Study Objectives Motor vehicle collisions (MVCs) are the second most common form of trauma among older adults. We sought to describe the incidence, risk factors, and consequences of persistent pain among older adults evaluated in the emergency department (ED) after an MVC. Methods We conducted a prospective longitudinal study of patients aged 65 years or older who presented to one of eight EDs after MVC between June 2011 and June 2014 and were discharged home after evaluation. ED evaluation was done via in-person interview; follow-up data were obtained via mail-in survey or phone call. Pain severity (0-10 scale) overall and for 15 parts of the body (locations) were assessed at each follow-up time point. Principal component analysis was used to assess the dimensionality of the locations of pain data. Participants reporting pain severity ≥4 attributed to the MVC at six months were defined as having persistent pain. Results Of the 161 participants, 72% reported moderate to severe pain at the time of the ED evaluation. At six months, 26% of participants reported moderate to severe MVC-related pain. ED characteristics associated with persistent pain included acute pain severity, pain located in the head, neck, and jaw or low back and legs, poor self-rated health, less formal education, pre-MVC depressive symptoms, and patient's expected time to physical recovery more than 30 days. Compared to those without persistent pain, individuals with persistent pain were substantially more likely at 6 month follow-up to have also experienced a decline in their capacity for physical function (73% vs. 36%; difference = 37%, 95% CI 19%-52%), a new difficulty with activities of daily living (42% vs. 17%; difference = 26%, 95% CI 10%-43%), a one point or more reduction overall self-rated health on a 5-point scale (54% vs. 30%; difference = 24%, 95% CI 6%-41%), and a change in their living situation in order to obtain additional help (23% vs. 8%; difference = 15%, 95% CI 2%-31%). Conclusion Among older adults discharged home from the ED after evaluation following an MVC, persistent pain is common and frequently associated with functional decline and disability.

Objective To characterize risk factors for and consequences of posttraumatic stress disorder (PTSD) among older adults evaluated in the emergency department (ED) following motor vehicle collision (MVC). Design Prospective multicenter longitudinal study (2011–2015). Setting 9 EDs across the United States. Participants Adults aged 65 years and older who presented to an ED after MVC without severe injuries. Measurements PTSD symptoms were assessed 6 months after the ED visit using the Impact of Event Scale-Revised. Results Of 223 patients, clinically significant PTSD symptoms at 6 months were observed in 21% (95% CI 16%–26%). PTSD symptoms were more common in patients who did not have a college degree, had depressive symptoms prior to the MVC, perceived the MVC as life-threatening, had severe ED pain, and expected their physical or emotional recovery time to be greater than 30 days. Three factors (ED pain severity [0–10 scale], perceived life-threatening MVC [0–10 scale], and pre-MVC depressive symptoms [yes to either of two questions]), predicted 6 month PTSD symptoms with an area under the curve of 0.76. Compared to patients without PTSD symptoms, those with PTSD symptoms were at higher risk for persistent pain (72% vs. 30%), functional decline (67% vs. 42%), and new disability (49% vs. 18%). Conclusions Among older adults treated in the ED following MVC, clinically significant PTSD symptoms at 6 months were present in 21% of patients and were associated with adverse health outcomes. Increased risk for PTSD development can be identified with moderate accuracy using information readily available in the ED.

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