Facteurs pronostiques du devenir à un an des victimes d’accidents de la route – Cohorte ESPARR

Objectifs Les conséquences d’un accident de la route sont variées, cependant peu d’études ont pris en compte leur aspect multidimensionnel. Notre objectif est d’analyser cet aspect et de déterminer les facteurs prédisant le devenir à un an des victimes d’accident de la route. Méthodes L’analyse a porté sur 616 victimes d’accident de la route de la cohorte ESPARR, de 16 ans et plus, qui ont complété un an après l’accident, un questionnaire sur leur état de santé, leur statut familial, social, émotionnel, financier. Par une mise en ½uvre conjointe d’analyse des correspondances multiples et de classification ascendante hiérarchique, ces sujets sont classés dans des groupes homogènes en fonction des conséquences observées à un an. Ces groupes sont ensuite comparés sur leur qualité de vie à un an (WHOQol-Bref). Les facteurs prédictifs d’appartenir à un groupe sont analysés à partir de modèles de régression logistique multinomiale pondérée. Résultats Cinq groupes de victimes ont été identifiés : dans le groupe 1 les sujets ont une bonne récupération ; les sujets du groupe 2 ont des conséquences physiques uniquement ; les sujets des 3 autres groupes ont des conséquences multiples (physiques, sociales, environnementales). Des différences significatives entre les groupes apparaissent en matière de statut familial, de fragilité socioéconomique initiale, de gravité des lésions initiales, et du territoire anatomique des lésions (thorax, colonne, membres inférieurs). La qualité de vie est dégradée dans les groupes présentant des conséquences multiples. Outre la gravité initiale, la fragilité socioéconomique est un élément prédisant le fait d’être dans un groupe vivant de multiples conséquences. Conclusions Un an après l’accident, les victimes subissent encore de multiples conséquences en termes de santé physique, mais aussi mentale, dans leur vie sociale et leur environnement quotidien, conséquences qui peuvent être prédites tant par des caractéristiques accidentelles que par des facteurs socioéconomiques

Conséquences socioéconomiques pour les victimes un an après l'accident de la route : résultats de la cohorte ESPARR

ADELF épidémiologie sociale et inégalités de santé , TOULOUSE, FRANCE, 15-/05/2012 - 16/05/2012En accidentologie routière, peu d'études se sont penchées sur les conséquences post-accidentelles (physiques, psychologiques, professionnelles, etc.) du traumatisme. En particulier, les répercussions socioéconomiques ont été très peu étudiées en France. Notre objectif est d'étudier la relation entre une situation socioéconomique dégradée un après l'accident et une situation de vulnérabilité sociale avant l'accident. Matériel et méthodes : l'étude s'est appuyée sur les données de la cohorte prospective ESPARR (cohorte représentative des victimes corporelles d'accidents du département du Rhône). 1168 personnes (âgées >15 ans) ont accepté, lors de l'accident, de participer à un suivi sur cinq ans par auto-questionnaires. Á partir des données d'inclusion, nous avons réalisé une ACM suivie d'une classification hiérarchique ascendante qui a permis de classer les victimes en six groupes de vulnérabilité socioéconomique. Puis les conséquences à un an en termes d'emploi, de logement, de retentissement financier, etc. ont été décrites. Une analyse en régression logistique multivariée a été réalisée pour étudier 4 types de conséquences socioéconomiques. Résultats : à un an, 10 % des répondants n'ont pas repris leur activité (4 % ont perdu leur emploi). Près d'¼ des répondants ont dû changer d'employeur et/ou d'emploi. ¼ des victimes subissent encore des répercussions financières de l'accident à un an. La gravité est toujours le facteur qui prédit de façon prépondérante les conséquences socioéconomiques. Toutefois, le fait d'être vulnérable socialement avant l'accident est également un facteur associé aux conséquences : après ajustement, le groupe des plus vulnérables a ainsi plus de risque d'avoir des difficultés financières immédiatement après l'accident que le groupe des « insérés » (OR=3,1 ; 1,7-5,7). La même observation est faite si l'on regarde le fait de ne pas travailler à un an (OR= 4,1 ; 1,7-10,0). Conclusions : la fragilité socioéconomique initiale que connait la victime accroit la dégradation socioéconomique engendrée par l'accident

Evaluation of the Injury Impairment Scale, a tool to predict road crash sequelae, in a French cohort of road crash survivors

Objective The objective of the present study was to validate sequela prediction by the Maximal Injury Impairment Score (M-IIS), in comparison with the Functional Independence Measure (FIM) assessed at 1 year's follow-up of severe road crash victims. Methods The study population came from the ESPARR cohort: 178 victims (with Maximal Abbreviated Injury Scale ≥3) of road crashes in the Rhône administrative département of France, aged ≥16 years and with medical examination including FIM scoring 1 year post-accident. Two thresholds were tested for both scores. Firstly, the relation between FIM and M-IIS was assessed on logistic regression models adjusted on age and presence of complications at 1 year post-accident. The predictive capacity of M-IIS was expressed as its negative and positive predictive values, and considered as good when ≥80%. Results Sixty-three of the 178 adult subjects (mean age = 37.7 years; range = 16.1–82.9 yrs) showed post-accident complications. One-year sequela prediction on M-IIS was greater in head, spine and limb lesions, but limited to slight impairments (M-IIS = 1). There was a significant correlation between FIM and M-IIS, although “age” and “medical complications” were confounding factors on certain multivariate models. The predictive capacity of M-IIS was low, for whatever type of sequela. Conclusions M-IIS, in this severely injured population, failed to predict sequelae at 1 year as measured by the FIM, despite a good correlation between the two. Complications are to be taken into account in assessing the M-IIS's capacity to predict sequelae. Further evaluation will be needed on larger series or assessment of other indicators and measures of sequelae at 1 year, to obtain a robust tool to predict road crash sequelae

Outcomes one year after a road accident: results from the ESPARR cohort

Objective: Reducing the rates of death, trauma and sequelae associated with road accidents is the prime goal of road safety authorities, and success requires having data on victims' outcomes in the long term. The present study examined the outcome of adult road accident victims one year after their accident. Design: A follow-up study. Methods: The cohort comprised 886 injured road-accident victims, aged ≥ 16 years, and living in the Rhône administrative Département, France (taken from the ESPARR Cohort). Data were collected on victim characteristics at the time of crash, and self-reported outcomes one year later. The population of respondents at the one-year questionnaire follow-up was divided into two categories according to injury severity, as mild-to-moderate (M.AIS<3) or severe (M.AIS3+). Qualitative variables were compared between these 2 groups using chi² or Fisher exact tests. Results: At one year post-accident, 45% of the mild-to-moderate injury group versus only 20% of severely injured subjects reported full recovery of health (p<0.001). 20% of the cohort, as a whole, reported permanent pain. More than half of the severely injured subjects reported that the accident had had an impact on the everyday life of their family; this was twice as many as in the mild-to-moderate injury group (55% vs. 22%). Most of the severely injured reported impact on leisure, projects and emotional life : 20% reported relational difficulties in the couple, 16% reported impaired sexual life, and the rate of separation was significantly higher than in the mild-to-moderate injury group (5% vs. 1%; p<0.001). Mean time off work was significantly longer in the severe injury group: 245±158 days vs. 75±104 days (p<0.001); and 32% of the severe injury group (p<0.001) who had stopped work had not returned at 1 year, compared to 5% of the mild-to-moderate injury group. Conclusions: One year after a road accident, the consequences for victims remain significant. In terms of physical impact, pain frequently persists, impairing daily life for many. There is an elevated rate of chronic PTSD (Post traumatic stress disorder) and a non-negligible impact on affective and occupational life

Predictive factors of chronic post-traumatic stress disorder 6 months after a road traffic accident

Background: This study sets out to identify risk factors for post-traumatic stress disorder (PTSD) after a road traffic accident with a view to improving prevention. Methods: The study used a prospective cohort of road traffic accident casualties. All subjects over 15 years of age were recruited in the course of an interview conducted while they were receiving care in a hospital of the Rhône area administrative département. Six months after their accident, they answered a self-administered postal questionnaire that included the Post-traumatic Check-List Scale (PCLS) in order to evaluate PTSD. Multivariate logistic regression analysis was conducted to compare those subjects with a PCLS score of 44 or over with those with a lower score, in order to identify factors that might be associated with PTSD. Results: 592 subjects (out of 1168) returned the 6-month questionnaire and 541 completed the PCLS test. One hundred subjects had a PCLS score ≥44, suggesting PTSD, and 441 subjects did not. The factors associated with PTSD were initial injury severity, post-traumatic amnesia, the feeling of not being responsible for their accident and persistent pain 6 months after it. A lower odds-ratio was associated with users of two-wheel than four-wheel motor vehicles (OR = 0.4; 0.2-0.9). Conclusion: Besides predictive factors for PTSD (injury severity, post-traumatic amnesia and the feeling of not being responsible for their accident), our study suggested a reduced risk of PTSD among two-wheel motor vehicle users

Quality of life one year after a road accident: Results from the adult ESPARR cohort

BACKGROUND: There are a few studies assessing repercussions in road accident victims, which reported their results in quality of life (QoL), on an epidemiologic point of view. METHODS: ESPARR (follow-up of victims of road accident in the Rhône) is a prospective cohort study of 1,168 individuals (age ≥ 16 years) involved in road traffic accidents, having been admitted to one of the hospitals in the Rhône département (France). The World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-Bref) was used to assess QoL at the 1-year follow-up.χ analysis was performed to test differences between groups, logistic regression was performed to examine predictors of global QoL and health, and linear regression was performed to examine predictors of the four functioning domains of the WHOQOL-Bref. RESULTS: Lesion severity (New Injury Severity Index ≥ 16; odds ratio, 2.6; 95% confidence interval, 1.7-3.9) and presence of head lesions (odds ratio, 1.5; 95% confidence interval, 1.1-2.2) were predictive of unsatisfactory QoL. Female sex, educational level lower than school graduation, severe injury, intention to lodge a complaint, early postaccident medical complications were predictive of health dissatisfaction. Several factors seemed to be associated to a poor QoL; notably, posttraumatic stress disorder was associated with low scores in all four WHOQOL-Bref domains. Socioeconomic factors were also significant, notably financial problems. CONCLUSION: The strong points of the present study lie in the fact that it is based on a representative cohort of road accident victims in an area in which all those treated within the hospital system after a road accident have been registered. The present study shows the strong correlation between QoL and posttraumatic stress disorder. LEVEL OF EVIDENCE: prospective study, all patients enrolled at the same point, 76% follow-up

Predicting self-reported recovery one year after major road traffic accident trauma

Objective: The aim of this study was to examine the selfreported health status of road traffic accident victims and the predictors of self-assessed recovery 1 year after major trauma in a French population. Design: A follow-up study. Methods: The cohort comprised 276 seriously injured victims of road traffic accidents, aged > 16 years from the Rhône administrative department, France. Victim characteristics at the time of the crash and self-reported health status 1 year after trauma were collected. Predictive factors for self-assessed recovery were examined using a Poisson regression approach. Results: The majority of victims were male (76%); most had severe injuries (76%), involving mainly the lower limbs and the head (68% and 55%, respectively). At 1-year follow-up, 80% reported being not fully recovered. Self-reported health status was not significantly associated with age, gender, being in employment, type of road user, or health status during the year preceding the accident, but rather with low socioeconomic status, high injury severity, and presence of lower limb injury. Conclusion: Care for subjects who are at high risk of not fully recovering (manual workers, the very seriously injured, and those with lower limb injury) needs to be extended and improved. Longer follow-up studies on the risk factors for not fully recovering are needed in order to reduce harmful consequences for victims

One year after mild injury: comparison of health status and quality of life between casualties with whiplash versus other injuries

Objectives: To compare health status, family and occupational impact and quality of life one year after an accident between casualties with whiplash versus other mild injuries, and to explore the relation between initial injury (whiplash vs. other) and quality of life. Design: Prospective cohort study. Subjects: The study used data from the ESPARR cohort (a representative cohort of road accident casualties) and included 173 casualties with “pure” whiplash and a population of 207 casualties with other mild injuries (MAIS-1). Quality of life at 1-year follow-up was assessed on the WHOQoL-Bref questionnaire. Methods: Correlations between explanatory variables and quality of life were explored by Poisson regression to provide adjusted relative risks, with analysis of variance for the various quality of life scores explored. Results: One year post-accident, more whiplash than other casualties complained of non-recovery of health status (56% vs. 43%) and of occupational impact of pain (31% vs. 23%). Quality of life and post-traumatic stress disorder were similar in the two groups. Impaired quality of life did not correlate with whiplash when models were adjusted on sociodemographic variables and history of psychological distress. Whatever the initial lesion, post-traumatic stress disorder (PTSD) was a determining factor for poorer quality of life. Conclusions: Sociodemographic factors, pre-accident psychological history prior and post-traumatic stress disorder were the main factors influencing quality of life, rather than whether or not the injury was whiplash. PTSD may also be related to pain

Cognitive and behavioural post-traumatic impairments: What is the specificity of a brain injury ? A study within the ESPARR cohort

Objectif : La diversité et l'étendue des déficits observés après un traumatisme crânien varient suivant la nature des lésions et leur gravité. Afin de mieux comprendre les interactions et leurs conséquences à long terme, nous avons étudié et comparé le profil cognitif et neurocomportemental d’une cohorte de victimes d’accidents de la voie publique avec ou sans traumatisme crânien, un an après l'accident. Méthode : La population d’étude est constituée de 207 blessés graves de La cohorte ESPARR. Cette cohorte de 1168 accidentés de la route dans le Rhône âgés de 16 ans et plus, et de toute gravité inclus selon critères : résidant dans le Rhône, victime d'un accident de la circulation impliquant au moins un véhicule à roues, ayant eu lieu dans le Rhône, vivant au moment de son arrivée à l'hôpital, et se présentant dans l'un des différents services d'urgences du Rhône. La représentativité de cette cohorte en termes de critères sociogéographiques et de caractéristiques de l'accident a été assurée par la nature spécifique du recrutement. Les plaintes et déficiences cognitivo-comportementales ont été évaluées un an après l’accident avec la Neurobehavioral Rating Scale-Revised et le Trail-Making-Test. Nous avons distingué, dans notre population d'étude de blessés graves, trois catégories de patients : les traumatisés crâniens modérés/graves (n=48), les traumatisés crâniens légers (n=89) et les blessés graves sans traumatisme crânien (n=70), basés sur le score de Glasgow, la présence de signes de déficits neurologiques, d'une aggravation de l'état neurologique dans les 72 heures et/ou d'une imagerie anormale. Résultats : Les symptômes les plus fréquemment observés étaient l’anxiété, l’irritabilité, les troubles mnésiques et attentionnels, la dépression et la labilité de l’humeur. L’humeur dépressive et l’irritabilité sont relevées aussi fréquemment dans les trois groupes. Les troubles de mémoire, d’attention, l’anxiété et la diminution des initiatives sont plus spécifiques au traumatisme crânien et les troubles exécutifs sont typiques d’un traumatisme crânien modéré/grave. Discussion-conclusion : La présence et la sévérité initiale du TC conditionnent la nature et la fréquence des séquelles à un an d’évolution. Certains troubles comme l'irritabilité, habituellement associée à un traumatisme crânien, n'apparaissent pas comme spécifiques à cette population, tout comme l'humeur dépressive. Ainsi, les interactions entre troubles cognitifs, émotivo-affectifs et neuro-comportementaux sont mises en avant