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motor vehicle accident (MVA)

Etiology: Risk factors: 1) 5 to 10 times more common in patients with sleep apnea 2) use of cell phones associated with 4-fold increased risk [2] 3) drivers over 75 years of age a) twice the crash rate per mile driven relative to drivers 25-54 years b) drive fewer miles, thus have among the lowest crash rates of any age group c) are less likely to survive a crash than younger drivers d) tend to drive less at night, during adverse weather conditions, or on congested roads 4) MVA/million miles traveled a) age 16-19: 26.8 b) age 40-45: 3.7* c) age 80-85: 15.1 d) age 85+: 38.8 5) other risk factors a) dementia b) depression c) stroke d) syncope - risk of motor vehicle accident following emergency department visit for syncope is not increased in the following year [10] e) seizures, including subtle hard-to-detect focal seizures [9] f) sleep deprivation g) cataracts [8] * lowest accident rate by age group Epidemiology: - elderly account for 14% of vehicle occupant fatalities & 18% of pedestrian fatalities (2008) [5] Clinical manifestations: - Waddell's triad (pedestrian child struck by motor vehicle) a) femur fracture (femoral shaft) b) intra-abdominal or intrathoracic injury c) contralateral head injury Management: - physician warnings to potentially unfit drivers may reduce motor vehicle accidents (MVA) [2] - risk of MVA reduced but still elevated [2] - warning patients not to drive may compromise doctor- patient relationship [2] - depression common among warned drivers [2] - correction of visual impairment - cataract surgery of small benefit [8]

Related

assessment of older drivers head injury whiplash (neck hyperextension)

General

accident

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. McEvoy SP et al, Role of mobile phones in motor vehicle crashes resulting in hospital attendance: A case-crossover study. BMJ 2005 Aug 20/27; 331:428-30. PMID: 16012176 http://bmj.bmjjournals.com/cgi/content/full/331/7514/428
  3. Redelmeier DA et al Physicians' Warnings for Unfit Drivers and the Risk of Trauma from Road Crashes N Engl J Med 2012 367:1228-1236 Sept 27, 2012 PMID: 23013074 http://www.nejm.org/doi/full/10.1056/NEJMsa1114310
  4. Medical Knowledge Self Assessment Program (MKSAP) 16, American College of Physicians, Philadelphia 2012
  5. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  6. Hanrahan RB, Layde PM, Zhu S, Guse CE, Hargarten SW. The association of driver age with traffic injury severity in Wisconsin. Traffic Inj Prev. 2009 Aug;10(4):361-7 PMID: 19593714
  7. Ayers JW, Leas EC, Dredze M et al. Pokemon GO - a new distraction for drivers and pedestrians. JAMA Intern Med 2016 Sep 16; PMID: 27635638 http://archinte.jamanetwork.com/article.aspx?articleid=2553331
  8. Schlenker MB, Thiruchelvam D, Redelmeier DA. Association of Cataract Surgery With Traffic Crashes. JAMA Ophthalmol. Published online June 28, 2018. PMID: 29955857 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2686118
  9. George J Car Accidents Common With Undetected Epilepsy - Subtle seizures may include brief hallucinations or deja vu. MedPage Today October 20, 2020 https://www.medpagetoday.com/neurology/seizures/89205 - Pellinen J et al Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy. Epilepsia. Oct 10, 2020 PMID: 33078409 https://onlinelibrary.wiley.com/doi/abs/10.1111/epi.16707
  10. Staples JA, Erdelyi A, Merchant K et al Syncope and the Risk of Subsequent Motor Vehicle Crash. A Population-Based Retrospective Cohort Study. JAMA Intern Med. Published online August 1, 2022. PMID: 35913711 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2794651