1. bookVolume 59 (2020): Issue 4 (December 2020)
Journal Details
License
Format
Journal
First Published
29 Jul 2010
Publication timeframe
4 times per year
Languages
English
access type Open Access

Quality of life in road traffic accident survivors

Published Online: 18 Oct 2020
Page range: 202 - 210
Received: 26 Apr 2020
Accepted: 19 Aug 2020
Journal Details
License
Format
Journal
First Published
29 Jul 2010
Publication timeframe
4 times per year
Languages
English
Abstract Introduction

The loss of quality of life is the major consequence following a non-fatal road traffic accident (RTA). Previous research regarding quality of life did not include uninjured RTA survivors. The research aim was thus to evaluate the quality of life of the RTA survivors regardless of whether or not they sustained injures, and to identify factors associated with decreased quality of life after the RTA.

Methods

A cohort of 200 RTA survivors with and without injuries was followed after experiencing an RTA. The quality of life and mental health outcomes were assessed 1 month following RTA. A vast range of sociodemographic, pre-RTA health-related, RTA related, RTA injury-related, compensation-related factors and mental health outcomes were investigated.

Results

Decreased quality of life following an RTA showed an association with the low socioeconomic status of the RTA victims, poor pre-RTA health, injury-related factors, compensation-related factors and psychological disorders after the RTA.

Conclusions

Identifying predictors of decreased quality of life following an RTA will enable planning interventions targeting the most important factors that influence recovery of RTA victims. Assessing and recording of self-reported quality of life should be a part of the routine protocol in RTA survivors’ health-care.

Keywords

Ključne besede

Introduction

About 50 million people around the world suffer from non-fatal road traffic accident (RTA) injuries every year (1). In 2018, 13,989 people were injured in RTAs in Croatia (2). The non-fatal consequences of RTAs are numerous: functional and cognitive impairments, psychological consequences and a decrease in the quality of life of the survivors (3).

Decreased quality of life (QoL) is the major consequence of RTAs (4). Research shows that the physical and mental components of health-related QoL are decreased in the long-term, even in RTA survivors with minor injuries (5, 6, 7). QoL consistently and independently predicts return to pre-injury employment and life participation among RTA survivors who sustained mild/moderate injuries (8). Research also shows that psychiatric disorders in RTA survivors decrease QoL (9), especially PTSD (4, 7, 10, 11), depressive disorder (4, 9) and anxiety disorder (9). Other potential factors that influence QoL in RTA survivors are expectations regarding recovery, pain level, social support, perceived life-threat in the RTA (4, 12, 13), level of education, injury severity, compensation claim, early medical complications and socioeconomic factors, especially financial problems (11). The research regarding the impact of RTA injury severity on the QoL following the RTA is inconsistent, some studies found that injury severity does not predict later QoL (4, 6, 9), while others found the contrary (11, 14).

However, all published studies on QoL following an RTA only include the injured RTA survivors, and thus there is no knowledge on the QoL of the uninjured survivors. Furthermore, there are no QoL studies conducted among RTA victims in Croatia.

The research aim was therefore to evaluate the quality of life of the RTA survivors regardless of whether or not they sustained injures, and to identify factors associated with decreased quality of life after the RTA.

Methods

A cohort of 200 RTA survivors recruited at the Institute of Emergency Medicine of the Vukovar-Srijem County in Croatia were included in a prospective study. They were assessed 1 month following the RTA. Inclusion criteria for participating were being an RTA survivor and aged 18 and older. RTA survivors with cognitive dysfunctions and inability to give consent were excluded, as well as those aged under 18. Recruitment of the participants and data collection was done by a medical doctor.

During the research period, from October 2016 to December 2017, 640 people were involved in RTAs. Figure 1 gives details on the formation of the prospective cohort.

Figure 1

Cohort recruitment diagram.

Using a specially designed questionnaire the following data about RTA survivors was collected in this study: age, gender, place of residence, education, employment, marital status, self-assessed economic status and religiousness. Using the same questionnaire, data regarding pre-RTA health-related factors such as smoking, alcohol consumption, drug abuse, earlier road crash experience, traumatic exposures, prior PTSD, chronic diseases, psychiatric diseases and previous permanent pain was also collected.

Finally, the RTA-related factors explored through the same questionnaire were the type of road user, number of motor vehicles that were involved in the RTA, the injured and fatalities, fault for causing the RTA, compensation status, memory loss after the RTA, loss of consciousness in the RTA, injury status and severity, hospitalization, surgery and rehabilitation, self-assessed life-threat and pain following the RTA. The classification and detailed description of all collected data are shown in Tables 1, 2 and 3.

Sociodemographic factors and health status before the RTA.

Sociodemographic factors and health status N %
Sex
Male 108 54.0
Female 92 46.0
Age group (years)
Younger (18–41) 97 48.5
Older (≥42) 103 51.5
Place of residence
Urban 87 43.5
Rural 113 56.5
Education
Primary 38 19.0
Secondary 125 62.5
Higher education 37 18.5
Employment
Employed 116 58.0
Out of work 52 26.0
Retired from work 32 16.0
Relationship status
Single 71 35.5
Has a partner 129 64.5
Self-assessed economic status
Under average 40 20.0
Average 116 58.0
Above average 44 22.0
Religiousness
No 19 9.5
Yes 181 90.5
Smoking
No 129 64.5
Yes 71 35.5
Alcohol use
No 99 49.5
Yes 101 50.5
Drug abuse
No 197 98.5
Yes 3 1.5
Use of medications
No 98 49.0
Yes 102 51.0
Type of medications
None 98 49.0
Non-psychiatric 78 9.0
Psychiatric 7 3.5
All types 17 8.5
Previous RTAs
No 116 58.0
Yes 84 42.0
Traumatic exposures
No 96 48.0
Yes 104 52.0
Prior PTSD
No 193 96.5
Yes 7 3.5
Chronic disease
No 116 58.0
Yes 84 42.0
Psychiatric disease
No 178 89.0
Yes 22 11.0
Permanent pain
No 181 90.5
Yes 19 9.5

RTA details.

RTA details. N %
Type of road users
Driver of motor vehicle 122 61.0
Co-driver or a passenger 61 30.5
Pedestrian or a cyclist 17 8.5
Motor vehicles crashed
None 1 0.5
One 92 46.0
Two or more 107 53.5
Injured
None 29 14.5
One 84 42.0
2–3 72 36.0
More than 3 15 7.5
Fatal outcomes
No 195 97.5
Yes 5 2.5
At fault
No 123 61.5
Yes 70 35.0
Unknown 7 3.5
Claimed compensation
No 113 56.5
Yes 87 43.5
Obtained compensation
No 180 90.0
Yes 20 10.0

Health status following the RTA.

Health status following the RTA N %
Number of injuries
Without injures 31 15.5
One 45 22.5
Multiple 124 62.0
Injury location
None 31 15.5
Head 18 9.0
Face 2 1.0
Neck 8 4.0
Chest 8 4.0
Abdomen 1 0.5
Spine 3 1.5
Upper extremities 3 1.5
Lower extremities 10 5.0
Several locations 116 58.0
Major injury
Without injuries 31 15.5
Head 58 29.0
Neck 37 18.5
Chest 19 9.5
Abdomen 12 6.0
Upper extremities 17 8.5
Lower extremities 26 13.0
Injury level
Without injury 31 15.5
Minor 96 48.0
Moderate 36 18.0
Serious 28 14.0
Severe 6 3.0
Critical 3 1.5
Self-assessed life-threat
No 108 54.0
Yes 92 46.0
Loss of consciousness
No 168 84.0
Yes 32 16.0
Loss of memory
No 172 86.0
Yes 28 14.0
Hospitalization
No 136 68.0
Yes 64 32.0
Days in hospital
None 136 68.0
1–3 27 13.5
4–10 19 9.5
11 and more 18 9.0
Surgery
No 180 90.0
Yes 20 10.0
Rehabilitation
No 154 77.0
Yes 46 23.0
Pain following the RTA
No 47 23.5
Yes 153 76.5
Symptoms of PTSD
No 129 64.5
Yes 71 35.5
Symptoms of depression
No 160 80.0
Yes 40 20.0
Symptoms of anxiety
No 191 95.5
Yes 9 4.5

Based on medical records related to the RTA, the injury severity was assessed using the Abbreviated Injury Scale (AIS) (15). The final score was assigned using the New Injury Severity Scale (NISS). NISS classifies injuries as minor, moderate, serious, severe and critical (16).

The PTSD Checklist for Civilians (PCL-C) was used for the assessment of PTSD symptoms following the RTA (17). A cut-point of 30 was used, as suggested for general population (18).

The Beck Anxiety Inventory (BAI) was used for the assessment of anxiety symptoms following the RTA, with the cut-point of 22 (19).

The Beck Depression Inventory—I (BDI—I) was used for the assessment of depression symptoms following the RTA, with the cut-point of 11 (20).

The Short Form-36 (SF-36) was used for the assessment of QoL following the RTA (21). In this QoL is a multidimensional concept describing a satisfactory, balanced and healthy life comprising both biopsychosocial and socioeconomic aspects (22), such as physical health, psychological status, independence level, social relations, personal beliefs and relations within a specific environment (11). SF-36 is the most widely used instrument for assessing health-related QoL, and has been standardized and validated. This self-reporting measure contains 36 items and is used for the assessment of health status across eight domains: physical function (PF), role limitations due to physical health (RP), role limitations due to emotional problems (RE), vitality (VT), mental health, referring to the absence of anxiety and depression, (MH), social functioning (SF), bodily pain (BP) and general health (GH). The result scores range from 0 to 100, and higher obtained values present better perception of the QoL (23). The Croatian version of SF-36 was validated and found reliable in the Croatian population (24).

The normality of data distribution was tested with the Kolmogorov-Smirnov test; thereafter descriptive statistics were applied. The Mann-Whitney U test and Kruskal-Wallis test were applied for the comparison of numerical variables. Spearman’s correlation was applied to test the correlation between the QoL domains and psychological outcomes following the RTA. The statistical significance level was set at p<0.05. The statistical package Statistica for Windows 2010 (version 10.0, StatSoft Inc., Tulsa, OK, USA) was used for the analysis.

Results
RTA Survivors’ Characteristics

Participants’ median age was 42.5 years (interquartile range 28.3-56.0), 54.0% were males, 56.5% had rural residence, 62.5% finished high-school education, 58.0% were employed, 64.5% had a partner, 58.0% reported self-assessed average economic status, 90.5% were religious, 64.5% were non-smokers, 49.5% never used alcohol, 51.0% used medications, 42.0% had prior RTA experience, 52.0% reported previous traumatic exposures, 42.0% had previous chronic disease, 11.0% had previous psychiatric disease and 9.5% suffered previous permanent pain (Table 1). Non-participants and participants had similar age, gender and primary injury location.

RTA details are shown in Table 2, and these reveal that 61.0% of the participants were drivers of motor vehicles, 53.5% were involved in the RTA involving two or more vehicles, 42.0% were in the RTA with one victim, 2.5% were in the RTA with fatalities, 61.5% of the participants were not at fault for causing the RTA, 43.5% of the participants claimed compensation and 10.0% received compensation.

The health status of the participants following the RTA is shown in Table 3. Multiples injures were sustained by 62.0% of the participants, 15.5% of the participants had no injuries, 48.0% sustained minor injuries, 18.0% sustained moderate injuries, 14.0% sustained serious injuries, 3.0% sustained severe injuries and 1.5% sustained critical injuries in the RTA. Threat to life was experienced by 46.0% of the participants, 16.0% reported unconsciousness, 14.0% reported amnesia, 32.0% were hospitalized, 10.0% underwent surgical treatment, 23.0% underwent rehabilitation procedures, 76.5% reported pain following the RTA, 35.5% reported PTSD symptoms, 20.0% reported depression symptoms and 4.5% reported anxiety symptoms following the RTA.

Quality of Life After the RTA

The median values of QoL obtained across eight domains are presented in Table 4.

Quality of life of the participants after the RTA.

QoL domains Median Interquartile range
Physical functioning 70.0 30.0–100.0
Role limitations due to physical health 0.0 0.0–100.0
Role limitations due to emotional health 100.0 67.0–100.0
Vitality 60.0 50.0–75.0
Mental health 68.0 52.0–76.0
Social functioning 75.0 50.0–100.0
Bodily pain 55.0 33.0–80.0
General health 70.0 55.0–84.0

The sociodemographic factors that were found to be associated with lower QoL domains were female gender, older age group, lower education level, unemployment, lower self-assessed economic status and irreligiousness. Pre-RTA health showed an association with lower QoL domains after the RTA, in terms of alcohol abstinence, previous traumatic exposure, previous chronic disease, previous psychiatric disease, previous permanent pain, use of medications and especially psychiatric medication use. Injury-related factors found associated with lower QoL domains were injury affliction, injury severity, self-assessed life-threat, pain following the RTA, hospitalization and its duration, surgery, unconsciousness in the RTA and rehabilitation following the RTA. Among RTA-related factors, not being at fault in the RTA, claiming compensation, obtaining compensation and vulnerable road users had lower QoL (Table 5).

Factors influencing quality of life following the RTA.

QoL domains
  Factors PF PR ER VT MH SF BP GH
Sociodemographic
Gender p=0.681

Mann-Whitney U test

p=0.651

Mann-Whitney U test

p=0.020

Mann-Whitney U test

p=0.072

Mann-Whitney U test

p=0.064

Mann-Whitney U test

p=0.408

Mann-Whitney U test

p=0.052

Mann-Whitney U test

p=0.118

Mann-Whitney U test

Age group p=0.084

Mann-Whitney U test

p=0.204

Mann-Whitney U test

p=0.226

Mann-Whitney U test

p=0.078

Mann-Whitney U test

p=0.012

Mann-Whitney U test

p=0.079

Mann-Whitney U test

p=0.959

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Place of residence p=0.795

Mann-Whitney U test

p=0.098

Mann-Whitney U test

p=0.876

Mann-Whitney U test

p=0.427

Mann-Whitney U test

p=0.096

Mann-Whitney U test

p=0.069

Mann-Whitney U test

p=0.224

Mann-Whitney U test

p=0.469

Mann-Whitney U test

Education p=0.478

Kruskal-Wallis test

p=0.045

Kruskal-Wallis test

p=0.182

Kruskal-Wallis test

p=0.344

Kruskal-Wallis test

p=0.152

Kruskal-Wallis test

p=0.828

Kruskal-Wallis test

p=0.118

Kruskal-Wallis test

p=0.034

Kruskal-Wallis test

Employment p=0.087

Kruskal-Wallis test

p=0.403

Kruskal-Wallis test

p=0.037

Kruskal-Wallis test

p=0.094

Kruskal-Wallis test

p=0.067

Kruskal-Wallis test

p=0.988

Kruskal-Wallis test

p=0.007

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

Marital status p=0.628

Mann-Whitney U test

p=0.965

Mann-Whitney U test

p=0.101

Mann-Whitney U test

p=0.465

Mann-Whitney U test

p=0.671

Mann-Whitney U test

p=0.874

Mann-Whitney U test

p=0.525

Mann-Whitney U test

p=0.708

Mann-Whitney U test

Self-assessed economic status p=0.014

Kruskal-Wallis test

p=0.032

Kruskal-Wallis test

p=0.049

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p=0.245

Kruskal-Wallis test

p=0.003

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

Religiousness p=0.898

Mann-Whitney U test

p=0.407

Mann-Whitney U test

p=0.868

Mann-Whitney U test

p=0.010

Mann-Whitney U test

p=0.041

Mann-Whitney U test

p=0.130

Mann-Whitney U test

p=0.072

Mann-Whitney U test

p=0.862

Mann-Whitney U test

Pre-RTA health
Body mass index p=0.182

Kruskal-Wallis test

p=0.496

Kruskal-Wallis test

p=0.754

Kruskal-Wallis test

p=0.319

Kruskal-Wallis test

p=0.538

Kruskal-Wallis test

p=0.141

Kruskal-Wallis test

p=0.612

Kruskal-Wallis test

p=0.182

Kruskal-Wallis test

Smoking p=0.620

Mann-Whitney U test

p=0.214

Mann-Whitney U test

p=0.260

Mann-Whitney U test

p=0.056

Mann-Whitney U test

p=0.096

Mann-Whitney U test

p=0.198

Mann-Whitney U test

p=0.510

Mann-Whitney U test

p=0.097

Mann-Whitney U test

Alcohol consumption p=0.020

Mann-Whitney U test

p=0.007

Mann-Whitney U test

p=0.046

Mann-Whitney U test

p=0.009

Mann-Whitney U test

p=0.028

Mann-Whitney U test

p=0.036

Mann-Whitney U test

p=0.005

Mann-Whitney U test

p=0.003

Mann-Whitney U test

Drug abuse p=0.637

Mann-Whitney U test

p=0.314

Mann-Whitney U test

p=0.969

Mann-Whitney U test

p=0.214

Mann-Whitney U test

p=0.566

Mann-Whitney U test

p=0.500

Mann-Whitney U test

p=0.425

Mann-Whitney U test

p=0.272

Mann-Whitney U test

Previous RTAs p=0.840

Mann-Whitney U test

p=0.774

Mann-Whitney U test

p=0.709

Mann-Whitney U test

p=0.589

Mann-Whitney U test

p=0.083

Mann-Whitney U test

p=0.793

Mann-Whitney U test

p=0.864

Mann-Whitney U test

p=0.133

Mann-Whitney U test

Previous traumatic exposures p=0.983

Mann-Whitney U test

p=0.510

Mann-Whitney U test

p=0.471

Mann-Whitney U test

p=0.032

Mann-Whitney U test

p=0.116

Mann-Whitney U test

p=0.394

Mann-Whitney U test

p=0.604

Mann-Whitney U test

p=0.031

Mann-Whitney U test

Prior PTSD p=0.890

Mann-Whitney U test

p=0.612

Mann-Whitney U test

p=0.986

Mann-Whitney U test

p=0.941

Mann-Whitney U test

p=0.308

Mann-Whitney U test

p=0.882

Mann-Whitney U test

p=0.776

Mann-Whitney U test

p=0.206

Mann-Whitney U test

Chronic disease p=0.039

Mann-Whitney U test

p=0.026

Mann-Whitney U test

p=0.410

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.043

Mann-Whitney U test

p=0.073

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Psychiatric disease p=0.435

Mann-Whitney U test

p=0.061

Mann-Whitney U test

p=0.024

Mann-Whitney U test

p=0.057

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.452

Mann-Whitney U test

p=0.039

Mann-Whitney U test

p=0.010

Mann-Whitney U test

Previous permanent pain p=0.828

Mann-Whitney U test

p=0.771

Mann-Whitney U test

p=0.069

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.033

Mann-Whitney U test

p=0.172

Mann-Whitney U test

p=0.052

Mann-Whitney U test

p=0.014

Mann-Whitney U test

Use of medications p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.058

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Types of medications p<0.001b p<0.001

Kruskal-Wallis test

p=0.253

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001b p<0.001

Kruskal-Wallis test

RTA injury-related
Injury affliction p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.228

Mann-Whitney U test

p=0.061

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.003

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.008

Mann-Whitney U test

Injury severity p<0.001b p<0.001

Kruskal-Wallis test

p=0.347

Kruskal-Wallis test

p=0.081

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

Self-assessed life-threat p=0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.013

Mann-Whitney U test

p=0.002

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Pain following the RTA p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.002

Mann-Whitney U test

Hospitalization p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.200

Mann-Whitney U test

p=0.177

Mann-Whitney U test

p=0.053

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Hospitalization duration p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p=0.318

Kruskal-Wallis test

p=0.244

Kruskal-Wallis test

p=0.128

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

Surgery p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.281

Mann-Whitney U test

p=0.045

Mann-Whitney U test

p=0.036

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Loss of consciousness p=0.033

Mann-Whitney U test

p=0.088

Mann-Whitney U test

p=0.334

Mann-Whitney U test

p=0.393

Mann-Whitney U test

p=0.597

Mann-Whitney U test

p=0.298

Mann-Whitney U test

p=0.311

Mann-Whitney U test

p=0.355

Mann-Whitney U test

Loss of memory p=0.226

Mann-Whitney U test

p=0.150

Mann-Whitney U test

p=0.962

Mann-Whitney U test

p=0.196

Mann-Whitney U test

p=0.097

Mann-Whitney U test

p=0.116

Mann-Whitney U test

p=0.984

Mann-Whitney U test

p=0.190

Mann-Whitney U test

Rehabilitation p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.086

Mann-Whitney U test

p=0.095

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.012

Mann-Whitney U test

RTA-related
Fault p=0.109

Kruskal-Wallis test

p=0.659

Kruskal-Wallis test

p=0.393

Kruskal-Wallis test

p=0.322

Kruskal-Wallis test

p=0.657

Kruskal-Wallis test

p=0.537

Kruskal-Wallis test

p=0.024

Kruskal-Wallis test

p=0.461

Kruskal-Wallis test

Fatalities p=0.953

Mann-Whitney U test

p=0.541

Mann-Whitney U test

p=0.618

Mann-Whitney U test

p=0.762

Mann-Whitney U test

p=0.147

Mann-Whitney U test

p=0.157

Mann-Whitney U test

p=0.343

Mann-Whitney U test

p=0.421

Mann-Whitney U test

Compensation claim p=0.072

Mann-Whitney U test

p=0.140

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.005

Mann-Whitney U test

p=0.178

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.031

Mann-Whitney U test

p=0.367

Mann-Whitney U test

Obtained compensation p=0.474

Mann-Whitney U test

p=0.102

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.232

Mann-Whitney U test

p=0.537

Mann-Whitney U test

p=0.155

Mann-Whitney U test

p=0.370

Mann-Whitney U test

p=0.607

Mann-Whitney U test

Type of road users p=0.007

Kruskal-Wallis test

p=0.053

Kruskal-Wallis test

p=0.502

Kruskal-Wallis test

p=0.156

Kruskal-Wallis test

p=0.070

Kruskal-Wallis test

p=0.113

Kruskal-Wallis test

p=0.017

Kruskal-Wallis test

p=0.004

Kruskal-Wallis test

PF = physical health; RP = role limitations due to physical health; RE = role limitations due to emotional health; VT = vitality; MH = mental health; SF = social functioning; BP = bodily pain; GH = general health

Mental health outcomes showed a reverse correlation with all QoL domains after the RTA. The correlations between QoL domains and the symptoms of depression, anxiety and PTSD are presented in Table 6.

Correlation between quality of life and mental health outcomes after the RTA.

QoL domains
Mental health PF PR ER VT MH SF BP GH
Depression symptoms rs=-0.410 rs=-0.364 rs=-0.430 rs=-0.588 rs=-0.586 rs=-0.582 rs=-0.438 rs=-0.593
p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

Anxiety symptoms rs=-0.274 rs=-0.263 rs=-0.523 rs=-0.446 rs=-0.378 rs=-0.485 rs=-0.427 rs=-0.442
p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

PTSD symptoms rs=-0.380 rs=-0.345 rs=-0.449 rs=-0.476 rs=-0.552 rs=-0.549 rs=-0.527 rs=-0.437
p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

PF = physical health; RP = role limitations due to physical health; RE = role limitations due to emotional health; VT = vitality; MH = mental health; SF = social functioning; BP = bodily pain; GH = general health

Discussion

The study explored the QoL following an RTA and the prospective cohort included RTA survivors both with and without injuries, unlike other studies exploring RTA outcomes only among the injured. The QoL of the RTA survivors one month after the experienced RTA was below the average scores for the general Croatian population in the following QoL domains: RP (0.0 vs. 61.5) and BP (55.0 vs. 64.6) (24). Other studies also found RTA survivors had lower QoL than general population norms (4, 6, 12, 23, 25).

The sociodemographic factors found associated with lower scores of the QoL domains in this study, i.e. older age, female sex, lower education level, unemployment, and lower economic level, are consistent with other research data. The Croatian general population sample reported lower QoL scores in the older age group and among females (24). Other studies of RTA victims also found older age to be associated with lower QoL after the RTA (4, 5, 6, 9, 11, 23, 25, 26, 27). A few studies also found female RTA survivors reporting lower QoL than males (5, 25, 28). Lower education level (7, 11, 12), unemployment (6, 9, 11) and lower economic status (11) of RTA victims were associated with lower QoL after the RTA in several studies. Irreligiousness has not been explored in the earlier studies, but was found relevant in this cohort.

Pre-RTA health status was found to be associated with lower QoL after the RTA. Other studies also found pre-injury health status (6, 9, 11, 12, 23, 27, 29), pre-injury chronic illness (6, 9, 11, 12, 23, 29) and pre-injury psychological history (7, 12, 23, 27, 29) to be associated with decreased QoL in the RTA victims. Use of medications and psychiatric medication use were found associated with all QoL domains except RE. This factor should be further explored, since people may not want to report a psychiatric disease due to stigmatization, but may report information regarding medications they use (30). This study also found previous traumatic exposure to be associated with lower VT and GH. Alcohol consumption was found to be positively associated with all QoL domains, indicating that moderate alcohol use has a positive effect on the QoL (31).

The most important injury-related factors associated with all QoL domains were pain following the RTA and self-assessed life-threat, with the latter also found to be significant in other studies (9, 12). Pain following an RTA is a well-known predictor of QoL (4, 6, 7, 9, 13, 27, 29). Given that a high baseline pain after the RTA is associated with poor long-term health outcomes, strategies to reduce pain levels should be introduced early following an RTA to reduce the risk of long-term health consequences (28). The results with regard to injury severity are inconsistent in the literature, some studies found it to be associated with lower QoL (3, 11, 12, 14, 23, 28, 32), while others found no association (5, 6, 9) or a negative association (4). However, in all studies where RTA survivors with mild injuries reported similar or worse QoL scores than RTA victims with more severe injuries, data were obtained from compensable injury claim registers restricted to a certain level of injuries i.e. mild to moderate. It can be argued that decreased QoL outcomes are the result of the compensable nature of the injury, leading to reporting bias for secondary gain (12). The current study showed not only that more severely injured had lower QoL scores, but also that RTA survivors without injuries had better QoL scores. Other research exploring traumatic injuries also showed that sustaining a traumatic (not RTA) injury was associated with lower QoL (33). Therefore, in order to obtain reliable data, research regarding the impact of RTA injury on health outcomes should include RTA victims with all injury levels along with those who are uninjured, possibly outside compensation settings.

Factors indirectly injury-related, i.e. hospitalization, duration of hospitalization, surgery, loss of consciousness during RTA and rehabilitation after the RTA, had a negative impact on the QoL after an RTA. Other research also found hospitalization to be associated with lower QoL scores (3, 9, 12, 27). Psychological consequences after the RTA, namely PTSD, depression and anxiety symptoms, showed correlations with all QoL domains. Other studies also found psychological distress (27), PTSD (4, 7, 11, 29) and anxiety/depression (4, 5, 6 9) to be independent predictors of QoL following the RTA. Vulnerable road users, i.e. pedestrians/cyclists reported lower scores of PF, BP and GH. This association is also probably injury-related, since there were no uninjured cyclists nor pedestrians in this study. These findings all corroborate that RTA injury and its severity are both relevant for the QoL outcomes.

Compensation claim is a thoroughly investigated factor showing a negative association with the QoL following an RTA in many studies (5, 7, 11, 27, 34, 35). In addition to the negative association of compensation claim with the QoL, this study showed that obtaining compensation was associated with a lower score of RE. Furthermore, not being at fault in the RTA was associated with higher scores of BP. Other research also found that not-at-fault RTA victims had lower QoL and reported significantly higher rate of neck and back pain than the at-fault group (28). This suggests that non-physical factors such as victimization, frustration and anger at being involved in an RTA that was the fault of someone else all affect well-being (28).

Most of the studies investigating the QoL of RTA survivors used the SF-36 questionnaire (4, 5, 14, 23, 28, 33, 34, 35) or its shortened version. the Short Form – 12 (SF-12) (6, 8, 9, 12, 13, 26, 27), while a minority used other available instruments for assessing QoL (7, 26, 31). Therefore, the data from this study are comparable with that in other QoL studies.

Strengths and Limitations

This study investigated a vast range of variables, sociodemographic, psychosocial, health-related, injury-related, RTA-related and compensation-related factors. Unlike other research, this one included uninjured RTA survivors with the traumatic experience of an RTA. Furthermore, the injured RTA victims included all levels of injury severity. Cohort recruitment was conducted outside any compensation scheme to eliminate secondary gain bias. All patients received immediate post-RTA healthcare in public healthcare settings irrelevant of their injury and health insurance status. Emergency and acute care, rehabilitation and other healthcare services for the RTA patients in Croatia are provided by public hospitals and are paid for by the state health insurance, and not like in some countries by third-party insurers in the scheme of a fault-based or no fault-based compensation system. As such, Croatian RTA victims receive equal healthcare and social benefits regardless of their involvement in compensation procedures. Given all the above, the studied cohort might be similar to general population in Croatia.

The limitations of this study include self-reported data collection. Pre-RTA physical and mental health problems were self-reported, without specific diagnostic tools or medical records. The recruited participants represent only 31.3% of registered RTA survivors, mostly due to the absence of contact information of the RTA victims (48.3%). The response rate was high, and 82.6% of the contacted RTA victims gave consent to participate. The telephone contact information of the patient is not a routinely obtained in Croatian emergency medicine institutes. Furthermore, there are objective reasons, such as the medical condition of the patients and absence of relatives, that hinder obtaining contact information. Nevertheless, given the relatively small sample size, more resources should be invested in obtaining RTA victims’ contact information and implementing this procedure in the routine protocols.

Conclusions

Decreased QoL following an RTA showed associations with the low socioeconomic status of the RTA victims, poor pre-RTA health, injury-related factors and psychological disorders after the RTA. Identifying the predictors of decreased QoL following an RTA will enable planning interventions targeting the most important factors influencing health of RTA victims. Assessing and recording of self-reported QoL should be a part of the routine protocol in RTA survivors’ healthcare.

Figure 1

Cohort recruitment diagram.
Cohort recruitment diagram.

Sociodemographic factors and health status before the RTA.

Sociodemographic factors and health status N %
Sex
Male 108 54.0
Female 92 46.0
Age group (years)
Younger (18–41) 97 48.5
Older (≥42) 103 51.5
Place of residence
Urban 87 43.5
Rural 113 56.5
Education
Primary 38 19.0
Secondary 125 62.5
Higher education 37 18.5
Employment
Employed 116 58.0
Out of work 52 26.0
Retired from work 32 16.0
Relationship status
Single 71 35.5
Has a partner 129 64.5
Self-assessed economic status
Under average 40 20.0
Average 116 58.0
Above average 44 22.0
Religiousness
No 19 9.5
Yes 181 90.5
Smoking
No 129 64.5
Yes 71 35.5
Alcohol use
No 99 49.5
Yes 101 50.5
Drug abuse
No 197 98.5
Yes 3 1.5
Use of medications
No 98 49.0
Yes 102 51.0
Type of medications
None 98 49.0
Non-psychiatric 78 9.0
Psychiatric 7 3.5
All types 17 8.5
Previous RTAs
No 116 58.0
Yes 84 42.0
Traumatic exposures
No 96 48.0
Yes 104 52.0
Prior PTSD
No 193 96.5
Yes 7 3.5
Chronic disease
No 116 58.0
Yes 84 42.0
Psychiatric disease
No 178 89.0
Yes 22 11.0
Permanent pain
No 181 90.5
Yes 19 9.5

Correlation between quality of life and mental health outcomes after the RTA.

QoL domains
Mental health PF PR ER VT MH SF BP GH
Depression symptoms rs=-0.410 rs=-0.364 rs=-0.430 rs=-0.588 rs=-0.586 rs=-0.582 rs=-0.438 rs=-0.593
p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

Anxiety symptoms rs=-0.274 rs=-0.263 rs=-0.523 rs=-0.446 rs=-0.378 rs=-0.485 rs=-0.427 rs=-0.442
p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

PTSD symptoms rs=-0.380 rs=-0.345 rs=-0.449 rs=-0.476 rs=-0.552 rs=-0.549 rs=-0.527 rs=-0.437
p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

p<0.001

Spearman’s correlation

Quality of life of the participants after the RTA.

QoL domains Median Interquartile range
Physical functioning 70.0 30.0–100.0
Role limitations due to physical health 0.0 0.0–100.0
Role limitations due to emotional health 100.0 67.0–100.0
Vitality 60.0 50.0–75.0
Mental health 68.0 52.0–76.0
Social functioning 75.0 50.0–100.0
Bodily pain 55.0 33.0–80.0
General health 70.0 55.0–84.0

Health status following the RTA.

Health status following the RTA N %
Number of injuries
Without injures 31 15.5
One 45 22.5
Multiple 124 62.0
Injury location
None 31 15.5
Head 18 9.0
Face 2 1.0
Neck 8 4.0
Chest 8 4.0
Abdomen 1 0.5
Spine 3 1.5
Upper extremities 3 1.5
Lower extremities 10 5.0
Several locations 116 58.0
Major injury
Without injuries 31 15.5
Head 58 29.0
Neck 37 18.5
Chest 19 9.5
Abdomen 12 6.0
Upper extremities 17 8.5
Lower extremities 26 13.0
Injury level
Without injury 31 15.5
Minor 96 48.0
Moderate 36 18.0
Serious 28 14.0
Severe 6 3.0
Critical 3 1.5
Self-assessed life-threat
No 108 54.0
Yes 92 46.0
Loss of consciousness
No 168 84.0
Yes 32 16.0
Loss of memory
No 172 86.0
Yes 28 14.0
Hospitalization
No 136 68.0
Yes 64 32.0
Days in hospital
None 136 68.0
1–3 27 13.5
4–10 19 9.5
11 and more 18 9.0
Surgery
No 180 90.0
Yes 20 10.0
Rehabilitation
No 154 77.0
Yes 46 23.0
Pain following the RTA
No 47 23.5
Yes 153 76.5
Symptoms of PTSD
No 129 64.5
Yes 71 35.5
Symptoms of depression
No 160 80.0
Yes 40 20.0
Symptoms of anxiety
No 191 95.5
Yes 9 4.5

RTA details.

RTA details. N %
Type of road users
Driver of motor vehicle 122 61.0
Co-driver or a passenger 61 30.5
Pedestrian or a cyclist 17 8.5
Motor vehicles crashed
None 1 0.5
One 92 46.0
Two or more 107 53.5
Injured
None 29 14.5
One 84 42.0
2–3 72 36.0
More than 3 15 7.5
Fatal outcomes
No 195 97.5
Yes 5 2.5
At fault
No 123 61.5
Yes 70 35.0
Unknown 7 3.5
Claimed compensation
No 113 56.5
Yes 87 43.5
Obtained compensation
No 180 90.0
Yes 20 10.0

Factors influencing quality of life following the RTA.

QoL domains
  Factors PF PR ER VT MH SF BP GH
Sociodemographic
Gender p=0.681

Mann-Whitney U test

p=0.651

Mann-Whitney U test

p=0.020

Mann-Whitney U test

p=0.072

Mann-Whitney U test

p=0.064

Mann-Whitney U test

p=0.408

Mann-Whitney U test

p=0.052

Mann-Whitney U test

p=0.118

Mann-Whitney U test

Age group p=0.084

Mann-Whitney U test

p=0.204

Mann-Whitney U test

p=0.226

Mann-Whitney U test

p=0.078

Mann-Whitney U test

p=0.012

Mann-Whitney U test

p=0.079

Mann-Whitney U test

p=0.959

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Place of residence p=0.795

Mann-Whitney U test

p=0.098

Mann-Whitney U test

p=0.876

Mann-Whitney U test

p=0.427

Mann-Whitney U test

p=0.096

Mann-Whitney U test

p=0.069

Mann-Whitney U test

p=0.224

Mann-Whitney U test

p=0.469

Mann-Whitney U test

Education p=0.478

Kruskal-Wallis test

p=0.045

Kruskal-Wallis test

p=0.182

Kruskal-Wallis test

p=0.344

Kruskal-Wallis test

p=0.152

Kruskal-Wallis test

p=0.828

Kruskal-Wallis test

p=0.118

Kruskal-Wallis test

p=0.034

Kruskal-Wallis test

Employment p=0.087

Kruskal-Wallis test

p=0.403

Kruskal-Wallis test

p=0.037

Kruskal-Wallis test

p=0.094

Kruskal-Wallis test

p=0.067

Kruskal-Wallis test

p=0.988

Kruskal-Wallis test

p=0.007

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

Marital status p=0.628

Mann-Whitney U test

p=0.965

Mann-Whitney U test

p=0.101

Mann-Whitney U test

p=0.465

Mann-Whitney U test

p=0.671

Mann-Whitney U test

p=0.874

Mann-Whitney U test

p=0.525

Mann-Whitney U test

p=0.708

Mann-Whitney U test

Self-assessed economic status p=0.014

Kruskal-Wallis test

p=0.032

Kruskal-Wallis test

p=0.049

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p=0.245

Kruskal-Wallis test

p=0.003

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

Religiousness p=0.898

Mann-Whitney U test

p=0.407

Mann-Whitney U test

p=0.868

Mann-Whitney U test

p=0.010

Mann-Whitney U test

p=0.041

Mann-Whitney U test

p=0.130

Mann-Whitney U test

p=0.072

Mann-Whitney U test

p=0.862

Mann-Whitney U test

Pre-RTA health
Body mass index p=0.182

Kruskal-Wallis test

p=0.496

Kruskal-Wallis test

p=0.754

Kruskal-Wallis test

p=0.319

Kruskal-Wallis test

p=0.538

Kruskal-Wallis test

p=0.141

Kruskal-Wallis test

p=0.612

Kruskal-Wallis test

p=0.182

Kruskal-Wallis test

Smoking p=0.620

Mann-Whitney U test

p=0.214

Mann-Whitney U test

p=0.260

Mann-Whitney U test

p=0.056

Mann-Whitney U test

p=0.096

Mann-Whitney U test

p=0.198

Mann-Whitney U test

p=0.510

Mann-Whitney U test

p=0.097

Mann-Whitney U test

Alcohol consumption p=0.020

Mann-Whitney U test

p=0.007

Mann-Whitney U test

p=0.046

Mann-Whitney U test

p=0.009

Mann-Whitney U test

p=0.028

Mann-Whitney U test

p=0.036

Mann-Whitney U test

p=0.005

Mann-Whitney U test

p=0.003

Mann-Whitney U test

Drug abuse p=0.637

Mann-Whitney U test

p=0.314

Mann-Whitney U test

p=0.969

Mann-Whitney U test

p=0.214

Mann-Whitney U test

p=0.566

Mann-Whitney U test

p=0.500

Mann-Whitney U test

p=0.425

Mann-Whitney U test

p=0.272

Mann-Whitney U test

Previous RTAs p=0.840

Mann-Whitney U test

p=0.774

Mann-Whitney U test

p=0.709

Mann-Whitney U test

p=0.589

Mann-Whitney U test

p=0.083

Mann-Whitney U test

p=0.793

Mann-Whitney U test

p=0.864

Mann-Whitney U test

p=0.133

Mann-Whitney U test

Previous traumatic exposures p=0.983

Mann-Whitney U test

p=0.510

Mann-Whitney U test

p=0.471

Mann-Whitney U test

p=0.032

Mann-Whitney U test

p=0.116

Mann-Whitney U test

p=0.394

Mann-Whitney U test

p=0.604

Mann-Whitney U test

p=0.031

Mann-Whitney U test

Prior PTSD p=0.890

Mann-Whitney U test

p=0.612

Mann-Whitney U test

p=0.986

Mann-Whitney U test

p=0.941

Mann-Whitney U test

p=0.308

Mann-Whitney U test

p=0.882

Mann-Whitney U test

p=0.776

Mann-Whitney U test

p=0.206

Mann-Whitney U test

Chronic disease p=0.039

Mann-Whitney U test

p=0.026

Mann-Whitney U test

p=0.410

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.043

Mann-Whitney U test

p=0.073

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Psychiatric disease p=0.435

Mann-Whitney U test

p=0.061

Mann-Whitney U test

p=0.024

Mann-Whitney U test

p=0.057

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.452

Mann-Whitney U test

p=0.039

Mann-Whitney U test

p=0.010

Mann-Whitney U test

Previous permanent pain p=0.828

Mann-Whitney U test

p=0.771

Mann-Whitney U test

p=0.069

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.033

Mann-Whitney U test

p=0.172

Mann-Whitney U test

p=0.052

Mann-Whitney U test

p=0.014

Mann-Whitney U test

Use of medications p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.058

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Types of medications p<0.001b p<0.001

Kruskal-Wallis test

p=0.253

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001b p<0.001

Kruskal-Wallis test

RTA injury-related
Injury affliction p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.228

Mann-Whitney U test

p=0.061

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.003

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.008

Mann-Whitney U test

Injury severity p<0.001b p<0.001

Kruskal-Wallis test

p=0.347

Kruskal-Wallis test

p=0.081

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

Self-assessed life-threat p=0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.013

Mann-Whitney U test

p=0.002

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Pain following the RTA p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.002

Mann-Whitney U test

Hospitalization p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.200

Mann-Whitney U test

p=0.177

Mann-Whitney U test

p=0.053

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Hospitalization duration p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p=0.318

Kruskal-Wallis test

p=0.244

Kruskal-Wallis test

p=0.128

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

p<0.001

Kruskal-Wallis test

Surgery p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.281

Mann-Whitney U test

p=0.045

Mann-Whitney U test

p=0.036

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

Loss of consciousness p=0.033

Mann-Whitney U test

p=0.088

Mann-Whitney U test

p=0.334

Mann-Whitney U test

p=0.393

Mann-Whitney U test

p=0.597

Mann-Whitney U test

p=0.298

Mann-Whitney U test

p=0.311

Mann-Whitney U test

p=0.355

Mann-Whitney U test

Loss of memory p=0.226

Mann-Whitney U test

p=0.150

Mann-Whitney U test

p=0.962

Mann-Whitney U test

p=0.196

Mann-Whitney U test

p=0.097

Mann-Whitney U test

p=0.116

Mann-Whitney U test

p=0.984

Mann-Whitney U test

p=0.190

Mann-Whitney U test

Rehabilitation p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.086

Mann-Whitney U test

p=0.095

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p<0.001

Mann-Whitney U test

p=0.012

Mann-Whitney U test

RTA-related
Fault p=0.109

Kruskal-Wallis test

p=0.659

Kruskal-Wallis test

p=0.393

Kruskal-Wallis test

p=0.322

Kruskal-Wallis test

p=0.657

Kruskal-Wallis test

p=0.537

Kruskal-Wallis test

p=0.024

Kruskal-Wallis test

p=0.461

Kruskal-Wallis test

Fatalities p=0.953

Mann-Whitney U test

p=0.541

Mann-Whitney U test

p=0.618

Mann-Whitney U test

p=0.762

Mann-Whitney U test

p=0.147

Mann-Whitney U test

p=0.157

Mann-Whitney U test

p=0.343

Mann-Whitney U test

p=0.421

Mann-Whitney U test

Compensation claim p=0.072

Mann-Whitney U test

p=0.140

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.005

Mann-Whitney U test

p=0.178

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.031

Mann-Whitney U test

p=0.367

Mann-Whitney U test

Obtained compensation p=0.474

Mann-Whitney U test

p=0.102

Mann-Whitney U test

p=0.001

Mann-Whitney U test

p=0.232

Mann-Whitney U test

p=0.537

Mann-Whitney U test

p=0.155

Mann-Whitney U test

p=0.370

Mann-Whitney U test

p=0.607

Mann-Whitney U test

Type of road users p=0.007

Kruskal-Wallis test

p=0.053

Kruskal-Wallis test

p=0.502

Kruskal-Wallis test

p=0.156

Kruskal-Wallis test

p=0.070

Kruskal-Wallis test

p=0.113

Kruskal-Wallis test

p=0.017

Kruskal-Wallis test

p=0.004

Kruskal-Wallis test

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