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Older Accident Victims Often Suffer Pain, Physical Decline After ED Discharge

CHAPEL HILL, NC – For many older victims of motor vehicle crashes, the accident itself, treatment, and discharge from the emergency department are just the beginning of their ordeal, according to a new report.

The study, published recently in the Annals of Emergency Medicine, describes the incidence, risk factors, and consequences of persistent pain among older adults evaluated in the ED after a vehicle accident.

A University of North Carolina Chapel Hill-led study team conducted the prospective longitudinal study of patients aged 65 years or older who presented to one of eight EDs after motor vehicle crashes between June 2011 and June 2014 and were discharged home after evaluation.

Investigators used in-person interviews to gather information with follow-up data obtained through mail-in survey or telephone call. Pain severity on a 0-to-10 scale overall and for 15 parts of the body were assessed at each follow-up point. After six months, participants reporting pain severity greater than or equal to 4 attributed to the motor vehicle crash were defined as having persistent pain.

Results indicate that, of the 161 participants, 72% reported moderate to severe pain at the ED evaluation. At 6 months, 26% of participants still reported moderate to severe motor vehicle crash-related pain.

Characteristics associated with persistent pain included acute pain severity; pain located in the head, neck, and jaw or lower back and legs; poor self-rated health; less formal education; pre-motor vehicle crash depressive symptoms; and patient’s expected time to physical recovery of more than 30 days.

Compared with patients without persistent pain, those with persistent pain were substantially more likely at six-month follow-up to have also experienced a decline in their capacity for physical function -- 73% vs. 36%.

They also were more likely to report a new difficulty with activities of daily living, 42% vs.17%; a 1-point or more reduction in overall self-rated health on a 5-point scale, 54% vs. 30%; and a change in their living situation to obtain additional help, 23% versus 8%.

“Among older adults discharged home from the ED post-evaluation after a motor vehicle crash, persistent pain is common and frequently associated with functional decline and disability,” study authors concluded.

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