Return to work following road accidents: factors associated with late work resumption.

OBJECTIVE: To analyse factors associated with late return to work in road accident victims. MATERIALS AND METHODS: The ESPARR cohort comprises road accident victims monitored over time from initiation of hospital care. A total of 608 ESPARR cohort subjects were working at the time of their accident and answered questionnaires at 6 months and/or 1 year. For each level of overall severity of injury (Maximum - Abbreviated Injury Scale (M-AIS) 1, 2, 3 and 4-5), a time-off-work threshold was defined, beyond which the subject was deemed to be a late returner; 179 subjects were considered to be late in returning to work, while 402 showed a normal pattern of return. Logistic regression identified factors associated with late return. RESULTS: Type of journey, overall injury severity and intention to press charges emerged as factors predictive of late return to work on the basis of the data collected at inclusion alone. After adjustment, pain (odds ratio (OR): 2.6; 95% confidence interval (95% CI) 1.0-6.7) and physical sequelae (OR: 3.8; 95% CI 1.7-8.3) at 6 months and the fact of pressing charges (OR: 2.6; 95% CI 1.2-5.5) remained significantly linked with late return to work. CONCLUSION: Impaired health status at 6 months after the initial accident (in the form of persistent pain and physical sequelae) is a determining factor delaying return to work following a road traffic accident.

Predictive factors of chronic post-traumatic stress disorder 6 months after a road traffic accident.

BACKGROUND: This study sets out to identify risk factors for post-traumatic stress disorder (PTSD) after a road traffic accident with a view to improving prevention. METHODS: The study used a prospective cohort of road traffic accident casualties. All subjects over 15 years of age were recruited in the course of an interview conducted while they were receiving care in a hospital of the Rhône area administrative département. Six months after their accident, they answered a self-administered postal questionnaire that included the Post-traumatic Check-List Scale (PCLS) in order to evaluate PTSD. Multivariate logistic regression analysis was conducted to compare those subjects with a PCLS score of 44 or over with those with a lower score, in order to identify factors that might be associated with PTSD. RESULTS: 592 subjects (out of 1168) returned the 6-month questionnaire and 541 completed the PCLS test. One hundred subjects had a PCLS score ≥ 44, suggesting PTSD, and 441 subjects did not. The factors associated with PTSD were initial injury severity, post-traumatic amnesia, the feeling of not being responsible for their accident and persistent pain 6 months after it. A lower odds-ratio was associated with users of two-wheel than four-wheel motor vehicles (OR=0.4; 0.2-0.9). CONCLUSION: Besides predictive factors for PTSD (injury severity, post-traumatic amnesia and the feeling of not being responsible for their accident), our study suggested a reduced risk of PTSD among two-wheel motor vehicle users.

Self-reported road traffic violations in France and how they have changed since 1983.

GOALS: The goal was to gain a picture of current driver behaviour, and of the links between committed violations and accident history. It was also to identify how driver behaviour has changed over the last 20 years. METHODS: A questionnaire-based cross-sectional study of a sample of 1161 drivers about the frequency of violations and the perception of the dangers and penalties associated with them was used in 2005. Self-reported violations and mental representations were also compared to the results of Biecheler who used similar methods (Biecheler-Fretel, 1983). RESULTS, CONCLUSIONS: Road traffic violations are frequent in France, particularly among male drivers. Several violations are linked with history of accidents in our sample. Frequently or fairly frequently exceeding the speed limit by 10 km/h (a violation reported by almost 53% of our sample), increases accident occurrence by a factor of 1.4. Progress in drivers' behaviour has been slow and nonuniform, and appears in part to be related to safety campaigns that have been run (seat belts, alcohol). The results could inform future campaigns. In particular, a campaign on the use of indicators would seem worthwhile.

Functional outcome after road-crash injury: description of the ESPARR victims cohort and 6-month follow-up results.

OBJECTIVE: It is essential to know about the long-term consequences of road crashes involving corporal injury in order to adopt relevant public health measures. METHODS: The ESPARR cohort comprises 1168 road-crash victims, aged 16 or over, managed in hospitals in the Rhône administrative départment (France). It is based on the Registry of Road Traffic Casualties, which has been collecting exhaustive data since 1995. Two groups are monitored: mild to moderate (M-AIS 1 or 2) and severe (M-AIS > or =3). Patients were interviewed at the point of primary care, between 1 October 2004 and 31 July 2006. 6 months later, their state of health and presence of pain were compared. Multivariate analysis (logistic regression) was performed to identify factors related to residual pain. RESULTS: Adults of the cohort were compared to the road crash population as a whole recorded over the same period in the same area. At 6 months post-accident, only 31.9% of victims deemed their health status to have entirely returned to normal; 63.8% of mild to moderate and 89.2% of severe cases reported residual pain, but neither pain frequency nor intensity correlated with M-AIS. Residual pain was related to lower limb injuries (OR=1.6; 95% CI=1.1-2.4). After adjustment, pain was essentially related to age, seriousness of the lesions and a stay in a rehabilitation unit. CONCLUSION: The ESPARR cohort provides a unique opportunity in France to describe the trajectory of a road crash victim, in terms both of care and rehabilitation and of resumption of work and personal activity.

Individuals taking a French driving licence points recovery course: their attitudes towards violations.

This paper sets out to describe the drivers attending driving licence points recovery courses (PRC), in order to modify the psychologist's approach during the sessions. The paper describes a questionnaire-based survey of a representative sample of 853 drivers taking a "course designed to raise awareness about the causes and consequences of road traffic accidents". The data are analyzed in part by applying a multiple correspondence analysis. Among those taking part in PRC, recognizing whether they commit violations or not seems to be independent from the perceived probability of sanctioning and the perceived danger. The group of course-takers is divided into two main clusters ("offenders" and "victims") which require a completely different approach on the part of the training staff.

Diseases, consumption of medicines and responsibility for a road crash: a case-control study.

UNLABELLED: The role of medical conditions in crashes is a topic of public debate. Some studies suggest that there has been a reduction in road traffic crashes subsequent to the medical restrictions introduced on drivers with medical deficiencies. As in today's society the car is an important factor for independence and socialization, it seems important to consider whether diseases or consumption of drugs increase the risk of causing a road crash in comparison to well-known major crash risk factors. A case-control study was conducted (733 injured drivers). The cases were subjects who were partly or totally responsible for their crash. The 304 controls were the non-responsible drivers. Diseases and medicine consumption were analyzed using logistic regression models. Cases were characterized by a higher percentage of young men. They were more frequently affected by fatigue, as were subjects who had consumed alcohol. A higher risk in subjects suffering from hypertension is observed (adjusted odds ratio [adjOR]=3.82; 95%CI=[1.42-10.24]). An association between antidepressant consumption and responsibility appeared (adjOR=3.61; 95%CI=[1.30-10.03]). CONCLUSION: Medical factors associated with responsibility were arterial hypertension and antidepressant consumption. Other medical conditions do not seem to play a preponderant role comparing to individual behaviours.

Tiring job and work related injury road crashes in the GAZEL cohort.

The objective was to describe at-work and commuting crashes occurring in a cohort of French employees and to investigate occupational risk factors. The subjects were employees of the French national electricity and gas companies, Electricité de France and Gaz de France (EDF-GDF), who volunteered to join a research cohort (the GAZEL cohort which included 20,625 participants in 1989). Only crashes with injuries were considered. Crashes for the periods 1989--2001 were recorded together with the type of journey (commuting, work, private), the type of road-user, self-estimated responsibility, and injuries sustained by the subject. Annual incidences for gender/age groups and socio-occupational groups were computed for each of the two types of work related crashes. Occupational risk factor analyses were conducted using a Cox proportional hazards regression model with time-dependent covariates adjusting for the main confounders. A total of 146,285 person years at work were observed. Two indicators of self-reported work fatigue were associated with the occurrence of at-work crashes: "nervously tiring work" for males (RR=1.6, 95% CI [1.1; 2.3]), sustained standing for females (RR=3.0, 95% CI [1.0; 8.4]), adjusting for health status, location of residence, type of family, transport mode and mileage. As regards crashes while commuting, a self-reported uncomfortable position at work was a risk factor among women (RR=1.9, 95% CI [1.1; 3.3]). On the other hand, these occupational factors were not linked to road crashes in private trips. Work related road crashes seem then to be a matter for a specific prevention. Preventing employees from becoming exhausted should be considered as the first way to initiate such a prevention.