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

Abstract

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.

Association Between Perceived Threat and the Development of Posttraumatic Stress Disorder Symptoms in Patients With Life‐threatening Medical Emergencies

“…Seventy-two percent of patients reported at least one positive PTSD symptom at 30 days (defined as a score of 2 or more on at least one PCL-5 question), and 25% reported clinically significant PTSD symptoms (defined as scored 2 or more on at least one B item [questions 1-5], one C item [questions 6 and 7], two D items [questions [8][9][10][11][12][13][14], or two E items [questions [15][16][17][18][19][20] or a total score greater than 32). 19,20 Among the entire cohort the median (IQR) PCL-5 score was 7 (0 to 30).…”

“…Perceived threat (conceptualized as a self‐measured sense of life endangerment and personal vulnerability) has previously been described as a contributor to the development of traumatic injury–induced PTSD (e.g., after motor vehicle crash or military‐related trauma) . The Trauma Recovery Project, a large multicenter epidemiologic study, cites perceived threat to life as a significant predictor of PTSD symptoms among patients experiencing traumatic injury .…”

“…7 Perceived threat (conceptualized as a self-measured sense of life endangerment and personal vulnerability) 8,9 has previously been described as a contributor to the development of traumatic injury-induced PTSD (e.g., after motor vehicle crash or military-related trauma). [10][11][12] The Trauma Recovery Project, a large multicenter epidemiologic study, cites perceived threat to life as a significant predictor of PTSD symptoms among patients experiencing traumatic injury. 13 Similarly, a meta-analysis of risk factors of PTSD found that individuals with increased reports of perceived threat during a traumatic life experience showed higher levels of PTSD symptoms thereafter.…”

Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults

“…5,6 A prospective validation study of field triage processes showed that half of seriously injured older adults are missed by the guidelines and transported to non-trauma centers. 5 Because older adults are a particularly vulnerable population with high morbidity and mortality following injury, [7][8][9][10][11] developing better methods for the early identification of high-risk patients is a major priority for field triage.…”

Assessment of sleep quality, post-traumatic stress disorder, and locus of control in motor vehicle accident survivors

“…5 Furthermore, a study to categorize risk factors and effects of PTSD in older adults after motor vehicle accidents found that PTSD symptoms were significantly associated with adverse health outcomes. 6 Stressors such as witnessing death, serious injury, or sexual violence may be relived in the form of flashbacks or nightmares accompanied by persistent anxiety, depression, and physical reactivity and may result in severe disabilities in psychological, social, and occupational wellbeing. 7 A diagnosis of PTSD may be made if several specific criteria are met as per the diagnostic criteria set in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and appropriate and timely treatment can significantly improve the patient's prognosis.…”