Evaluation of the Injury Impairment Scale, a Tool to Predict Road Crash Sequelae, in a French Cohort of Road Crash Survivors

Abstract

Objective: The objective of the present study was to validate sequelae prediction by the Maximal Injury Impairment Score (M-IIS) in comparison with the Functional Independence Measure (FIM) assessed at 1-year follow-up of severe road crash victims.

Methods: The study population came from “the Etude et Suivi d’une Population d’Accidentés de la Route dans le Rhône” (ESPARR; Rhône Area Road Crash Victim Follow-up Study) cohort: 178 victims (with Maximal Abbreviated Injury Scale ≥ 3) of road crashes in the Rhône administrative department of France, aged ≥ 16 years and with medical examination including FIM scoring 1 year postaccident. Two thresholds were tested for both scores. Firstly, the relation between FIM and M-IIS was assessed on logistic regression models adjusted on age and presence of complications at 1 year postaccident. The predictive capacity of M-IIS was expressed as its negative and positive predictive values and was considered good when 80 percent or better.

Results: Sixty-three of the 178 adult subjects (mean age = 37.7 years; range = 16.1–82.9 years) showed postaccident complications. One-year sequelae prediction on M-IIS was greater in head, spine, and limb lesions but limited to slight impairments (M-IIS = 1). There was a significant correlation between FIM and M-IIS, although age and medical complications were confounding factors on certain multivariate models. The predictive capacity of M-IIS was low for all types of sequelae.

Conclusions: M-IIS, in this severely injured population, failed to predict sequelae at 1 year as measured by the FIM, despite a good correlation between the two. Complications are to be taken into account in assessing the M-IIS's capacity to predict sequelae. Further evaluation will be needed on larger series or assessment of other indicators and measures of sequelae at 1 year to obtain a robust tool to predict road crash sequelae.

Keywords:

• Injury Impairment Scale
• Functional Independence Measure
• ESPARR
• Road study
• Evaluation

ACKNOWLEDGMENTS

We acknowledge funding from the French Ministry of Equipment, Transport, Housing, Tourism and Sea (Programme Predit 3 “New Knowledge in the Field of Road Safety”: No. SU0400066) and from the French Ministry of Health (Programmes PHRC 2003: PHRC-N03 and PHRC 2005: PHRC-N051).

The authors are grateful to the victims for their cooperation in data collection. The authors thank all those who assisted in carrying out this study: Nadia Baguena, Jean Yves Bar, Amélie Boulanger, Elodie Paquelet, Stuart Nash, and Véronique Sotton for collecting the data; Irène Vergnes for organizing the databases; Anne-Marie Bigot, Nathalie Demangel, and Geneviève Boissier for subject database management; Blandine Gadegbeku, Amina NDiaye, and The Association for the Rhône Road Trauma Registry (ARVAC) for their help in collecting and providing medical data; the Scientific Committee (Daniel Floret, François Chapuis, Jean Michel Mazaux, Jean Louis Martin, and Jacques Gaucher); all of the hospital staff who accepted the interviewers’ presence and referred victims; and the Service d'Aide Medicale Urgente (SAMU), team who reported their daily emergency interventions.

Special thanks to Iain McGill for comments and manuscript editing.

The FIM scale, on which we had specific training, was implemented in partnership with the Institut Fédératif de Recherches sur le Handicap (IFRH), to which we are associated via the Mesure de l'Indépendance Fonctionnelle-Réseau Fédératif de Reserche sur le Handicap (MIF-RFRH) platform.