Elsevier

Injury

Volume 51, Issue 3, March 2020, Pages 620-627
Injury

Predictors of severe or multiple subsequent injuries over 24 months among an already-injured cohort in New Zealand

https://doi.org/10.1016/j.injury.2019.12.038Get rights and content

Highlights

  • Interventions to reduce subsequent injuries among already injured people have the potential to reduce the overall burden of injury.

  • This study has identified a number of factors that put people at increased risk of severe or multiple subsequent injuries.

  • Factors identified may be useful indicators to help identify people who may benefit from targeted injury prevention strategies or interventions.

Abstract

Introduction

Interventions to reduce subsequent injuries among already-injured people presenting to healthcare providers may reduce the overall burden of injury. However, in order to develop such interventions it is necessary to understand what predicts subsequent injuries. This knowledge is currently limited for general injury populations. This prospective Subsequent Injury Study aims to determine pre-injury sociodemographic and heath factors, and injury-related factors, that predict subsequent injury claims reported to Accident Compensation Corporation (ACC, New Zealand's universal injury insurer) in the 24 months following an ACC entitlement claim injury (‘sentinel’ injury). Two separate outcome variables were used to identify subsequent injuries of interest: having (1) at least one high severity injury claim (New Injury Severity Scores ≥4), or (2) two or more claims (injuries of any severity).

Methods

This study combines: (1) participant interviews (from our earlier Prospective Outcomes of Injury Study), (2) ACC data about sentinel injuries which led to participants being recruited, and all subsequent injuries involving an ACC claim in the 24 months following that sentinel injury, and (3) hospital discharge data for sentinel and subsequent injuries involving hospitalisation. Potential predictors (pre-sentinel injury sociodemographic and health variables, sentinel injury related variables) were identified using modified Poisson regression models.

Results

Severe and multiple ACC-reported subsequent injuries (ACC-SI) were each more likely to occur for participants with a self-reported prior injury affecting them at the time of their sentinel injury, and for those who prior to their sentinel injury event had pain/discomfort, or were physically active on five or more days of the week. A lower likelihood of severe or multiple ACC-SI was more common in those aged 30–64 years compared with those aged 18–29 years, those of ‘other’ ethnicity compared to sole New Zealand European ethnicity, and if the sentinel injury involved hospitalisation. Multiple ACC-SI were more likely for males, and for participants with ≥2 chronic conditions compared to those with none.

Conclusions

Factors identified in this study may provide useful flags to help healthcare providers and policy makers identify people at increased risk of severe or multiple subsequent injuries who may benefit from targeted injury prevention strategies or interventions.

Section snippets

Background

Injuries comprise 10% of the global disability burden [1], with multiple injury events sustained over time contributing to this burden. The Accident Compensation Corporation (ACC), New Zealand's universal injury insurer, receives approximately 1.95 million claims per year [2], a rate of about 400 claims per 1000 people. In the Subsequent Injury Study (SInS) [3], 58% of 2856 participants reported at least one subsequent injury event to ACC in the 24 months following an ACC entitlement claim (a

Methods

The SInS protocol has been published previously [22]. In brief, SInS combined three sources of data. Firstly, self-reported data from participant interviews undertaken approximately three months following an ACC entitlement claim injury event (the ‘sentinel’ injury) as part of the earlier POIS [23,24] Secondly, ACC claims related to participants’ sentinel injury, as well as for subsequent injury events in the following 24 months, and thirdly, the National Minimum Data Set (NMDS) of hospital

Results

In the 24 months following their sentinel injury event, 589 (21%) of 2856 participants had ≥1 severe ACC-SI (NISS≥4) (Outcome 1) and 888 (31%) had ≥2 ACC-SI regardless of severity (Outcome 2). No ACC-SI events were reported by 1203 (42%) participants. Analyses for Outcome 1 are therefore restricted to 1792 participants (1203 participants with no ACC-SI, and 589 with the outcome of interest). Analyses for Outcome 2 are restricted to 2091 participants (1203 with no ACC-SI and 888 participants

Discussion

People who present for treatment with healthcare providers following an injury are a readily identifiable group that could benefit from intervention strategies that may prevent subsequent injury events. In order to understand how best to target interventions it is necessary to understand the characteristics that increase the risk of subsequent injuries, and who may benefit from targeted injury prevention interventions. This paper has examined predictors of severe subsequent injury and multiple

Conclusions

Factors identified in this study may be useful indicators to aid healthcare providers and policy makers identify people at increased risk of severe or multiple subsequent injuries who may benefit from targeted injury prevention strategies or interventions. Although the ACC system is unique worldwide, the predictors of subsequent injury identified here are likely to be generalisable to people experiencing a wide range of sentinel and subsequent injury types including both hospitalisation and

Data sharing statement

Due to ethical constraints the data cannot be shared but anyone interested in pursuing collaborative research should contact [email protected].

Funding

The Subsequent Injury Study was funded by the Health Research Council of New Zealand (2015-2017; 15/091). The Prospective Outcomes of Injury Study was funded by the Health Research Council of New Zealand (2007-2013; 10/052) and co-funded by the Accident Compensation Corporation, New Zealand (2007-2010). The views and conclusions in the article are the authors and may not represent those of the funders.

CRediT authorship contribution statement

Helen Harcombe: Conceptualization, Visualization, Formal analysis, Data curation, Writing - original draft, Writing - review & editing. Gabrielle Davie: Conceptualization, Visualization, Data curation, Writing - review & editing. Emma Wyeth: Conceptualization, Visualization, Writing - review & editing. Shanthi Ameratunga: Visualization, Writing - review & editing. Denise Powell: Visualization, Writing - review & editing. Sarah Derrett: Conceptualization, Visualization, Data curation, Writing -

Declaration of Competing Interest

None.

Acknowledgments

The authors are grateful to the study participants for sharing their information.

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