title: A population-based cohort study of longer-term changes in health of car drivers involved in serious crashes.
abstract: 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 follow-up 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. s.ameratunga@auckland.ac.nz
authors.forename: Shanthi N
authors.initials: SN
authors.lastname: Ameratunga
authors.forename: Robyn N
authors.initials: RN
authors.lastname: Norton
authors.forename: Jennie L
authors.initials: JL
authors.lastname: Connor
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robinson
authors.forename: Ian
authors.initials: I
authors.lastname: Civil
authors.forename: John
authors.initials: J
authors.lastname: Coverdale
authors.forename: Derrick
authors.initials: D
authors.lastname: Bennett
authors.forename: Rod T
authors.initials: RT
authors.lastname: Jackson
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D013997:Time Factors; D014947:Wounds and Injuries / Q000145:classification* / Q000523:psychology