title: 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Previous traffic offences were a significant risk factor for alcohol-related road trauma and severe road trauma leading to ICU admission or death.
authors.affiliation: Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Australia; School of Population Health, University of Western Australia, Perth, Australia; Murdoch University, Perth, Australia.
authors.forename: Kwok M
authors.initials: KM
authors.lastname: Ho
authors.affiliation: State Trauma Unit, Royal Perth Hospital, Perth, Australia.
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Rao
authors.affiliation: State Trauma Unit, Royal Perth Hospital, Perth, Australia.
authors.forename: Maxine
authors.initials: M
authors.lastname: Burrell
authors.affiliation: Public Health and Clinical Services Division, Western Australia Department of Health, Perth, Australia.
authors.forename: Tarun S
authors.initials: TS
authors.lastname: Weeramanthri
mesh_terms: D000063:Accidents, Traffic / Q000331:legislation & jurisprudence / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000328:Adult; D000428:Alcohol Drinking; D015331:Cohort Studies; D057237:Criminals / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012309:Risk-Taking; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000209:etiology*; D055815:Young Adult