Recent Motor Vehicle Accident Research Articles

Cryptococcal Meningitis in an Immunocompetent Male: Case Report

Cryptococcal meningitis is a life-threatening condition caused by an invasive, opportunistic, encapsulated saprophytic fungus, either Cryptococcus neoformans or Cryptococcus gattii most often in immunocompromised patients, especially those with human immunodeficiency virus (HIV). Overwhelming invasive infection of immunocompetent patients is rather uncommon, and diagnosis is often challenging due to a more indolent course. We present a case of cryptococcal meningitis (CM) in a 72-year-old immunocompetent male following a recent motor vehicle accident.

Ecchymotic patches

A 70-year-old man with notable back pain from a recent motor vehicle accident saw another provider before he presented to his primary care physician for a routine annual physical. The patient had circular ecchymotic patches on his back.What is your diagnosis?

Secondary adrenal insufficiency: an insidious consequence of the opioid epidemic?

A 22-year-old woman was admitted to the medicine service with generalised abdominal pain and nausea. Medical history included a recent motor vehicle accident resulting in multiple orthopaedic injuries and development...

PTSD and Romantic Relationship Satisfaction: Cluster- and Symptom-Level Analyses.

Previous studies have demonstrated bidirectional associations between posttraumatric stress disorder (PTSD) and romantic relationship dissatisfaction. Most of these studies were focused at the level of the disorder, examining the association between relationship dissatisfaction and having a diagnosis of PTSD or the total of PTSD symptoms endorsed. This disorder-level approach is problematic for trauma theorists who posit symptom-level mechanisms for these effects. In the present study, we examined the prospective, bidirectional associations between PTSD symptom clusters (e.g., reexperiencing) and relationship satisfaction using the data from 101 previously studied individuals who had had a recent motor vehicle accident. We also conducted exploratory analyses examining the prospective, bidirectional associations between individual PTSD symptoms and relationship satisfaction. Participants had completed the PTSD Checklist-Civilian Version and the Relationship Assessment Scale at 4, 10, and 16 weeks after the MVA. We performed time-lagged mixed-effects regressions to examine the effect of lagged relationship satisfaction on PTSD clusters and symptoms, and vice versa. No cluster effects were significant after controlling for a false discovery rate. Relationship satisfaction predicted prospective decreases in reliving the trauma (d = 0.42), emotional numbness (d = 0.46), and irritability (d = 0.49). These findings were consistent with the position that relationship satisfaction affects PTSD through symptom-level mechanisms.

PTSD symptom severity and psychiatric comorbidity in recent motor vehicle accident victims: A latent class analysis

We conducted a latent class analysis (LCA) on 249 recent motor vehicle accident (MVA) victims to examine subgroups that differed in posttraumatic stress disorder (PTSD) symptom severity, current major depressive disorder and alcohol/other drug use disorders (MDD/AoDs), gender, and interpersonal trauma history 6-weeks post-MVA. A 4-class model best fit the data with a resilient class displaying asymptomatic PTSD symptom levels/low levels of comorbid disorders; a mild psychopathology class displaying mild PTSD symptom severity and current MDD; a moderate psychopathology class displaying severe PTSD symptom severity and current MDD/AoDs; and a severe psychopathology class displaying extreme PTSD symptom severity and current MDD. Classes also differed with respect to gender composition and history of interpersonal trauma experience. These findings may aid in the development of targeted interventions for recent MVA victims through the identification of subgroups distinguished by different patterns of psychiatric problems experienced 6-weeks post-MVA.

Patient-related risk factors for fracture-healing complications in the United Kingdom General Practice Research Database

Background and purpose A variety of risk factors have been hypothesized to contribute to the development of fracture-healing complications; however, population-based estimates of the strength of these risk factors are limited. In this case-control study, we evaluated patient-related risk factors for fracture-healing complications.Methods Using the United Kingdom General Practice Research Database, we identified patients with a fracture-healing complication (delayed union, nonunion, or malunion) between 1988 and 2008. 4 controls (i.e. patients with normal healing) were matched to each case on general practice, fracture site, fracture date, and length of history in the database. We used conditional logistic regression to estimate odds ratios (ORs) of various risk factors, including demographics, comorbidities, and medication use.Results Diabetes and use of non-steroidal anti-inflammatory drugs (NSAIDs) within 12 months before the initial fracture were associated with a higher odds of a fracture-healing complication (type-I diabetes: adjusted OR = 2.3, 95% CI: 1.3–3.8; type-II diabetes: adjusted OR = 2.3, CI: 1.4–3.7; NSAIDs: adjusted OR = 2.6, CI: 2.1–3.2). Patients who had a motor vehicle accident recorded within 1 month before their initial fracture were also at increased odds of a fracture-healing complication (adjusted OR = 2.6, CI: 1.2–5.4).Interpretation Diabetes, NSAID use, and a recent motor vehicle accident were most consistently associated with an increased risk of a fracture-healing complication, regardless of fracture site or specific fracture-healing complication. This analysis suggests that certain patient-related characteristics influence the development of fracture-healing complications in general, even though specific healing complications may differ by their mechanism.

Delayed Bronchostenosis After Blunt Chest Trauma in Children: CT and Pathologic Findings

Tracheobronchial disruption is an uncommon injury associated with blunt chest trauma. We report CT features and pathologic findings of two pediatric cases in which a bronchial injury was unnoticed initially but was diagnosed later by appearance of delayed bronchostenosis with distal atelectasis after blunt chest trauma in recent motor vehicle accidents. Pathologically, obliteration of the bronchial lumen was caused by dense fibrous overgrowth and granulation tissue.

Effects of varying scoring rules of the Clinician-Administered PTSD Scale (CAPS) for the diagnosis of post-traumatic stress disorder in motor vehicle accident victims

We examined the effects of varying the scoring rules for the CAPS (Clinician Administered PTSD Scale) on the diagnosis of PTSD in a sample of 100 victims of recent motor vehicle accidents. This was done by assessing, for each scoring rule, the rate of categorical diagnosis and the effect on group mean scores on measures of subjective distress and role impairment. Changing from the most liberal to the most conservative scoring rule results in a change in diagnosis of PTSD from 44% to 29% of the sample. Comparisons of those included as PTSD under the most conservative scoring criteria vs those excluded (who had previously been included) reveal significantly greater subjective distress and role impairment among those who continue to be included in the PTSD category. Thus, changes in scoring rules have clinically significant effects on the incidence and severity of diagnosed PTSD. This indicates that the selection of scoring rules has important implications for epidemiological estimates of the prevalence of PTSD, and that PTSD studies using different scoring rules as inclusion criteria may be using somewhat different samples.

Short-term follow-up of post-traumatic stress symptoms in motor vehicle accident victims

Ninety-eight victims of recent motor vehicle accidents (MVA), who sought medical attention as a result of the MVA, were followed up prospectively 6 months after the initial assessment, using Keller, Lavori, Friedman, Nielsen, Endicott, McDonald-Scott and Andreasen's ( Archives of General Psychiatry, 44, 540–548, 1987) LIFE methodology so that month-by-month changes in post-traumatic stress disorder (PTSD) symptoms could be determined. For the 40 MVA victims who initially met the full criteria for PTSD, 10 no longer met the criteria 4 months after the initial assessment, a decrease significant at the P < 0.01 level, and 20 no longer met the full criteria at 6 months ( P < 0.001). On a symptom-by-symptom basis, there were significant declines among the fraction of those who initially met the criteria for PTSD for all avoidance and numbing symptoms by the 6-month follow-up, whereas most of the hyperarousal symptoms did not show significant declines.

Psychological morbidity associated with motor vehicle accidents

Fifty victims of recent motor vehicle accidents (MVAs), who had sought medical attention after their accidents, were assessed for possible psychological morbidity as a result of the accident. Forty age, gender-matched controls were also assessed with the same instruments. Forty-six percent of the MVA victims met the criteria for current post-traumatic stress disorders (PTSD) as a result of the accident while 20% showed a sub-syndromal version (the reexperiencing symptom cluster plus either the avoidance/numbing cluster or the over-arousal cluster) of PTSD. Although all MVA victims showed some form of driving reluctance, only 1 S met the criteria for driving phobia. Those MVA victims who met the criteria for PTSD or sub-syndromal PTSD were significantly more likely to have experienced previous trauma, other than a serious MVA, and were more likely ( P = 0.008) to have previously met the criteria for PTSD as a result of that trauma. Forty-eight percent of MVA victims who met the criteria for current PTSD also met the criteria for current major depression. Significantly more current MVA-PTSDs had suffered previous major depressive episodes.

The psychophysiology of motor vehicle accident related posttraumatic stress disorder

Fifty victims of recent motor vehicle accidents (MVAs) and 40 non-MVA controls participated in a psychophysiological assessment in which heart rate (HR), systolic and diastolic blood pressures, forehead EMG and electrodermal activity were measured during mental arithmetic, idiosyncratic audiotaped descriptions of the victim's own MVA, and a standard videotape of MVAs. The MVA victims were subdivided into 23 with full posttraumatic stress disorder (PTSD), 10 with sub-syndromal PTSD, and 17 without PTSD. HR response to the idiosyncratic audiotape reliably ( p

Pseudopneumothorax

An asymptomatic 18-year-old man presented for treatment of alcohol and substance abuse. He related a history of a recent motor vehicle accident with chest trauma and remote history of colonic interposition for esophageal atresia. Radiographic investigation yielded an interesting set of roentgenograms.