Trauma Outcomes in Nonfatal Road Traffic Accidents: A Portuguese Medico-Legal Approach

Abstract

The objective of this study was to compare the outcomes of nonfatal road traffic accidents by the victims’ age group and sex. We used the Portuguese medico-legal rules for personal injury assessment, in the scope of the Civil Law in that country, which includes a three-dimensional methodology. This was a retrospective study including 667 victims of road traffic accidents aged 3–94 years old. Their final medico-legal reports all used the Portuguese methodology for personal injury assessment. Outcomes were analysed by the victims’ age group (children, working-age adults, and older people) and sex. Road traffic accidents were generally serious (ISS mean 9.5), with higher severity in children and older people. The most frequent body sequelae were musculoskeletal (64.8%), which were associated with functional and situational outcomes. Temporary damage resulted in an average length of impairment of daily life of 199.6 days, 171.7 days to return to work, and an average degree of quantum doloris (noneconomic damage related to physical and psychological harm) of 3.7/7. The average permanent damage was 7.3/100 points for Permanent Functional Deficit, 0.43/3 for Permanent Professional Repercussion, 2/7 for Permanent Aesthetic Damage, 3.9/7 for Permanent Repercussion on Sexual Activity and 3.2/7 for Permanent Repercussion on Sport and Leisure Activities. Overall, 19% of people became permanently dependent (10.6% needed third-party assistance). The medico-legal methodology used, considering victims’ real-life situation, allows a comprehensive assessment. There were several significant differences among the three age groups but none between sexes. These differences and the impact of the more severe cases justify further detailed medico-legal studies in these specific situations on children, older people, and severely injured victims. Key points: This was a retrospective study of accident mechanisms and injury outcomes in Portugal, and considered the outcomes in the victims’ real-life situation. Lesions from road traffic accidents were generally serious, with higher severity among children and older people. The most frequent sequels were musculoskeletal, and associated with functional and situational outcomes. Both temporary and permanent outcomes had repercussions for the victims. There were significant differences between children, working-age adults and older people, but none between sexes.

Are There Any Differences in Road Traffic Injury Outcomes between Older and Younger Adults? Setting the Grounds for Posttraumatic Senior Personal Injury Assessment Guidelines

“…However, despite an absence of a significant OR, we noticed a tendency towards more days of Total Temporary Functional Deficit in the older population, in agreement with other authors [ 18 , 28 ] and as we found in our previous study without matching ISS samples ( p = 0.001) [ 25 ]. Nevertheless, we should note that seniors are more vulnerable to bed rest and reduced food intake, which should be avoided due to the effects of immobilisation (loss of strength and muscle mass, decrease in aerobic capacity, and functional decline); such effects already appear with just ten days of bed rest [ 43 , 44 , 45 ].…”

“…A significant difference was found for Partial Temporary Functional Deficit , with a higher OR in G2. This result was also found in a previous study ( p = 0.005) [ 25 ] and may be related to the more demanding physical rehabilitation period in younger people, given the greater need for their activity ( Table 2 ).…”

“…Although the literature reports that the elderly have greater resilience to pain than adults [ 5 , 16 ], in our first study [ 25 ], a higher Quantum Doloris average was found in the elder group ( p < 0.001), but in the current study, no significant differences were observed ( Table 2 ). This last result was expected, considering that the concept of Quantum Doloris includes the severity of acute injuries, which was forcibly similar in both groups [ 42 ].…”

“…This coefficient corresponds to the average of the final scores resulting from each scale of three referred levels and considers five severity groups of increasing severity. The meaning of each level is [ 25 , 35 , 42 ]: Body level: assesses biological outcomes, which may include morphological, anatomical, histological, physiological, and even genetic particularities; Capacities / functions level: assesses physical and mental capacities (current or potential), taking into account age and sex, irrespective of the live setting; Life situations / participation / activities level: assesses the confrontation (concrete or potential) between those affected and the reality of their physical, familial, social, cultural, educational, and professional environment. …”

“…RTAs in senior victims differ in their characteristics and outcomes from RTAs in young and middle-aged adult victims [ 24 ]. The energy needed to cause injuries decreases as the person’s age increases, having more severe consequences than in younger people; road accidents occur because some particularities of this age group are related to more frequent health fragilities [ 25 ]. Older adults generally suffer less serious trauma mechanisms, although the risk of severe and critical injuries is more considerable, causing significant morbidity and mortality, which increases with age [ 17 , 18 , 24 , 26 , 27 , 28 , 29 , 30 ].…”