Harcombe H1, Davie G1, Wyeth E2, Ameratunga S3, Powell D4, Derrett S1
1University of Otago, Injury Prevention Research Unit, Preventive and Social Medicine, Dunedin, New Zealand, 2University of Otago, Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin, New Zealand, 3University of Auckland, Section of Epidemiology and Biostatistics, School of Population Health, Auckland, New Zealand, 4University of Canterbury, College of Education, Health and Human Development, Christchurch, New Zealand
Background: Injury is an important issue worldwide, comprising 10% of the global disability burden. Multiple injury events sustained by the same people over time is a major contributor to the injury burden. Preventing subsequent injury events from occurring should be an important consideration in injury prevention. Despite having seen a healthcare provider such as a physiotherapist at least once for a substantial 'sentinel' injury, our previous research found that 58% of participants went on to have at least one subsequent injury event involving an injury insurance claim in the following 24 months. Healthcare providers (such as physiotherapists) have the potential to deliver subsequent injury prevention initiatives, however, what predicts subsequent injuries among general injury populations is not currently well understood.
Purpose: This study aims to determine pre-injury and injury-related factors that predict having: 1) at least one severe subsequent injury (New Injury Severity Score ≥4), and 2) two or more subsequent injuries in the 24 months following a sentinel injury event.
Methods: Participants (n=2856) aged 18-64 years were recruited to the earlier Prospective Outcomes of Injury Study (POIS) following an injury (of any type) that involved an entitlement claim with New Zealand's universal no-fault injury insurer, the Accident Compensation Corporation (ACC). Data were combined from: 1) POIS participant interviews undertaken approximately three months following the 'sentinel' injury, 2) ACC claims data for participants' sentinel injuries and subsequent injuries occurring in the following 24 months, and 3) hospital discharge data for sentinel and subsequent injuries. Pre-sentinel injury socio-demographic, and health characteristics and sentinel-injury related variables, were analysed using modified Poisson regression models to directly estimate relative risks (RRs).
Results: Severe and multiple ACC-reported subsequent injuries (ACC-SI) were both more likely to occur for participants with a prior injury affecting them at the time of their sentinel injury (RR 1.42, 95% confidence interval (CI) 1.22, 1.66, and RR 1.3, 95% CI 1.16, 1.45 respectively), those who had pain/discomfort prior to their sentinel injury (RR 1.34, 95% CI 1.12, 1.63, and RR 1.20, 95% CI 1.04, 1.40 respectively) , and for participants who were physically active on five or more days of the week (RR 1.20, 95% CI 1.04, 1.38, and RR 1.16, 95% CI 1.04, 1.29). Factors predictive of having a lower likelihood of severe or multiple ACC-SI included being aged 30-64 years compared with those aged 18-29 years, and if the sentinel injury involved hospitalisation. Multiple ACC-SI were more likely for males, and for participants with two or more chronic conditions.
Conclusion(s): Factors identified in this study may provide useful flags to help physiotherapists and other healthcare providers identify people at increased risk of severe or multiple subsequent injuries who may benefit from increased attention or targeted injury prevention strategies. Further understanding of the reasons behind the aspects identified may help determine the best injury prevention approach.
Implications: People presenting to healthcare providers such as physiotherapists following injury are a clearly identifiable group for injury prevention initiatives. Understanding predictors of subsequent injury may inform targeted initiatives aimed at preventing subsequent injuries
Keywords: Injury, Prevention, Predictors
Funding acknowledgements: Health Research Council of New Zealand (HRC) (15/091, 2015-2017); POIS funded by HRC (10/052, 2007-2013) and ACC (2007-2010).
Purpose: This study aims to determine pre-injury and injury-related factors that predict having: 1) at least one severe subsequent injury (New Injury Severity Score ≥4), and 2) two or more subsequent injuries in the 24 months following a sentinel injury event.
Methods: Participants (n=2856) aged 18-64 years were recruited to the earlier Prospective Outcomes of Injury Study (POIS) following an injury (of any type) that involved an entitlement claim with New Zealand's universal no-fault injury insurer, the Accident Compensation Corporation (ACC). Data were combined from: 1) POIS participant interviews undertaken approximately three months following the 'sentinel' injury, 2) ACC claims data for participants' sentinel injuries and subsequent injuries occurring in the following 24 months, and 3) hospital discharge data for sentinel and subsequent injuries. Pre-sentinel injury socio-demographic, and health characteristics and sentinel-injury related variables, were analysed using modified Poisson regression models to directly estimate relative risks (RRs).
Results: Severe and multiple ACC-reported subsequent injuries (ACC-SI) were both more likely to occur for participants with a prior injury affecting them at the time of their sentinel injury (RR 1.42, 95% confidence interval (CI) 1.22, 1.66, and RR 1.3, 95% CI 1.16, 1.45 respectively), those who had pain/discomfort prior to their sentinel injury (RR 1.34, 95% CI 1.12, 1.63, and RR 1.20, 95% CI 1.04, 1.40 respectively) , and for participants who were physically active on five or more days of the week (RR 1.20, 95% CI 1.04, 1.38, and RR 1.16, 95% CI 1.04, 1.29). Factors predictive of having a lower likelihood of severe or multiple ACC-SI included being aged 30-64 years compared with those aged 18-29 years, and if the sentinel injury involved hospitalisation. Multiple ACC-SI were more likely for males, and for participants with two or more chronic conditions.
Conclusion(s): Factors identified in this study may provide useful flags to help physiotherapists and other healthcare providers identify people at increased risk of severe or multiple subsequent injuries who may benefit from increased attention or targeted injury prevention strategies. Further understanding of the reasons behind the aspects identified may help determine the best injury prevention approach.
Implications: People presenting to healthcare providers such as physiotherapists following injury are a clearly identifiable group for injury prevention initiatives. Understanding predictors of subsequent injury may inform targeted initiatives aimed at preventing subsequent injuries
Keywords: Injury, Prevention, Predictors
Funding acknowledgements: Health Research Council of New Zealand (HRC) (15/091, 2015-2017); POIS funded by HRC (10/052, 2007-2013) and ACC (2007-2010).
Topic: Musculoskeletal; Disability & rehabilitation
Ethics approval required: Yes
Institution: New Zealand Health and Disability Multi-Region Ethics Committee
Ethics committee: New Zealand Health and Disability Multi-Region Ethics Committee
Ethics number: MEC/07/07/093
All authors, affiliations and abstracts have been published as submitted.
