title: Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision.
abstract: BACKGROUND
  Motor vehicle collisions (MVCs) are the second most common injury mechanism resulting in emergency department (ED) visits by older adults. MVCs result in substantial pain and psychological distress among younger individuals, but little is known about the occurrence of these symptoms in older individuals. We describe the frequency of and characteristics associated with pain, distress, and anticipated time for physical and emotional recovery for older adults presenting to the ED after MVC in comparison to younger adults.
  
  
  METHODS
  In-person interviews were conducted for adults presenting to one of eight EDs after MVC without an obvious fracture or injury requiring admission as part of two prospective studies. Pain severity was assessed using a 0-10 verbal scale. Distress was assessed using the Peritraumatic Distress Inventory (range 0-52). Patients were asked to estimate their expected time for physical and emotional recovery; these responses were dichotomized to <30 or ≥30 days. ED pain and distress and associations between patient and collision characteristics and ED pain and distress were examined for patients age 65 years and older and patients age 18 to 64.
  
  
  RESULTS
  Older (n = 96) and younger (n = 943) adults had the same mean pain scores (5.5, SD 2.5 vs. 5.5, SD 2.4). Distress scores were lower in older than in younger adults (15.5, SD 9 vs. 19.2, SD 10). A higher percentage of older adults than younger adults had an anticipated time to physical recovery ≥30 days (41%, 95% confidence interval [CI] 28%-55% vs. 11%, 95% CI 9%-13%). Similarly, older adults were more likely to have an anticipated time for emotional recovery ≥30 days (45%, 95% CI 35%-55% vs. 17%, 95% CI 15%-20%). Older adults were less likely than younger adults to have moderate or severe neck pain (score ≥4) (25%, 95% CI 23% to 41% vs. 54%, 95% CI 48% to 60%) or back pain (31%, 95% CI 23% to 46% vs. 56%, 95% CI 51 to 62%) but more likely to have moderate or severe chest pain (42%, 95% CI 32% to 50% vs. 20%, 95% CI 16 to 23%). Pre-MVC depressive symptoms and pain catastrophizing were positively associated with pain and distress in both older and younger adults.
  
  
  CONCLUSIONS
  In our cohort, older adults who presented to the ED after MVC experienced similar pain severity as younger patients and less distress but were more likely to estimate their times for physical and emotional recovery to be 30 days or more. Increased emergency provider awareness of acute pain and distress symptoms among older patients experiencing MVC may improve outcomes for these patients.
authors.affiliation: School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Gregory.Pereira@uphs.upenn.edu.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Pereira
authors.affiliation: Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA. smclean@aims.unc.edu.|Departments of Emergency Medicine and Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA. smclean@aims.unc.edu.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: McLean
authors.affiliation: Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA. tjtkacik@gmail.com.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Tkacik
authors.affiliation: Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA. raswor@beaumont.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Swor
authors.affiliation: Department of Emergency Medicine, Spectrum Health - Butterworth Campus, Grand Rapids, MI, USA. jeffrey.jones@spectrum-health.org.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Jones
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. dlee@nshs.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. dpeak@partners.org.
authors.forename: David A
authors.initials: DA
authors.lastname: Peak
authors.affiliation: Department of Emergency Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI, USA. rdomeier@aol.com.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Domeier
authors.affiliation: Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA. niels.rathlevmd@baystatehealth.org.
authors.forename: Niels K
authors.initials: NK
authors.lastname: Rathlev
authors.affiliation: Department of Emergency Medicine and Pediatrics, University of Florida-Jacksonville, Jacksonville, FL, USA. phyllis.hendry@jax.ufl.edu.
authors.forename: Phyllis L
authors.initials: PL
authors.lastname: Hendry
authors.affiliation: Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA. tplattsm@med.unc.edu.|Departments of Emergency Medicine and Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA. tplattsm@med.unc.edu.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Platts-Mills
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005431:Florida / Q000453:epidemiology; D050723:Fractures, Bone / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008404:Massachusetts; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D018986:Motor Vehicles; D009518:New York / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology* / Q000523:psychology*; D010147:Pain Measurement; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult