10.1016/j.aap.2024.107574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Health-related quality of life (HRQoL) should be considered when evaluating the burden of road trauma (RT) injuries. This study aimed to identify distinct HRQoL trajectories following minor to severe RT injury and determine characteristics of trajectory membership. METHODS This prospective inception cohort study recruited 1480 RT survivors from three emergency departments in British Columbia, Canada (July 2018 - March 2020). HRQoL outcome was measured with the Short Form 12 survey (SF-12) and the 5-level version of the EuroQol instrument (EQ-5D-5L) at baseline (pre-injury) and at 2, 4, 6, and 12 months post-injury. Potential predictors of outcome trajectory included sociodemographic, psychological, medical, crash, and injury factors collected at baseline. We used a latent growth mixture model to identify distinct recovery trajectories and multinomial logistic regression to determine predictors of trajectory membership. RESULTS Three distinct HRQoL trajectories were identified for SF-12 subscales and EQ-5D-5L measures: Low/Moderate-Stable, High-Large decline, and High-Slight decline. Participants in the Low/Moderate-Stable trajectory had persistent low to moderate HRQoL before and after the injury. Those in the High-Large decline trajectory had good pre-injury HRQoL followed by persistently decreased HRQoL afterwards. The High-Slight decline trajectory was characterized by good pre-injury HRQoL and only a slight decline afterwards. Participants in the Low/Moderate-Stable and High-Large decline trajectories were considered at risk of permanently poor HRQoL following RT injury given their low HRQoL over a long period of time. Characteristics that placed participants in the Low/Moderate-Stable trajectory were older age, female gender, poor pre-injury health (medical comorbidity, prescribed medication use, complaints in the injured body area(s)), pre-injury somatic symptoms, pain catastrophizing or psychological distress, injury severity (ISS) and injury pain. Patients with head injury were less likely to be in the Low/Moderate-Stable trajectory. Risk factors for membership in the High-Large decline trajectory included older age (for physical HRQoL), younger age (for mental HRQoL), female gender, living alone, pre-injury psychological distress, ISS, injury pain, no expectations for a fast recovery, as well as head injuries, spine/back injuries or lower extremity injuries. CONCLUSIONS This study highlighted the heterogeneity of HRQoL trajectories following RT injury and the importance of considering differences between characteristics of survivors. In addition to injury type and severity, outcome is related to demographic factors, pre-injury health and pre-injury psychological factors.
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Affiliation(s)
- Somayeh Momenyan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lulu X Pei
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leona K Shum
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lina Jae
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Taylor
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Staples
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Momenyan S, Chan H, Erdelyi S, Pei LX, Shum LK, Jae L, Taylor J, Staples JA, Brubacher JR. Health-related quality of life in the year following road trauma: Longitudinal analysis using piecewise latent curve modeling. J Affect Disord 2024; 354:509-518. [PMID: 38490589 DOI: 10.1016/j.jad.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Road trauma (RT) survivors have reduced health-related quality of life (HRQoL). We identified phases and predictors of HRQoL change following RT injury. METHODS In a prospective cohort study of 1480 Canadian RT survivors aged 16 to 103 years (July 2018 - March 2020), physical component (PCS) and mental component (MCS) summary scores from the SF-12v2 were measured pre-injury and 2, 4, 6, and 12 months post-injury and their trajectories were analyzed with piecewise latent growth curve modeling. Potential predictors of HRQoL changes included sociodemographic, psychological, medical, and trauma-related factors. RESULTS PCS and MCS scores worsened from pre-injury to 2-months (phase 1) and then improved (phase 2), but never regained baseline values. Older age, somatic symptoms and pain catastrophizing were associated with lower preinjury PCS and MCS scores. Psychological distress was associated with lower preinjury MCS scores and higher preinjury PCS scores. Phase 1 PCS scores decreased most in females, participants with fewer pre-injury somatic symptoms and those without expectations for fast recovery. Phase 1 MCS decreases were associated with younger age, female sex, living alone, lower psychological distress, lack of expectation for fast recovery and higher injury pain. In phase 2, MCS improved most in participants not using recreational drugs; PCS improved most in participants with higher education and longer recovery expectations. LIMITATIONS There may be recall bias with reporting pre-injury HRQoL. Selection bias is possible. CONCLUSIONS Many factors influence HRQoL following RT. These findings may inform measures to minimize HRQoL reduction following RT and speed up subsequent recovery.
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Affiliation(s)
- Somayeh Momenyan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lulu X Pei
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leona K Shum
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lina Jae
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Taylor
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Staples
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Pei LX, Chan H, Staples JA, Taylor JA, Harris DR, Jae L, Brubacher JR. Twelve-month recovery following road trauma: Results from an inception cohort in Vancouver, Canada. Ann Phys Rehabil Med 2024; 67:101828. [PMID: 38479251 DOI: 10.1016/j.rehab.2024.101828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Injury-related disability following road trauma is a major public health concern. Unfortunately, outcome following road trauma and risk factors for poor recovery are inadequately studied, especially for road trauma survivors with minor injuries that do not require hospitalization. OBJECTIVES This manuscript reports 12-month recovery outcomes for a large cohort of road trauma survivors. METHODS This was a prospective, observational inception cohort study of 1,480 road trauma survivors recruited between July 2018 and March 2020 from 3 trauma centres in British Columbia, Canada. Participants were aged ≥16 years and arrived in a participating emergency department within 24 h of a motor vehicle collision. Data on baseline health and injury severity were collected from structured interviews and medical records. Outcome measures, including the SF-12, were collected during follow-up interviews at 2, 4, 6 and 12 months. Predictors of recovery outcomes were identified using Cox proportional hazards models and summarized using hazard ratios. RESULTS Only 42 % of participants self-reported full recovery and only 66 % reported a return to usual daily activities. Females, older individuals, pedestrians, and those who required hospital admission had a poorer recovery than other groups. Similar patterns were observed for the SF-12 physical component. For the SF-12 mental component, no significant differences were observed between participants admitted to hospital and those discharged home from the ED. Return to work was reported by 77 % of participants who had a paying job at baseline, with no significant differences between sex and age groups. CONCLUSIONS In a large cohort of road trauma survivors, under half self-reported full recovery one year after the injury. Poor mental health recovery was observed in both participants admitted to hospital and those discharged home from the ED. This finding may indicate a need for early intervention and continued mental health monitoring for all injured individuals, including for those with less serious injuries.
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Affiliation(s)
- Lulu X Pei
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John A Staples
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John A Taylor
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Devin R Harris
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lina Jae
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
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Pei LX, Chan H, Erdelyi S, Jae L, Brubacher JR. Circumstances and outcome of active transportation injuries: protocol of a British Columbian inception cohort study. BMJ Open 2023; 13:e079219. [PMID: 37879691 PMCID: PMC10603471 DOI: 10.1136/bmjopen-2023-079219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Active transport (AT) is promoted by urban planners and health officials for its environmental, economic and societal benefits and its uptake is increasing. Unfortunately, AT users can be injured or killed due to falls or collisions. Active transport injury (ATI) prevention efforts are hindered by limited research on the circumstances, associated infrastructure, injury pattern, severity and outcome of ATI events. This study seeks to address these knowledge gaps by identifying built environment features associated with injury and risk factors for a poor outcome following ATI. METHODS AND ANALYSIS This prospective observational study will recruit an inception cohort of 2000 ATI survivors, including pedestrians, cyclists and micromobility users aged 16 years and older who arrive at a participating emergency department within 48 hours of sustaining an ATI. Baseline interviews capture demographic and socioeconomic information, pre-injury health and functional status, as well as circumstances of the injury event and recovery expectations. Follow-up interviews at 2, 4, 6 and 12 months postinjury (key stages of recovery) use standardised health-related quality of life tools to determine physical and mental health outcomes, functional recovery and healthcare resource use and lost productivity costs. ETHICS AND DISSEMINATION The Active Transportation Injury Circumstances and Outcome Study is approved by our institutional research ethics board and the research ethics boards of all participating sites. This study aims to provide healthcare providers with knowledge of risk factors for poor outcome following ATI with the goal of improving patient management. Additionally, this study will provide insight into the circumstances of ATI events including built environment features and how those circumstances relate to recovery outcomes. This information can be used to inform city engineers and planners, policymakers and public health officials to plan roadway design and injury prevention policy.
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Affiliation(s)
- Lulu X Pei
- Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Herbert Chan
- Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon Erdelyi
- Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lina Jae
- Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Pei LX, Chan H, Shum LK, Jae L, Staples JA, Taylor JA, Harris DR, Brubacher JR. Demographic and clinical profile of an inception cohort of road trauma survivors. BMC Public Health 2023; 23:1534. [PMID: 37568139 PMCID: PMC10422727 DOI: 10.1186/s12889-023-16487-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/09/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Road trauma is a major public health concern, often resulting in reduced health-related quality of life and prolonged absenteeism from work even after so-called 'minor' injuries that do not result in hospitalization. This manuscript compares pre-injury health, sociodemographic characteristics and injury details between age, sex, and road user categories in a cohort of 1,480 road trauma survivors. METHODS This was a prospective observational inception cohort study of road trauma survivors recruited between July 2018 and March 2020 from three trauma centres in British Columbia, Canada. Participants were aged ≥ 16 years and arrived in a participating emergency department within 24 h of involvement in a motor vehicle collision. Data were collected from structured interviews and review of medical records. RESULTS The cohort of 1,480 road trauma survivors included 280 pedestrians, 174 cyclists, 118 motorcyclists, 683 motor vehicle drivers, and 225 passengers. Median age was 40 (IQR = [27, 57]) years; 680 (46%) were female. Males and younger patients were significantly more likely to report better pre-injury physical health. Motorcyclists and cyclists tended to report better physical health and less severe somatic symptoms, whereas pedestrians and motor vehicle drivers reported better mental health. Injury severity and hospital admission rates were higher in pedestrians and motorcyclists and lower in motorists. Upper and lower extremity injuries were most common in pedestrians, cyclists and motorcyclists, whereas neck injuries were most common in motor vehicle drivers and passengers. CONCLUSIONS In a large cohort of road trauma survivors, overall injury severity was low. Motorcyclists and pedestrians, but not cyclists, had more severe injuries than motorists. Extremity injuries were more common in vulnerable road users. Future research will investigate one-year recovery outcomes and identify risk factors for poor recovery.
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Affiliation(s)
- Lulu X Pei
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Leona K Shum
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Lina Jae
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - John A Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - John A Taylor
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Devin R Harris
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
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