Background & Aims

Up to 50% of people who experience a minor to moderate road traffic injury (RTI) will continue to report pain, disability, and psychological distress up to two years after their injury [1, 2]. Some studies have shown that pain, poor general health, or a history of psychological problems prior to injury are associated with worse post-injury pain, higher incidence of psychological comorbidities, greater work disability, and decreased quality of life [3-5]. This abstract reports the results of meta-analyses conducted as part of a larger review which aimed to synthesise the evidence relating to the associations between pre-injury health and post-injury health-related outcomes following minor to moderate RTI.

Methods

We conducted searches (EMBASE, CINAHL, Cochrane Central, PubMed, Web of Science and PsycINFO; July 2023, no date restrictions). We included peer-reviewed cohort studies of minor to moderate RTI which assessed associations between pre-injury health (physical and mental health and quality of life) and post-injury pain, psychological problems, work-disability, and quality of life outcomes. We assessed risk of bias using the Quality in Prognosis Tool [6]. Where possible, we used random effects meta-analyses to estimate pooled effects (odds ratio, OR; crude, and adjusted for age, sex and baseline symptoms) and their confidence interval (95%CI) for each association. We did not apply further adjustments in our analysis process. The proportion of variability in point estimates attributed to heterogeneity was quantified with the I2 statistic and results were presented using forest plots. We rated the quality of evidence using GRADE for prognostic reviews  [7].

Results

We included 11 studies involving 16,580 participants and were able to meta-analyse results of 6 associations. We found that the presence of pre-injury regional pain was associated with post-injury acute pain (<4wk post-injury; adjusted OR=2.02, 95%CI [1.21, 3.36], I2=43%, n=2,076; moderate quality evidence), chronic pain (>12mo; adjusted OR=2.41, 95%CI [1.51, 3.83],  I2=67%, n=2,133;  moderate), global recovery (6mo; adjusted OR=1.42, 95%CI [1.18, 1.71], I2=0%, n=3,724;  moderate), and work disability (>12mo; adjusted OR=2.62, 95%CI [1.65, 4.16], I2=0%, n=727;  moderate). Pre-injury poor general health was not associated post-injury chronic pain (>12mo; adjusted OR=1.37, 95%CI [0.93, 2.01], I2=13%, n=2,716; low), and pre-injury psychological history (e.g. anxiety and depression) was not associated with work disability (>12mo; crude OR=1.58, 95%CI [0.82, 3.04], I2=53%, n=657; very low). We were unable to pool results for a number of potentially important associations because too few studies were available (e.g. associations between pre-injury mental health, physical health, sleep, prior trauma and post-injury pain and psychological comorbidities).

Conclusions

Associations between pre-injury health and post-injury outcomes for minor to moderate RTI is under-researched. We found moderate quality evidence that the presence of pre-injury regional pain is strongly associated with post-injury acute and chronic pain, global recovery and work disability. Further, well-designed studies are needed to explore the association between various pre-injury health factors and post-injury recovery. The usefulness of the available evidence is limited by the use of self-reported pre-injury health status, study attrition, and varying approaches to confounder selection.

References

  1. Gopinath, B., et al., Overview of findings from a 2-year study of claimants who had sustained a mild or moderate injury in a road traffic crash: prospective study. BMC Res Notes, 2017. 10(1): p. 76.
  1. Hung, K.K.C., et al., Impacts of injury severity on long-term outcomes following motor vehicle crashes. BMC Public Health, 2021. 21(1): p. 602.
  2. Pozzato, I., et al., The contribution of pre-injury vulnerability to risk of psychiatric morbidity in adults injured in a road traffic crash: Comparisons with non-injury controls. J Psychiatr Res, 2021. 140: p. 77-86.
  3. Gopinath, B., et al., Predictors of health-related quality of life after non-catastrophic injury sustained in a road traffic crash. Annals of Physical and Rehabilitation Medicine, 2019.
  4. Beaudoin, F.L., et al., Persistent and Widespread Pain Among African-Americans Six Weeks after MVC: Emergency Department-based Cohort Study. West J Emerg Med, 2020. 22(2): p. 139-147.
  5. Hayden, J.A., et al., Assessing bias in studies of prognostic factors. Ann Intern Med, 2013. 158(4): p. 280-286.
  6. Foroutan, F., et al., GRADE Guidelines 28: Use of GRADE for the assessment of evidence about prognostic factors: rating certainty in identification of groups of patients with different absolute risks. Journal of Clinical Epidemiology, 2020. 121: p. 62-70.

Presenting Author

Wanyun Huang

Poster Authors

Wanyun Huang

Master of science

RECOVER Injury Research Centre, The University of Queensland, Queensland, Australia

Lead Author

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Nigel Armfield (PhD)

RECOVER Injury Research Centre, The University of Queensland, Queensland, Australia

Lead Author

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Yanfei Xie (PhD)

RECOVER Injury Research Centre, The University of Queensland, Queensland, Australia

Lead Author

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Michele Sterling

RECOVER Injury Research Centre, The University of Queensland, Queensland, Australia

Lead Author

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Topics

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