Can high-risk older drivers be identified through performance-based measures in a Department of Motor Vehicles setting? Prospective validation of an out-of-hospital decision rule to identify seriously injured children involved in motor vehicle crashes. The influence of fault on health in the immediate post-crash period following road traffic crashes. The Effect of Compensation on General Health in Patients Sustaining Fractures in Motor Vehicle Trauma A randomized controlled trial of the effectiveness of brief-CBT for patients with symptoms of posttraumatic stress following a motor vehicle crash. Cognitive training decreases motor vehicle collision involvement of older drivers. Prediction of Remission of Acute Posttraumatic Stress Disorder in Motor Vehicle Accident Victims The Impact of Event Scale: validation of an Italian version. Creative arts program as an intervention for PTSD: a randomized clinical trial with motor vehicle accident survivors. Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. Does access to compensation have an impact on recovery outcomes after injury? Symptoms of traumatic stress in mothers of children victims of a motor vehicle accident. Role of psychosocial stress in recovery from common whiplash Physical and psychological factors predict outcome following whiplash injury Population-based, inception cohort study of the incidence, course, and prognosis of mild traumatic brain injury after motor vehicle collisions. A controlled evaluation of cognitive behavioural therapy for posttraumatic stress in motor vehicle accident survivors. A prospective study on paediatric traffic injuries: health-related quality of life and post-traumatic stress
OBJECTIVES To evaluate the relationship between performance-based risk factors and subsequent at-fault motor vehicle collision ( MVC ) involvement in a cohort of older drivers . DESIGN Prospect i ve cohort study . SETTING Motor Vehicle Administration ( MVA ) field sites in Maryl and . PARTICIPANTS Of the 4,173 older drivers invited to participate in the study , 2,114 individuals aged 55 to 96 agreed to do so . These analyses focus on 1,910 individuals recruited through MVA field sites . MEASUREMENTS  Gross Impairment Screening Battery  , which included  Rapid Pace Walk , Head/Neck Rotation , Foot Tap , Arm Reach , Cued Recall , Symbol Scan , Visual Closure subtest of the Motor Free Visual Perception Test ( MVPT ) , Delayed Recall , and Trail Making Test with an Abbreviated Part A and  st  and ard Part B ; Useful Field of View ( UFOV ) subtest 2 ; a Mobility Question naire ; and MVC occurrence . RESULTS In drivers aged 55 and older with intact vision ( 20/70 far visual acuity and 140 degrees visual field ) , age , sex , history of falls , and poorer cognitive performance , as measured using Trails B , MVPT , and UFOV subtest 2 , were predictive of future at-fault MVC involvement . After adjusting for annual mileage , participants aged 78 and older were 2.11 as more likely to be involved in an at-fault MVC , those who made four or more errors on the MVPT were 2.10 times as likely to crash , those who took 147 seconds or longer to complete Trails B were 2.01 times as likely to crash , and those who took 353 ms or longer on subtest 2 of the UFOV were 2.02 times as likely to incur an at-fault MVC . Older adults , men , and individuals with a history of falls were more likely to be involved in subsequent at-fault MVCs . CONCLUSION Performance-based cognitive measures are predictive of future at-fault MVCs in older adults . Cognitive performance , in particular , is a salient predictor of subsequent crash involvement in older adults . High-risk older drivers can be identified through brief , performance-based measures administered in a MVA setting OBJECTIVES To prospect ively vali date a previously published out-of-hospital clinical decision rule to identify seriously injured children involved in motor vehicle crashes ( MVCs ) . METHODS The authors selected 20 Los Angeles County Fire Department fire stations , based on pediatric MVC call volume and geographic diversity , and 21 associated hospitals for participation in the study . Immediately following an MVC call involving a pediatric patient aged 0 - 14 years , each engine/paramedic squad completed a data form ( 15 variables , including vital signs , Glasgow Coma Scale score , and vehicular and crash characteristics ) . This study was conducted over a 24-month period . Outcomes included : 1 ) " serious injury " as defined by an Injury Severity Score ( ISS ) > or = 16 ( primary outcome ) , and 2 ) need for specialized trauma care ( emergent intubation , major nonorthopedic operative intervention or death in the first 24 hours , or pediatric intensive care unit stay longer than 48 hours ) , as assessed by retrospective chart review . Accuracy measures and binominal confidence intervals ( CIs ) were calculated for the decision rule validation . RESULTS One hundred seventy-five children were prospect ively enrolled in the study ; 36 children were excluded due to lack of hospital participation or missing hospital charts . There were four children with ISS > or = 16 ( 3 % ) and six children requiring specialized trauma care ( 4 % ) . The sensitivities and specificities of the rule were : 100 % ( 95 % CI = 40 % to 100 % ) and 73 % ( 95 % CI = 65 % to 81 % ) for serious injury , and 83 % ( 95 % CI = 36 % to 100 % ) and 74 % ( 95 % CI = 65 % to 81 % ) for specialized trauma care , respectively . CONCLUSIONS Although definitive conclusions are limited by the sample size , the decision rule identified all seriously injured children involved in MVCs and had moderate specificity . The decision rule was less sensitive for identifying children requiring specialized trauma care . Larger validation studies are needed to adequately assess the utility of this rule before implementation OBJECTIVE To compare the early health status of people who sustained injuries during road traffic crashes ( RTC ) in which they were at fault ( AF ) , with people who sustained injuries in RTC in which they were not at fault ( NAF ) . DESIGN Prospect i ve cohort study . SUBJECTS People presenting to the emergency department with mild to moderate musculoskeletal injuries following RTC . MAIN OUTCOME MEASURES Physical Component Score ( PCS ) and Mental Component Score ( MCS ) of the Short Form 36 ( SF-36 ) health status measure ; Hospital Anxiety and Depression Scale ( HADS ) and the Functional Rating Index ( FRI ) recorded immediately post-crash . RESULTS 193 people participated in the study and were enrolled a mean of 9.3 days following the crash . The mean age was 37 years and 60 % were female . 71 % were NAF . There was a significantly higher number of females in the NAF group ( 65 % compared with 35 % males ; p<0.001 ) . Neck and back injuries were reported by 90.4 % of the NAF group compared to 69.1 % of the AF group ( p<0.001 ) . There were no significant differences in PCS , FRI or pain intensity between the two groups at a mean of 9.3 days after the crash . The mean MCS for the NAF group was significantly worse than for the AF group ( 31.4 compared to 37.3 ; p = 0.005 ) . The SF-36 domain revealed a significantly worse adjusted mean role emotional score for the NAF group ( 23.4 compared to 32.5 , p = 0.002 ) . Females had significantly worse MCS score than males ( 30.6 and 38.1 respectively ; p<0.001 ) and worse adjusted mean anxiety and depression scores ( 10 compared to 7.8 ; p = 0.002 and 7.6 compared to 5.5 ; p = 0.002 respectively ) . CONCLUSIONS Despite there being no difference in physical health status , the NAF group demonstrated more emotional and mental disturbance than the AF group ; and this was significantly worse for females . Treatment strategies should focus on addressing early pain and disability as well as providing appropriate psychological interventions , particularly for people not at fault following RTC Objectives : The receipt or pursuit of compensation after injury has been associated with poor outcomes . This study aims to determine the association between compensation-related factors and general health in patients with fractures sustained in motor vehicle trauma . Design : Prospect i ve survey . Setting : Metropolitan trauma centers . Patients / Participants : The study population was patients aged 18 years and older , presenting acutely with at least one fracture involving the long bones , pelvis , patella , talus , or calcaneus , result ing from motor vehicle trauma , and presenting acutely to 1 of 15 hospitals . Intervention : Patients were surveyed on admission to determine general factors , injury factors , and socioeconomic factors . Employment status at follow-up , compensation-related factors , and the main outcome variables were measured by survey at 6 months after injury . Multiple regression was used to determine significant predictors of outcome . Main Outcome Measurement : Physical and mental health summaries of the SF-36 General Health Survey . Results : Of the 306 patients recruited to the study , five were excluded , and completed question naires were available for 232 ( 75.8 % ) . Cl aim ing compensation was strongly associated with poor physical and mental health on univariate analysis , but it was not significant on multivariate analysis . The use of a lawyer in relation to the injury was the most significant variable associated with poor physical and mental health , after adjusting for other factors . Conclusions : Lawyer involvement , rather than pursuit of compensation , is associated with poor general health after fractures sustained in motor vehicle injuries . Although this may represent a direct effect , further research is recommended to determine the cause for this association BACKGROUND Motor vehicle crashes ( MVCs ) are leading contributors to the global burden of disease . Patients attending accident and emergency ( A&E ) after an MVC may develop symptoms of posttraumatic stress disorder ( PTSD ) . There is evidence that brief cognitive behavioural therapy ( B-CBT ) can be effective in treating PTSD ; however , there are few studies of the use of B-CBT to treat PTSD in MVC survivors . AIMS This study examined the effects of B-CBT and a self-help program on the severity of psychological symptoms in MVC survivors at risk of developing PTSD . METHOD Sixty participants who attended A&E after a MVC were screened for PTSD symptoms and r and omized to a 4-weekly session B-CBT or a 4-week self-help program ( SHP ) booklet treatment conditions .  Psychological assessment s were completed at baseline ( 1-month post-MVC ) and posttreatment ( 3- and 6-month follow-ups ) by utilizing Impact of Event Scale-Revised ( IES-R ) and Hospital Anxiety and Depression Scale ( HADS ) . RESULTS There were significant improvements in the measures of anxiety , depression , and PTSD symptoms over time . Participants treated with B-CBT showed greater reductions in anxiety at 3-month and 6-month follow-ups , and in depression at 6-month follow-up . A comparison of effect size favoured B-CBT for the reduction of anxiety and depression symptoms measured by HADS . A high level of pretreatment anxiety and depression were predictive of negative outcome at 6-month follow-up in the SHP condition . There was no differential effect on PTSD symptoms measured by IES-R. CONCLUSIONS This trial supports the efficacy of providing B-CBT as a preventive strategy to improve psychological symptoms after an MVC OBJECTIVES To test the effects of cognitive training on subsequent motor vehicle collision ( MVC ) involvement of older drivers . DESIGN R and omized , controlled , multisite , single-blind clinical trial . SETTING Community-dwelling seniors at four U.S. sites : Birmingham , Alabama ; Baltimore , Maryl and ; Indianapolis , Indiana ; and State College , Pennsylvania . PARTICIPANTS Nine hundred eight older drivers ( mean age 73.1 ; 18.6 % African American ) who were r and omized to one of three cognitive interventions or a control condition .  INTERVENTIONS Up to 10 sessions of cognitive training for memory , reasoning , or speed of processing .  MEASUREMENTS State-recorded MVC involvement up to 6 years after study enrollment . RESULTS Speed-of-processing and reasoning training result ed in lower rates of at-fault collision involvement over the subsequent approximately 6-year period than controls . After adjusting for age , sex , race , education , mental status , health , vision , depressive symptoms , and testing site , participants r and omized to the speed-of-processing and reasoning interventions had an approximately 50 % lower rate ( per person-mile ) of at-fault MVCs than the control group ( rate ratio ( RR ) = 0.57 , 95 % confidence interval ( CI ) = 0.34 - 0.96 for speed of processing ) , and ( RR = 0.50 , 95 % CI = 0.27 - 0.92 for reasoning ) . There was no significant difference observed for the memory group . CONCLUSION Cognitive speed-of-processing and reasoning training result ed in a lower at-fault MVC rate in older drivers than in controls . Considering the importance of driving mobility , the costs of crashes , and the benefits of cognitive training , these interventions have great potential to sustain independence and quality of life of older adults . More research is needed to underst and the effects of different types and quantities of training One hundred forty five individuals who sought medical attention as a result of a motor vehicle accident ( MVA ) , and who were initially assessed 1 to 4 months post-MVA , were followed up prospect ively for 6 months to determine how many of the 55 with posttraumatic stress disorder ( PTSD ) and the 43 with sub-syndromal PTSD would remit and what variables would predict remission . Thirty ( 55 % ) of those with initial PTSD had remitted at least in part by 6 months while 67 % of those with sub-syndromal PTSD had remitted ( and 5 % had worsened ) . Four variables , including severity of initial symptoms , degree of initial physical injury , relative degree of physical recovery by 4 months and whether a close family member suffered a trauma during the follow-up interval , combined to classify 6-month clinical status of 84 % of those with initial PTSD secondary to MVAs OBJECTIVE To vali date an Italian version of the Impact of Event Scale ( IES ) in patients addressing the emotional impact of a recent road accident . METHODS Seventy-nine subjects were examined within 1 - 34 weeks after an accident by means of ( 1 ) . an Italian version of the IES , ( 2 ) . a free description of the accident , and ( 3 ) . a question naire assessing subjects ' behaviour and feelings . RESULTS IES data were analysed by means of the principal component analysis ( PCA ) method , followed by a quartimax rotation , obtaining a two-factor solution interpreted as intrusion ( Factor 1 ) and avoidance ( Factor 2 ) . Furthermore , the scores to the two subscales were considered in order to assess their predictive value on some variables linked to the traumatic event . Intrusion significantly discriminated the emotional intensity and fear level of subjects as a consequence of the accident . CONCLUSIONS The IES is a two-dimensional test capable of evaluating posttraumatic stress . The intrusion and avoidance factors explained 40 % of the total variance . The two-factor solution has a psychological counterpart and is similar to the findings of earlier studies conducted on a larger number of subjects in other countries The aim of this study is to determine whether the creative arts program ( HA ) is effective in preventing the onset of Posttraumatic stress disorder ( PTSD ) . PTSD develops in 10 - 20 % of motor vehicle accident survivors ( MVAs ) . MVAs in the initial months after the accident were r and omly assigned to receive 8-week HA intervention ( n = 26 ) or wait the list  ( WL , n = 26 ) . The arts program consisted of writing and drawing .  PTSD severity was assessed at 2 , 6 , and 12 months post injury with a clinical interview ( Clinician-Administered PTSD Scale , CAPS ) and self-report instrument ( Impact of Event Scale-Revised , IES-R ) . Secondary outcomes were post-traumatic growth ( PTG ) , depression and anxiety symptoms . Repeated measures analysis of variance indicated that both HA and WL group exhibited a significant effect of time ( P < 0.01 ) on CAPS , but no significant group differences over time . There were no group differences on depression or anxiety over time . Pessimists did not benefit more from attending the HA than they did from attending the WL . Our results fail to support the hypothesis that the creative arts program is effect in avoiding MVA-related PTSD symptoms . But it only seems to be a short-term , rather than a long-term effect A prospect i ve longitudinal study assessed 967 consecutive patients who attended an emergency clinic shortly after a motor vehicle accident , again at 3 months , and at 1 year . The prevalence of posttraumatic stress disorder ( PTSD ) was 23.1 % at 3 months and 16.5 % at 1 year . Chronic PTSD was related to some objective measures of trauma severity , perceived threat , and dissociation during the accident , to female gender , to previous emotional problems , and to litigation . Maintaining psychological factors , that is , negative interpretation of intrusions , rumination , thought suppression , and anger cognitions , enhanced the accuracy of the prediction . Negative interpretation of intrusions , persistent medical problems , and rumination at 3 months were the most important predictors of PTSD symptoms at 1 year . Rumination , anger cognitions , injury severity , and prior emotional problems identified cases of delayed onset OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries .  Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not support previous research showing that access to compensation is associated with poor recovery outcomes . The relationship between access to compensation and health outcomes is complex , and more high-level research is required BACKGROUND Motor vehicle accidents ( MVAs ) are the main cause of Posttraumatic stress disorder ( PTSD ) in industrialized countries . This includes the frequently occurring but understudied situation of parents learning that their children were injured . However , unlike in other types of trauma survivors , little is known about the predictors of PTSD symptoms in mothers whose child has suffered an MVA . METHODS A group of 72 mothers and 28 fathers were prospect ively assessed for peritraumatic distress , peritraumatic dissociation , and PTSD symptoms 1 and 5 weeks after their child had suffered an MVA . RESULTS Levels of peritraumatic distress and dissociation were comparable to other trauma victims , 18 % of the mothers were considered to be suffering from probable PTSD . In mothers , significant positive correlations were found between PTSD symptoms and peritraumatic distress ( r=.34 ) and dissociation ( r=.37 ) , whereas mothers ' PTSD symptoms were associated with decreased peritraumatic dissociation in fathers ( r=-.37 ) . Even after controlling for covictim/witness status , peritraumatic distress was a predictor of mothers ' PTSD symptoms , explaining 14 % of the variance . CONCLUSIONS Peritraumatic response and PTSD symptoms should be routinely assessed among parents whose child has experienced a traumatic event It is widely accepted that psychosocial factors are related to illness behaviour and there is some evidence that they may influence the rate of recovery from post-traumatic disorders . The abilities of psychosocial stress , somatic symptoms , and subjectively assessed cognitive impairment to predict delayed recovery from common whiplash were investigated in a follow-up study . 78 consecutive patients referred 7.2 ( SD 4.5 ) days after they had sustained common whiplash in car accidents were assessed for psychosocial stress , negative affectivity , personality traits , somatic complaints , and cognitive impairment by semistructured interview and by several st and ardised tests . On examination 6 months later 57 patients were fully recovered and 21 had persisting symptoms . The groups ' scores for the independent variables assessed at the baseline examination were compared . Stepwise regression analysis showed that psychosocial factors , negative affectivity , and personality traits were not significant in predicting the outcome . However , initial neck pain intensity , injury-related cognitive impairment , and age were significant factors predicting illness behaviour . This study , which was based on a r and om sample and which considered many other possible predictive factors as well as psychosocial status , does not support previous findings that psychosocial factors predict illness behaviour in post-trauma patients & NA ; Predictors of outcome following whiplash injury are limited to socio‐demographic and symptomatic factors , which are not readily amenable to secondary and tertiary intervention . This prospect i ve study investigated the predictive capacity of early measures of physical and psychological impairment on pain and disability 6 months following whiplash injury . Motor function ( ROM ; kinaesthetic sense ; activity of the superficial neck flexors ( EMG ) during cranio‐cervical flexion ) , quantitative sensory testing ( pressure , thermal pain thresholds , brachial plexus provocation test ) , sympathetic vasoconstrictor responses and psychological distress ( GHQ‐28 , TSK , IES ) were measured in 76 acute whiplash participants . The outcome measure was Neck Disability Index scores at 6 months . Stepwise regression analysis was used to predict the final NDI score . Logistic regression analyses predicted membership to one of the three groups based on final NDI scores ( < 8 recovered , 10–28 mild pain and disability , > 30 moderate/severe pain and disability ) . Higher initial NDI score ( 1.007–1.12 ) , older age ( 1.03–1.23 ) , cold hyperalgesia ( 1.05–1.58 ) , and acute post‐traumatic stress ( 1.03–1.2 ) predicted membership to the moderate/severe group . Additional variables associated with higher NDI scores at 6 months on stepwise regression analysis were : ROM loss and diminished sympathetic reactivity . Higher initial NDI score ( 1.03–1.28 ) , greater psychological distress ( GHQ‐28 ) ( 1.04–1.28 ) and decreased ROM ( 1.03–1.25 ) predicted subjects with persistent milder symptoms from those who fully recovered . These results demonstrate that both physical and psychological factors play a role in recovery or non‐recovery from whiplash injury . This may assist in the development of more relevant treatment methods for acute whiplash OBJECTIVE To determine the incidence , course , and prognosis of adult mild traumatic brain injury ( MTBI ) caused by motor vehicle collisions . DESIGN Prospect i ve , population -based , inception cohort study . SETTING The province of Saskatchewan , Canada , with a population of about 1,000,000 inhabitants . PARTICIPANTS All adults ( N=1716 ) incurring an MTBI in a motor vehicle collision between November 1997 and December 1999 in Saskatchewan . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Age- and sex-stratified incidence rates , time to self-reported recovery , and prognostic factors over a 1-year follow-up . RESULTS Of 7170 adults injured in a motor vehicle collision over the 2-year inception period , 1716 ( 24 % ) met our cohort definition of MTBI . There were more women affected ( 53 % ) , and MTBI was most common in the 18- to 23-year-old group . Most were not hospitalized ( 73 % ) , but 28 % reported loss of consciousness and 23 % reported posttraumatic amnesia . The annual incidence of MTBI per 100,000 adults was 106.1 ( 95 % confidence interval [ CI ] , 98.9 - 113.6 ) in the first year and 118.3 ( 95 % CI , 110.8 - 126.3 ) in the second year of the study . The 1-year follow-up rate was 84 % . The median time to recovery was 100 days ( 95 % CI , 97 - 103 ) , and about 23 % reported not having recovered by 1 year . Factors associated with delayed recovery included being older than 50 years , having less than a high school education , having poor expectations for recovery , having depressive symptoms , having arm numbness , having hearing problems , having headaches , having low back pain , and having thoracic back pain . Loss of consciousness and posttraumatic amnesia were not associated with recovery . CONCLUSIONS MTBI affects almost a quarter of persons reporting an injury after a traffic collision . The median time to recovery is 100 days , but 23 % have still not recovered by 1 year . A mix of biopsychosocial factors is associated with recovery , including a strong effect of poor expectations for recovery Seventy-eight motor vehicle accident survivors with chronic ( greater than 6 months ) PTSD , or severe sub-syndromal PTSD , completed a r and omized controlled comparison of cognitive behavioral therapy ( CBT ) , supportive psychotherapy ( SUPPORT ) , or a Wait List control condition with two detailed assessment s. Scores on the CAPS showed significantly greater improvement for those in CBT in comparison to the Wait List and to the SUPPORT conditions . The SUPPORT condition in turn was superior ( p=0.012 ) to the Wait List . Categorical diagnostic data showed the same results . An analysis of CAPS scores including drop-outs ( n=98 ) also showed CBT to be superior to Wait List and to SUPPORT with a trend for SUPPORT to be superior to Wait List . The CBT condition led to significantly greater reductions in co-morbid major depression and GAD than the other two conditions . Results held up well at a 3-month follow-up on the two active treatment conditions Objectives : To examine children 's reports of their health-related quality of life ( HRQoL )  following paediatric traffic injury , to explore child and parental post-traumatic stress , and to identify children and parents with adverse outcomes . Design : Prospect i ve cohort study . Assessment s : shortly after the injury , three months and six months post injury . Setting : Department of Traumatology , University Hospital . Subjects : Fifty-one young traffic injury victims aged 8 - 15 years . Main measures : TNO-AZL  Children 's Quality of Life question naire and the Impact of Event Scale . Results : Short-term adverse changes in the child 's HRQoL were observed for the child 's motor functioning and autonomy . At three months , 12 % of the children and 16 % of the parents reported serious post-traumatic stress symptoms . Increased stress at three months , or across follow-up , was observed among hospitalized children , children with head injuries , and children injured in a motor vehicle accident . Parental stress was related to low socioeconomic status and the seriousness of the child 's injury and accident ( hospitalization , head injury , serious injury , motor vehicle involved , others injured ) . Conclusions : The children reported only temporary effects in their motor functioning and autonomy . Post-traumatic stress symptoms following paediatric traffic injury were not only experienced by the children , but also by their parents
Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC .
OBJECTIVE The aim of this meta- analysis was to determine the psychological impact associated with motor vehicle crash (MVC)-related physical injuries .