283 The Association Between Acute Medical Illness and Motor Vehicle Collisions in the Elderly

Abstract

Study ObjectivesTo define the prevalence of acute medical illness, specifically, illness that might impair the ability to drive in the population of elderly patients evaluated in the emergency department (ED) following motor vehicle crashes (MVC) and, through case-control methods, estimate the potential causative role of such illness in these crashes.MethodsRetrospective chart review of all patients >65 years of age presenting to a single trauma center between 6/30/2000 and 7/1/2010 after an MVC. Exclusion criteria: arrival in arrest or transfer from an outside facility. An acute medical illness was defined as any of the following identified either on presentation or during the course of ED/inpatient treatment: TIA/stroke, seizure, syncope, hypoglycemia, hyperglycemia >800 mg/dL, acute coronary syndrome, cardiac arrhythmia, high-grade conduction block, pacemaker malfunction, acute COPD exacerbation, and dementia. Cases were defined as drivers and similarly aged passengers served as controls. Multivariate logistic regression was performed to compute the odds ratio for occupancy status on the outcome.Results912 patients met inclusion criteria, 668 of which were drivers (73%). The median age was 73 (IQR 68-79), with 472 (52%) females. 805 (96%) were transported by paramedics. An acute medical illness was identified during the course of care in 85 (9%) of elderly patients overall. 76/85 meeting criteria (89%) were also drivers. The univariate odds ratio associating occupancy status (driver vs. passenger) and the diagnosis of an acute medical illness was 3.12 (95% Confidence Interval [CI] 1.54-6.34). When adjusting for other variables, this association persisted (Table). The c statistic for the multivariate model was 0.77 and the Hosmer-Lemeshow goodness-of-fit p value was 0.86.Conclusion Study ObjectivesTo define the prevalence of acute medical illness, specifically, illness that might impair the ability to drive in the population of elderly patients evaluated in the emergency department (ED) following motor vehicle crashes (MVC) and, through case-control methods, estimate the potential causative role of such illness in these crashes. To define the prevalence of acute medical illness, specifically, illness that might impair the ability to drive in the population of elderly patients evaluated in the emergency department (ED) following motor vehicle crashes (MVC) and, through case-control methods, estimate the potential causative role of such illness in these crashes. MethodsRetrospective chart review of all patients >65 years of age presenting to a single trauma center between 6/30/2000 and 7/1/2010 after an MVC. Exclusion criteria: arrival in arrest or transfer from an outside facility. An acute medical illness was defined as any of the following identified either on presentation or during the course of ED/inpatient treatment: TIA/stroke, seizure, syncope, hypoglycemia, hyperglycemia >800 mg/dL, acute coronary syndrome, cardiac arrhythmia, high-grade conduction block, pacemaker malfunction, acute COPD exacerbation, and dementia. Cases were defined as drivers and similarly aged passengers served as controls. Multivariate logistic regression was performed to compute the odds ratio for occupancy status on the outcome. Retrospective chart review of all patients >65 years of age presenting to a single trauma center between 6/30/2000 and 7/1/2010 after an MVC. Exclusion criteria: arrival in arrest or transfer from an outside facility. An acute medical illness was defined as any of the following identified either on presentation or during the course of ED/inpatient treatment: TIA/stroke, seizure, syncope, hypoglycemia, hyperglycemia >800 mg/dL, acute coronary syndrome, cardiac arrhythmia, high-grade conduction block, pacemaker malfunction, acute COPD exacerbation, and dementia. Cases were defined as drivers and similarly aged passengers served as controls. Multivariate logistic regression was performed to compute the odds ratio for occupancy status on the outcome. Results912 patients met inclusion criteria, 668 of which were drivers (73%). The median age was 73 (IQR 68-79), with 472 (52%) females. 805 (96%) were transported by paramedics. An acute medical illness was identified during the course of care in 85 (9%) of elderly patients overall. 76/85 meeting criteria (89%) were also drivers. The univariate odds ratio associating occupancy status (driver vs. passenger) and the diagnosis of an acute medical illness was 3.12 (95% Confidence Interval [CI] 1.54-6.34). When adjusting for other variables, this association persisted (Table). The c statistic for the multivariate model was 0.77 and the Hosmer-Lemeshow goodness-of-fit p value was 0.86. 912 patients met inclusion criteria, 668 of which were drivers (73%). The median age was 73 (IQR 68-79), with 472 (52%) females. 805 (96%) were transported by paramedics. An acute medical illness was identified during the course of care in 85 (9%) of elderly patients overall. 76/85 meeting criteria (89%) were also drivers. The univariate odds ratio associating occupancy status (driver vs. passenger) and the diagnosis of an acute medical illness was 3.12 (95% Confidence Interval [CI] 1.54-6.34). When adjusting for other variables, this association persisted (Table). The c statistic for the multivariate model was 0.77 and the Hosmer-Lemeshow goodness-of-fit p value was 0.86. Conclusion