Date Published: April 22, 2015
Publisher: Public Library of Science
Author(s): Kwok M. Ho, Sudhakar Rao, Maxine Burrell, Tarun S. Weeramanthri, Koustuv Dalal.
Road trauma is a leading cause of death and injury in young people. Traffic offences are common, but their importance as a risk indicator for subsequent road trauma is unknown. This cohort study assessed whether severe road trauma could be predicted by a history of prior traffic offences.
Clinical data of all adult road trauma patients admitted to the Western Australia (WA) State Trauma Centre between 1998 and 2013 were linked to traffic offences records at the WA Department of Transport. The primary outcomes were alcohol exposure prior to road trauma, severe trauma (defined by Injury Severity Score >15), and intensive care admission (ICU) or death, analyzed by logistic regression. Traffic offences directly leading to the road trauma admissions were excluded. Of the 10,330 patients included (median age 34 years-old, 78% male), 1955 (18.9%) had alcohol-exposure before road trauma, 2415 (23.4%) had severe trauma, 1360 (13.2%) required ICU admission, and 267 (2.6%) died. Prior traffic offences were recorded in 6269 (60.7%) patients. The number of prior traffic offences was significantly associated with alcohol-related road trauma (odds ratio [OR] per offence 1.03, 95% confidence interval [CI] 1.02–1.05), severe trauma (OR 1.13, 95%CI 1.14–1.15), and ICU admission or death (OR 1.10, 95%CI 1.08–1.11). Drink-drinking, seat-belt, and use of handheld electronic device offences were specific offences strongly associated with road trauma leading to ICU admission or death—all in a ‘dose-related’ fashion. For those who recovered from road trauma after an ICU admission, there was a significant reduction in subsequent traffic offences (mean difference 1.8, 95%CI 1.5 to 2.0) and demerit points (mean difference 7.0, 95%CI 6.5 to 7.6) compared to before the trauma event.
Previous traffic offences were a significant risk factor for alcohol-related road trauma and severe road trauma leading to ICU admission or death.
Death and injury of young people due to road trauma is a worldwide problem affecting both developing and developed countries . According to the World Health Organisation’s Global Status Report on Road Safety , more than 1·2 million people die and up to 50 million others are injured on the world’s roads every year. The sad reality is that many of those who die or are injured with chronic disability after road trauma are young members of our society . This is likely due to the fact that young road users do have a higher tendency to pursue risk-taking behaviours .
Between January 1, 1998, and December 31, 2013, 13,907 episodes of road trauma admission to the State Trauma Centre were recorded; after excluding 3410 injured patients (mostly pedestrians or motor vehicle passengers) who never had a driver’s licence, and 160 patients who had 167 repeated admissions from road trauma injury during the study period, 10,330 patients were used in our analysis of the primary outcomes (Fig 1).
This study shows that prior traffic offences were common in patients involved in road trauma, and they were associated with alcohol exposure prior to road trauma and severe injury requiring ICU admission or death. The relationship was clearly dose-related and proportional to the number of demerit points and the number of traffic offences. The nature of the traffic offences was also important. Patients who recovered from severe injury requiring ICU admission appear to have reduced their subsequent traffic offences, but those who re-offended were more likely to be readmitted again due to road trauma.