Social determinants of health and 30-day mortality after inpatient elective surgery
Sankar A, Ding J, Black B, Wilton AS, Hwang SW, Wijeysundera DN, Baxter NN, Gomez D. JAMA Netw Open. 2026; 9;(1): e2553228.
Prior concussions and risk of disability for patients after a motor vehicle crash
Importance — Recovery after a motor vehicle crash can be slow, frustrating, and incomplete with lingering neurocognitive complications.
Objective — To examine whether a prior concussion for patients might be associated with a further increased risk of long-term disability after a motor vehicle crash.
Design, setting, and participants — This cohort study included adults surviving a motor vehicle crash treated in Ontario, Canada, from April 2003 to March 2023.
Exposure — Motor vehicle crash.
Main outcome — Long-term disability defined by official social service records, comparing those with a history of a prior concussion (cases) and those with no history of a prior concussion (controls).
Results — A total of 907 984 patients injured in a motor vehicle crash were included (mean [SD] age, 37 [14] years; 472 435 male [52.0%]); 19 851 patients had a prior concussion and 888 133 had no prior concussion. A total of 54 678 patients were subsequently diagnosed with long-term disability over 9 543 505 patient-years of follow-up (mean [SD], 10.5 [5.8] years), equal to an absolute risk of 1 in 17 per decade (5.7 per 1000 patient-years). Patients with a prior concussion had a 15% higher adjusted risk of long-term disability (95% CI, 9%-21%; P < .001) compared with those with no prior concussion. The increased risk of long-term disability was independent of other measured risk factors, applied to diverse patient groups, and included those involved as passengers or pedestrians. The increased risk extended across a spectrum of crash severity, was accentuated for single-vehicle events, replicated in analyses with artificial intelligence models adjusting for confounding, and remained distinct from the risks of death, readmission, or short-term health care costs.
Conclusions — This population-based cohort study suggests a significant increased risk of long-term disability after a motor vehicle crash, particular among patients with a prior concussion. More efforts at concussion prevention and traffic safety counseling may be justified for patients.