Research Centre for Injury Studies Flinders University Australia Measuring Non-fatal Road Injury...
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Research Centre for Injury Studies • Flinders University • Australia
Measuring Non-fatal Road Injury
Professor James HarrisonResearch Centre for Injury Studies and
AIHW National Injury Surveillance UnitFlinders University
October 2015
Research Centre for Injury Studies • Flinders University • Australia
Why measure serious road injury?• Deaths are important, but:
– Much less numerous than non-fatal cases– Becoming less common (thankfully)– Not a reliable guide to risk factors for disability
• Non-fatal injuries – Some are near-fatalities– Many leave persistent disability
Research Centre for Injury Studies • Flinders University • Australia
Why measure serious road injury?• Deaths are important, but:
– Much less numerous than non-fatal cases– Becoming less common (thankfully)– Not a reliable guide to risk factors for disability
• Non-fatal injuries – Some are near-fatalities– Many leave persistent disability
Measuring non-fatal road injury: - the case for doing so has become compelling - the questions now are exactly what to measure, and how best to do so.
Research Centre for Injury Studies • Flinders University • Australia
Three themes
Decide exactly what we need to know about serious road injury (…and are willing to pay for…)
• Information goals; definitions & specifications
Count the cases • Relevant attributes: sufficiently accurate, consistent & timely
Determine consequences (burden / disability / cost)• …in a way that is practicable and consistent with required attributes
(These themes are more distinct when measuring serious non-fatal road injury than when measuring road deaths.)
Research Centre for Injury Studies • Flinders University • Australia
Three themes
Decide exactly what we need to know about serious road injury (…and are willing to pay for…)
• Information goals; definitions & specifications
Count the cases • Relevant attributes: sufficiently accurate, consistent & timely
Determine consequences (burden / disability / cost)• …in a way that is practicable and consistent with required attributes
(These themes are more distinct when measuring serious non-fatal road injury than when measuring road deaths.)
Research Centre for Injury Studies • Flinders University • Australia
Severity• Much more to it than for road deaths• Which consequence (or outcome)?
– Probability of having died (though did not)– Disability (Which domains? As at when?)– Dollar cost (Of what? To whom? As at when?)
• Threshold for inclusion?• Directly observed cases? Weighted counts?
Research Centre for Injury Studies • Flinders University • Australia
Severity• Much more to it than for road deaths• Which consequence (or outcome)?
– Probability of having died (though did not)– Disability (Which domains? As at when?)– Dollar cost (Of what? To whom? As at when?)
• Threshold for inclusion?• Directly observed cases? Weighted counts?
‘Serious’, ‘severe’, etc. don’t have specific and generally accepted meanings.
Research Centre for Injury Studies • Flinders University • Australia
Severity• Much more to it than for road deaths• Which consequence (or outcome)?
– Probability of having died (though did not)– Disability (Which domains? As at when?)– Dollar cost (Of what? To whom? As at when?)
• Threshold for inclusion?• Directly observed cases? Weighted counts?
‘Serious’, ‘severe’, etc. don’t have specific and generally accepted meanings. AIS?
Research Centre for Injury Studies • Flinders University • Australia
Severity• Much more to it than for road deaths• Which consequence (or outcome)?
– Probability of having died (though did not)– Disability (Which domains? As at when?)– Dollar cost (Of what? To whom? As at when?)
• Threshold for inclusion?• Directly observed cases? Weighted counts?
AIS ‘maintains ties’ with these and other dimensions or components of severity:- Threat to life; mortality- Energy dissipated / absorbed- Tissue damage- Hospitalisation; need for intensive care- Treatment: duration / complexity / cost- Disability: temporary; permanent- Impairment- Quality of life
Research Centre for Injury Studies • Flinders University • Australia
Severity• Much more to it than for road deaths• Which consequence (or outcome)?
– Probability of having died (though did not)– Disability (Which domains? As at when?)– Dollar cost (Of what? To whom? As at when?)
• Threshold for inclusion? • Directly observed cases? Weighted counts?
AIS ‘maintains ties’ with these and other dimensions or components of severity:- Threat to life; mortality- Energy dissipated / absorbed- Tissue damage- Hospitalisation; need for intensive care- Treatment: duration / complexity / cost- Disability: temporary; permanent- Impairment- Quality of life
But validation is mainly with respect to mortality and threat to life. Much less evidence concerning disability, impairment, quality of life.
Research Centre for Injury Studies • Flinders University • Australia
Severity• Much more to it than for road deaths• Which consequence (or outcome)?
– Probability of having died (though did not)– Disability (Which domains? As at when?)– Dollar cost (Of what? To whom? As at when?)
• Threshold for inclusion?• Directly observed cases? Weighted counts?
Research Centre for Injury Studies • Flinders University • Australia
Severity• Much more to it than for road deaths• Which consequence (or outcome)?
– Probability of having died (though did not)– Disability (Which domains? As at when?)– Dollar cost (Of what? To whom? As at when?)
• Threshold for inclusion?• Directly observed cases? Weighted counts?
This choice is not self-evident. However, it is feasible to produce estimates for the same cases in terms of more than one outcome.
Research Centre for Injury Studies • Flinders University • Australia
Severity• Much more to it than for road deaths• Which consequence (or outcome)?
– Probability of having died (though did not)– Disability (Which domains? As at when?)– Dollar cost (Of what? To whom? As at when?)
• Threshold for inclusion?• Directly observed cases? Weighted counts?
Research Centre for Injury Studies • Flinders University • Australia
Severity• Much more to it than for road deaths• Which consequence (or outcome)?
– Probability of having died (though did not)– Disability (Which domains? As at when?)– Dollar cost (Of what? To whom? As at when?)
• Threshold for inclusion?• Directly observed cases? Weighted counts?
Research Centre for Injury Studies • Flinders University • Australia
Health state after injury?• Rapid progress in knowledge based on
– Prospective follow-up of sets of cases; with– Application of health outcome measures
• How to do this?– Special studies (each a one-off)– Routinely, as part of case documentation
• A world-leading system in Victoria follows all survivors of serious trauma by CATI to 24 months.
Research Centre for Injury Studies • Flinders University • Australia
Current projects• Outcomes to 24 months
– Gabbe, Simpson, Harrison, et al. (2015) Return to work and functional outcomes after major trauma: who recovers, when and how well? Ann Surg (accepted Sept 2015)
– Reports routine follow up to 24 months of all adult major trauma patients in Victoria injured mid-2007 to mid-2012 who survived to initial discharge (n=8,844)
– Results presented here expand on those in the paper, to show additional road injury case groups
• Outcomes & experiences to 5 years – NHMRC project grant; Professor Belinda Gabbe is CI-A– Cases: all in 1 year of Victorian follow-up system, already
interviewed at 6, 12, 24 months– This project is following the whole group to 5 years and conducting
face-to-face interviews with a sample (incl. qualitative topics)
Research Centre for Injury Studies • Flinders University • Australia
Survivors to discharge after serious injury: outcomes to 24 months (Victoria; onset 2007-12)
Months of follow-up
Type of case
Notes : RTI = Road Traffic In jury MV = Motor Vehic le
0
20
40
60
80
100
Per
cent
age
of m
ajor
trau
ma
patie
nts
All trauma cases
All RTI cases
MV Occupant
Motorcyclist
Pedal cyclist
Pedestrian6 12 24 6 12 24 6 12 24 6 12 24 6 12 24 6 12 24
Upper good recovery
Lower good recovery
Upper moderate disability
Lower moderate disability
Upper severe disability
Lower severe disability
Vegetative state
Death
Research Centre for Injury Studies • Flinders University • Australia
Survivors to discharge after serious injury: outcomes to 24 months (Victoria; onset 2007-12)
Months of follow-up
Type of case
Notes : RTI = Road Traffic In jury MV = Motor Vehic le
0
20
40
60
80
100
Per
cent
age
of m
ajor
trau
ma
patie
nts
All trauma cases
All RTI cases
MV Occupant
Motorcyclist
Pedal cyclist
Pedestrian6 12 24 6 12 24 6 12 24 6 12 24 6 12 24 6 12 24
Upper good recovery
Lower good recovery
Upper moderate disability
Lower moderate disability
Upper severe disability
Lower severe disability
Vegetative state
Death
Categories of Glasgow Outcome Scale - Extended
Research Centre for Injury Studies • Flinders University • Australia
Survivors to discharge after serious injury: outcomes to 24 months (Victoria; onset 2007-12)
Months of follow-up
Type of case
Notes : RTI = Road Traffic In jury MV = Motor Vehic le
0
20
40
60
80
100
Per
cent
age
of m
ajor
trau
ma
patie
nts
All trauma cases
All RTI cases
MV Occupant
Motorcyclist
Pedal cyclist
Pedestrian6 12 24 6 12 24 6 12 24 6 12 24 6 12 24 6 12 24
Upper good recovery
Lower good recovery
Upper moderate disability
Lower moderate disability
Upper severe disability
Lower severe disability
Vegetative state
Death
Research Centre for Injury Studies • Flinders University • Australia
Survivors to discharge after serious injury: outcomes to 24 months (Victoria; onset 2007-12)
Months of follow-up
Type of case
Notes : RTI = Road Traffic In jury MV = Motor Vehic le
0
20
40
60
80
100
Per
cent
age
of m
ajor
trau
ma
patie
nts
All trauma cases
All RTI cases
MV Occupant
Motorcyclist
Pedal cyclist
Pedestrian6 12 24 6 12 24 6 12 24 6 12 24 6 12 24 6 12 24
Upper good recovery
Lower good recovery
Upper moderate disability
Lower moderate disability
Upper severe disability
Lower severe disability
Vegetative state
Death
Research Centre for Injury Studies • Flinders University • Australia
Survivors to discharge after serious injury: outcomes to 24 months (Victoria; onset 2007-12)
Months of follow-up
Type of case
Notes : RTI = Road Traffic In jury MV = Motor Vehic le
0
20
40
60
80
100
Per
cent
age
of m
ajor
trau
ma
patie
nts
All trauma cases
All RTI cases
MV Occupant
Motorcyclist
Pedal cyclist
Pedestrian6 12 24 6 12 24 6 12 24 6 12 24 6 12 24 6 12 24
Upper good recovery
Lower good recovery
Upper moderate disability
Lower moderate disability
Upper severe disability
Lower severe disability
Vegetative state
Death
Research Centre for Injury Studies • Flinders University • Australia
SummaryWe should measure and monitor non-fatal road injuryThink carefully about exactly what information is needed
… and design information systems accordingly
Technical basisFollow-up registers for outcome measurement Population data linkage, to:
Combine data on crashes with health service data to get benefits of both.Refine indicators (e.g. to minimise under- and over-counting).Improve understanding of the extent to which post-injury disability reflects pre-injury state rather than effects of injury.
Monitoringp(survival)|diagnosis. Can be suitable for comparisons (national, international). No available method is perfect. TMPM?p(disability)|diagnosis. Apply periodically-updated weights to latest set of case-data to estimate future disability.