A population-based cohort study of longer-term changes in health of car drivers involved in serious crashes

Study objective: Evidence about the burden of disability after motor vehicle crashes has relied primarily on trauma center-based studies. We examine the impact of serious crashes on the longer-term health of car drivers, independent of natural variation, in a population-based study in Auckland, New Zealand. Methods: The study population comprised 218 car drivers surviving nonfatal crashes in Auckland, in which at least 1 occupant in the vehicle was admitted to a hospital, and a representative sample of 254 car drivers in the region, recruited from roadside surveys. All participants were interviewed at recruitment (subjects reported their precrash health) and 5 and 18 months later. The drivers' changes in health were obtained with a global health transition indicator and the Short Form-36, with analyses adjusting for potential confounders. Results: Compared with 7% of drivers in the comparison group, 43% of crash drivers admitted to the hospital (adjusted odds ratio 10.4; 95% confidence interval 5.5 to 19.6) and 20% of those not admitted (odds ratio 3.3; 95% confidence interval 1.4 to 8.3) reported that their overall health at 18-month followup was worse than at baseline (precrash). Among the drivers reporting worsened health, prospectively ascertained Short Form-36 scores revealed greater reductions in physical health in those admitted after the crash, but these scores improved from 5 to 18 months. In contrast, mental and general health scores worsened from 5 to 18 months in admitted and nonadmitted crash drivers. Conclusion: A substantial proportion of drivers surviving serious crashes experience reductions in longer-term health, a burden likely to be underappreciated among those not admitted to a hospital. Emergency departments could serve as useful settings in which to develop and validate clinical decision rules that can help target services for crash survivors at increased risk of adverse outcomes.