The journey from traffic offender to severe road trauma victim: destiny or preventive opportunity?

Abstract

Background: 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.

Methodology and principal findings: 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.

Significance: Previous traffic offences were a significant risk factor for alcohol-related road trauma and severe road trauma leading to ICU admission or death.

Fig 1. Flow chart showing inclusion and exclusion of patients for the study.

ICU, intensive care unit.

Fig 2. Relationship between cumulative traffic offences demerit points and risk of requiring intensive care unit (ICU) admission or death from road trauma.

Dotted lines delineate 95% confidence interval.

Fig 3. Differences in number of traffic offences between before and after road trauma requiring intensive care unit admission.

These results remained unchanged (reduction in number of traffic offences = 1.6, 95% confidence interval 1.1–2.0, p = 0.001) after including only those with at least one traffic offence after their injury.

Fig 4. Differences in number of demerit points between before and after road trauma requiring intensive care unit admission.

This result remained unchanged (reduction in number of demerit points = 3.7, 95% confidence interval 2.9–4.5, p = 0.001) after including only those with at least one traffic offence after their injury.