Main Study Results

Participants

A total of 120 patients enrolled in the study in all the partner countries (Greece=41, Germany=39, Italy=40). Out of the total participants initially enrolled in the study, 96 completed the first follow up and 93 completed the second follow up (Figure 1).

 

Participants’ profile

Socio-demographical: Three out of every four participants were men (77.5%) with a mean age of 41.8 years (SD 16.7).  Nearly half of them obtained high education (49.2%) and similar proportion was married or cohabited with someone (54.2%).

Road incident: One out of every three participants sustained the injury as motorcyclists (33.3%) and equal proportion of participants were injured as drivers of motorised four-wheel vehicles. Nearly two out of every five participants sustained the injury in city roads (40.0%) and a similar proportion of participants were injured in rural roads (34.2%). Many road incidents occurred at a straight road (63.3%), one in every three were described as front collisions (30.8%) and nearly half of them involved another car in the collision (42.9%). Many of the incidents occurred during leisure time (40.2%).

Injury profile: Half of the injuries were classified as serious injuries “MAIS-3” (50.0%), most of them involved multiple fractures (90.8%) and the most severe injuries in multi-trauma patients were located at the lower extremities (36.7%) and the head (34.2%).

Initial health care: Most of the participants were transferred to the hospital directly from the accident site (79.8%) most often by an ambulance with a doctor (52.9%). There was one in every four participants who were transferred by an ambulance without a doctor (25.0%) and one in every five participants transferred from another hospital (20.2%). The first care was delivered by an emergency doctor in the majority of the participants (70.6%). The mean Glasgow coma score was 12.0 (SD4.4) and the mean length of stay was 9.6 days.

 

Risk of disability and distress over time

Physical disability: The percentage of participants with physical disability (WHODAS 2.0 score ≥25) increased at the first follow up and decreased at the second follow up (Figure 2). The risk of physical disability was higher by 4.57 times six months after the injury and by 3.29 times twelve months after the injury as compared with the baseline time (before the injury).

 

 

Post-traumatic stress: The percentage of people with post-traumatic stress disorder PTSD (IES-R≥26) was lower at the first and the second follow up as compared with the baseline time (immediately after the injury) (Figure 3). There was a lower risk of PTSD by 71% lower twelve months after the injury as compared with the baseline time and 94% lower twelve months after the injury as compared with six months.

 

Depression: The percentage of people with depression (CES-D ≥16) was lower at the first and the second follow up as compared with the baseline time (immediately after the injury) (Figure 4). There was a 79% and an 87% lower risk of depression six months and twelve months after the injury, respectively, as compared with the baseline time (immediately after the injury).

 

Well-being: Twelve months after the injury, the aspects of well-being still highly affected due to the injury were “Pain”, followed by “Energy/fatigue” and “General health” (Figures 5-7). The aspect of well-being less affected by the injury twelve months after the injury was “Role limitations due to emotional problems”. With the “exemption of ““Role limitations due to emotional problems”, which remained unaffected and the “health change” which seemed to become more favorable through time, none of the aspects of well-being reached the levels recorded before the injury. The aspects most highly recovered were “Emotional well-being” and “Energy-fatigue”.

 

 

 

Pain: The percentage of people who sustained pain increased six months after the injury and decreased twelve months after the injury and this change was statistically significant (p=.001). There was 5.1% of participants who suffered pain before the road injury, 63.4% suffered pain due to the injury six months after the injury and 51.8% still suffered pain due to the injury twelve months after the injury (Figure 7).

 

 

Low social support: The percentage of people with low social support did not change in a significant way between baseline, 6 and 12 months after the injury (p=0.558) (Figure 8).

 

 

Impact of injury: The impact of the injury at the second follow up was lower by 73% than the baseline time and by 94% as compared with the first follow up.

 

 

Factors that have an impact on physical disability and psychological distress over time

 

Six months after the injury

Physical disability: The risk of presenting physical disability 6 months after the injury was 5.27 times higher for participants assigned a MAIS score equal or higher than 4 points (p=.018) and 3.09 times higher for participants sustaining injuries with the MAIS score in the low extremities as compared with those sustaining injuries with MAIS score in another body regions (p=.019).

Post-traumatic stress: The risk of being affected by post-traumatic stress six months after the injury was found to be 2.84 times higher for participants who sustained injuries with the MAIS score in the low extremities (p=.033) and 3.23 times higher for the participants who were affected by post-traumatic stress at baseline (p=.015).

Depression: The risk of presenting depression six months after the injury was 4.77  times higher for the participants who were affected by depression at baseline (p=.013) and 7.49 times higher for the participants who were divorced or widow (p=.017).

Pain: There was a 3% increased risk of suffering pain six months after the injury when the age increased by one year (p=.076). Additionally, the risk of suffering pain six months after the injury increased by 6.4 times for persons who sustained severe or critical injuries (MAIS ≥4), as compared with persons that sustained minor or moderate injuries (MAIS 1,2). On the contrary, the risk of suffering pain six months after the injury decreased by about 86% (p=.080) for persons who sustained the injury at “straight road” incidents and the risk was decreased by about 96% (p=.007) if the injury was sustained in “on bends” incidents as compared with “intersection” incidents.

Low social support: There was a 6% increased risk of having low social support six months after the injury when the age increased by one year (p=.013). Furthermore, the risk of having low social support 6 months after the injury decreased by 88% for persons who sustained serious injuries (MAIS=3) as compared with persons that sustained minor or moderate injuries (MAIS 1,2).

 

Twelve months after the injury

Physical disability: The risk of presenting physical disability twelve months after the injury was 3.98 times higher for participants who sustained injuries with the MAIS score in the low extremities (p=.013), and 11.75 times higher for participants who were divorced or widow (p=.005).

Post-traumatic stress: The risk of being affected by post-traumatic stress twelve months after the injury was found to be 5.26  times higher for participants who sustained injuries with the MAIS score in the low extremities as compared with those sustaining injuries with a MAIS score in other body regions (p=.006).

Depression: The risk of being affected by depression twelve months after the injury was 4.81 times higher for participants who were affected by depression at baseline (p=.055) and lower by 85% for people who sustained the injuries as users of 4 wheel motorized vehicles as compared with those who sustained the injuries as pedestrians or cyclists (p=.026). Furthermore, the risk of depression twelve months after the injury was found to increase by 5% with every additional year of the age (p=.053).

Pain: There was an increased risk of 3.18 times of suffering pain twelve months after the injury if the persons were in couple as compared with persons who were single (p=.030). Persons who sustained the injury at a road traffic incident at location other than an intersection, were shown to run a lower risk of suffering pain twelve months after the injury. More precisely, this risk decreased by 91%, 94% and 94% for road incidents located in straight roads, on bends, and parking spaces, respectively.

Low social support: There was a 7% increased risk of having low social support twelve months after the injury when the age increased by one year (p=.015). Moreover, the risk of having low social support twelve months after the injury decreased by 93% for persons who sustained the injury as drivers/passengers of four-wheel vehicles as compared to “vulnerable” road users.

 

Generally

It seems that physical functioning has a slow recovery over time while psychological status seems to have better recovery if not complete recovery one year after the injury.

 

 

Patient-reported injury costs

Total injury costs

The total annual cost of injury for the persons who were hospitalised in the selected ICU of all the partner countries for severe injury in 2013/2014, was estimated at 1.679.731€ (direct: 346.384€; indirect: 1.333.347€). The total direct costs of injury in Greece amounted to 30.106€ (direct cost per injured: 734€), in Germany 88.381€ (direct cost per injured: 2.266€) and in Italy 227.898€ (direct cost per injured: 5.697€). The total indirect costs of injury in Greece amounted to 475.559€ (indirect cost per injured: 11.599€), in Germany 310.542€ (indirect cost per injured: 7.963€) and in Italy 547.245€ (indirect cost per injured: 13.681€).

 

Injury costs by gender and age

Males accounted for approximately 79.0% of the total cost. Indirect cost represented nearly 85.0% of the total cost for males and 60.0% of the total cost for females. It seems that the group aged 25-49 accounted for 50.4% of the total injury cost and the age group of 50-64 years accounted for 25.4%. As regards the direct and indirect costs, persons aged 25-49 accounted for 39.8% of the total direct cost and 53.2% of the total indirect cost and persons aged 50-64 accounted for 35.3% of the total direct costs and 22.9% of the total indirect.

 

Injury costs by type of road user

It seems that motorcyclists accounted for 29.7% of the total injury cost and 32.4% of total indirect costs, while car drivers accounted for another 28.3% of the total injury costs and 29.5% of total indirect costs. Pedestrians on the other hand, accounted for 33.4% of the total direct costs and car drivers accounted for another 23.5% of the total direct costs.

 

Injury patterns in cost estimation

Persons sustaining severe injury classified as “MAIS 3+” accounted for 65% of the total injury costs and similar percentage of the total direct and indirect costs. However, the total injury costs per person, both the direct and indirect, were higher for persons sustaining slight injuries as compared with the ones sustaining severe injuries.

Persons severely affected at the central region of the body accounted for more than 40.0% of the total direct costs and more than 30.0% of the total indirect costs, while those affected at the lower extremities and those with multi-trauma accounted for approximately 25.0% of the direct and similarly for indirect costs, each. The total injury costs and the total indirect costs per person were highest for persons sustaining severe injuries at multiple regions. Persons affected at the central region showed the highest costs per person followed by the multi-trauma ones.

  

Hospitalisation costs (DRG)

A total of 2.050.167€ were spent for hospitalisation payments of 120 patients who sustained injury in road traffic crashes and were admitted in the ICU of the collaborating hospitals in the three partner countries. Out of these hospitalisation payments, a total of 298.150€ (7.272€ per person) was recorded in Greece, 1.382.565€ (35.450€ per person) in Germany and 369.452€ (9.236€ per person) in Italy.

 

Hospitalisation costs by gender and age

Men demonstrated higher overall hospitalisation costs as compared with women accounting for 75.0% of the total hospital payments for road traffic injury. In contrast, women demonstrated higher average hospital costs as compared with men.

Persons aged 25-49 presented the highest total hospitalisation costs accounting for nearly 41.0% of the total hospitalisation payments for road traffic injury, followed by the age group of 50-64 years, which accounted for 29.6% of the total hospital payments for injury of this kind. The age group of 50-64 years presented the highest average cost per person followed by the age group of 65+ years (Figure 1).

 

Hospitalisation costs by road user group

Motorcyclists presented the highest total hospitalisation costs accounting for nearly 46.5% of the total hospitalisation payments for road traffic injury, followed by car drivers who accounted for 27.5% of the total hospital payments for injury of this kind. Motorcyclists presented the highest average cost per person followed by truck/bus passengers (Figure 2).

 

Hospitalisation costs, injury severity and injury location

People sustaining severe injuries classified as “MAIS 3+” presented higher total hospitalisation costs as compared with those sustaining slight injuries classified as “MAIS 1,2”. Severely injured patients in fact accounted for 86.0% of the total hospital payments for road traffic injuries. Similarly, average hospital costs were by far higher for persons severely injured than for those slightly injured.

Persons severely affected at the central region of the body accounted for nearly 32.0% of the total hospitalisation costs for road traffic injuries followed by those affected at the upper region who accounted for another 31.0% of the total hospital costs of this kind. When looking into average costs, it is evident that hospitalisation costs were by far higher for persons sustaining severe injuries at the upper region (head, face) as compared with other body regions (Figure 3).

 

Summary of key results on cost estimation

Males, aged 25-49, motorcyclists and those severely injured (MAIS3+) with highest severity located at the central part of the body, accounted for the highest percentage of both the direct and indirect injury costs, with the exemption of the high participation of pedestrians in the total direct costs. As regards the the average direct costs, female, aged 50-64, pedestrians and those slightly injured (MAIS 1,2) with highest severity at the central region of the body, were highly represented in this cost category. On the contrary, male, aged 25-49, car passengers and truck drivers as well as those slightly injured (MAIS 1,2) with highest severity at multiple locations were overrepresented in the average indirect costs. As regards the the average hospitalisation costs, it seems that women, aged 50-64, motorcyclists, severely injured (MAIS 3+) with highest severity at the upper region (head, face, neck) accounted for the highest percentage of this cost.