Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study

Abstract

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.

Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons

“…Our findings are consistent with those of prior studies showing that older persons who present to an ED with traumatic injuries experience a short-term decline in function of 7% to 42%. 10–12,14 Instead of focusing on a single presenting problem, our study included ED visits for a large number of reasons, the most common being musculoskeletal, which represented almost one third of the ED-only visits. Although beyond the scope of the current study, determining whether the course of disability after an ED visit differs according to the presenting problem should be the focus of future research.…”

Post-Traumatic Stress Disorder among Older Adults Experiencing Motor Vehicle Collision: A Multicenter Prospective Cohort Study

“…Additional details regarding the collection of ED and follow-up data have been published for the parent study. 3,19 …”

“…2 More than 80% of older adults presenting to the ED after MVC do not have severe or life-threatening injuries and are discharged home after the ED evaluation. 2 Persistent pain among older adults experiencing MVC has been described, 3 but little is known about other adverse outcomes after this common injury mechanism in older adults.…”

Situation Awareness: Its proficiency amongst older and younger drivers, and its usefulness for perceiving hazards

“…c) Older individuals are more likely to suffer serious injury and are at more frequent risk of being fatally injured as a result of an accident -in the region of 2-5 times more than that of a younger person -due to their physical frailty (Department for Transport, 2004). They are also likely to take far longer to recover from their injuries, in comparison to younger accident victims (see Platts-Mills et al, 2015).…”