What are long term outcomes after a car crash

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Welcome back to the Forensic Chiropractor podcast.

Today’ study is Impacts of Injury severity on Long-term outcomes following motor vehicle crashes by Kevin Hung et al published in BMC Public Health in 2021. 

Like most studies they start by explaining why the study was done.  They reported that 10% of the global burden from disease is related to injuries of which the main contributor is MVCs.  They reported that in 2016 there were 1.35 million deaths from motor vehicle collisions.  That number blows my mind.  I can’t believe how many people die every year in MVC.  This number did decrease in 2025 to 1.19 million deaths worldwide. 

They want to document health outcomes based on severity of injuries.  Like lots of other studies they use length of stay in the hospital as one test of injury severity.  They also used the injury severity scale and this has also been shown to be a reasonable measurement to identify serious injury. 

Lots of prior studies have looked into this and here are some of their results listed in this study.  Work disability increased with length of stay.  Work earning capacity went down 35% for those that had a length of stay over 1 week compared to non-hospitalized who had only an 8% decrease in earnings.  One study showed a 10 fold risk of worse health outcomes among hospitalized crash patients.  Another study showed that patients who were hospitalized for 3 days had limitations with activities and discomfort for 24 months.    

This study took patients older than 17 who were injured in MVCs for a 3-year period.  95% of these patients came from hospital emergency departments and 5% came from other sources.  They excluded any patients with pre-existing cognitive impairments, very minor injuries or extremely severe injuries like severe traumatic brain injuries, spinal cord injuries, extensive burns or multiple amputations.

Eligible patients were contacted by phone within 28 days of the injury and there were 6 month and 12 month follow ups.  The outcomes they assessed included:

-Return to work

-Health related quality of life

-health status

-disability and function

- psychological factors

-pain

-compensation

They had 2 ways to assess how injured a patient was. 

First:

They divided patients into 3 categories of injury based on length of stay in a hospital. 

Mild injuries were people who had 1 or less days

Moderate injuries were people who had 2-6 days

And sever injuries were people who had 7 or more days. 

Second:

They also used the Injury severity scale to determine how injured patients were.  For this scale they had 1 being minor injuries and 6 most severe injuries. 

To assess injuries, they looked into different baseline information like: employment, pre-injury health, health status, lifestyle habits, pain, disability and functioning, health care utilization, work and social life.  The data was collected with a short form survey that had 12 questions.  The questions were divided into 2 categories.  Physical and mental components. 

They also used the Orebro musculoskeletal pain screening questionnaire and the World health Organization disability assessment II. 

For the study they had 2,019 patients enrolled and at the 12 month follow up they had 59.5% of participants finish the study.  This means that 1,201 patients were used for this study.

They broke down how sever patients injuries  were on the 2 categories.

First:

For this study 64.6% of patients were in the hospital one day or less, 25.1% were in the hospital for 2-6 days and 10.3% were in the hospital for 7 days or more. 

Second:

Injury severity score showed 43% of patients had moderate injuries and 4% had severe injuries. 

This study was for motor vehicle collision injuries.  This was broken down into 46% of injured people were occupants in a vehicle, 31% were on motorcycles, 14% were pedestrians and 8% were reported as other.

Results:

The longer the length of stay was associated with lower work participation, more pain, worse health related quality of life, more disability, more post-traumatic symptoms and worse psychological states at 6 and 12 months.  This was not clearly associated with pain catastrophizing.  In other words, they were not malingering or exaggerating their pain.  This is evidence that the longer the stay in the hospital the worse everything seems to be all around. 

For participants that stayed in the hospital 7 or more days they had a 50% less chance of staying in their jobs compared to those with 1 or less days hospitalization.  In general, this study showed that the more severe the injury the more there was a reduced work participation.    

Participants with severe injuries had negative impacts at 12 months on work participation, Health related quality of life, health status and disability.  The more the injury severity was the worse the mental health assessments were at 12 months. Minor injuries had the lowest mental health issues. 

This study showed that whiplash-related injuries are known to be poor recovery outcomes with chronicity.   This study showed that there is an association between 3^rd party insurance and worse long-term outcomes.  Prior studies have seen this and likely reasons are anxiety and stress with the claims process. 

The conclusion showed that the worse the injuries as seen with increased length of stay in a hospital or increased injury severity scale the worse the outcomes in almost all areas.   These areas include:

-decrease in paid work at 12 months

-mental health outcomes

-long term health

-pain

Real world

I am fortunate that as a chiropractor most of my patients injured in a motor vehicle collision have not been hospitalized.  I do have patients that were hospitalized and some for well over 7 days.  These patient often have very serious injuries and needed multiple surgeries.  The pattern that I have seen is that the physicians, and insurance companies assume these patients should be back to normal after being released.  It feels like once there are no more large surgical procedures to do that everyone assumes they are fine and do not need future care. 

As seen in today’s study these patient often have a hard time returning to work and end up loosing their jobs and seek new types of employment.  These patients often have mental health struggles and ongoing pain and dysfunction.  My experience correlates well with today’s study.    The pain persists for months to years for these patients.  I used today’s study with insurance companies to show that severely injured patients have long term symptoms and need long term care.

By the time I see some of these patients their MVCs were months prior.  They focused all treatment on surgeries and rehab from the surgeries.  It is only after being released from the surgeons that they realize they did not make a full recovery, but no other treatments are being offered.  This is the time that as a chiropractor addressing biomechanical injuries is important.  Unfortunately even after months of surgeries and treatments  insurance companies do not want patient’s starting new treatment.  I used this study to help me explain that these patients will have long term problems and a lot of times this comes from untreated injuries like biomechanical injuries. 

As an attorney I would use this article to show that with severe injuries earing potential decreased dramatically and for the long term.  This included a 50% chance of having to change jobs and make less money.  Although in the end we do not need to argue what could happened, but what did or is likely to happen and this study shows what is likely to happen for severe injury patients.