Motor Vehicle Accident Victims Research Articles

The impact of social support on the relationship between trauma history and posttraumatic stress disorder symptoms in motor vehicle accident victims.

The present study examined how different types of social support differentially moderated the relationship between trauma history characteristics and the development of posttraumatic stress disorder symptoms (PTSS) following a motor vehicle accident (MVA). Two hundred thirty-five MVA victims self-reported levels of social support and trauma history, and were evaluated for PTSS 6- and 12-months post-MVA. Results indicated that after controlling for gender, injury severity and income, number of prior trauma types and subjective responses to prior traumatization predicted subsequent PTSS (ps < .05). Appraisal social support was a significant moderator of the total number of types of trauma (appraisal: 6-months β = -.16, p < .05; 12-months β = -.17, p < .05) and subjective physical injury during the prior trauma (appraisal: 6-months β = -.14, p < .05; 12-months β = -.19, p < .05) in predicting PTSS. Results underscore the importance of examining both trauma history and social support as multi-dimensional constructs and suggest merit to addressing social support in trauma victims with a prior trauma history.

Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms.

Avoidance coping (AVC) is common in individuals with posttraumatic stress disorder (PTSD) and in individuals with alcohol use disorder (AUD). Given that PTSD and AUD commonly co-occur, AVC may represent a risk factor for the development of comorbid posttraumatic stress and alcohol use. In this study, the relationship between AVC and PTSD symptoms (PTSS) was examined in individuals with versus without AUDs. Motor vehicle accident (MVA) victims were assessed 6 weeks postaccident for AUD history (i.e. diagnoses of current or past alcohol abuse or dependence) and AVC. PTSS were assessed 6 weeks and 6 months post-MVA. All analyses were conducted on the full sample of MVA victims as well as on the subset of participants who were legally intoxicated (blood alcohol concentration ≥ 0.08) during the accident. It was hypothesized that the relationship between AVC and PTSS would be stronger in those individuals with an AUD history and especially strong in the subset of individuals who were legally intoxicated during the MVA. Results were largely supportive of this hypothesis, even after controlling for in-hospital PTSS, gender, and current major depression. Early assessment of AUD history and avoidance coping may aid in detecting those at elevated risk for PTSD, and intervening to reduce AVC soon after trauma may help buffer the development of PTSD + AUD comorbidity.

Autopsy investigation and Bayesian approach to coronary artery disease in victims of motor-vehicle accidents

BackgroundEach year, 1.2 million people die worldwide as a result of motor-vehicle accidents (MVA), representing a tremendous burden to healthcare. The aim of this study was to define the prevalence of coronary disease and its possible role in motor-vehicle accidents. Methods and resultsWe examined consecutive cases of non-hospital sudden death autopsies in the area of West Quebec during the period of 2002–2006, and we focused on those victims of MVA. Severe coronary artery disease (CAD) was defined as a narrowing of ≥75% of a cross-sectional area or the presence of acute plaque events in major epicardial coronary arteries. From a total cohort of 1260 autopsies, MVA were responsible for 123 deaths, 100 of whom were men and 23 were women. Significant CAD was documented in approximately 37% of these cases. In individuals older than 60 years, the prevalence of significant CAD and ischemia were 86.2% and 19.8%, respectively. A percentage of 40% of the coronary patients showed erratic driving before the accident, as observed by witnesses. Statistical analysis showed that an individual affected by CAD has 9% probability of suffering a motor-vehicle accident. ConclusionsThe prevalence of severe CAD and acute myocardial ischemia is very high among individuals who have suffered a MVA. Our data suggest the hypothesis that acute CAD could be the cause of accidents in a large group of the drivers affected by coronary disease. For these reasons CAD could be investigated in drivers above 50 years old, as a possible preventive measure and determinant of individual risk stratification.

Regionalized Pathology Correlates with Augmentation of mtDNA Copy Numbers in a Patient with Myoclonic Epilepsy with Ragged-Red Fibers (MERRF-Syndrome)

Human patients with myoclonic epilepsy with ragged-red fibers (MERRF) suffer from regionalized pathology caused by a mutation in the mitochondrial DNA (m.8344A→G). In MERRF-syndrome brain and skeletal muscles are predominantly affected, despite mtDNA being present in any tissue. In the past such tissue-specificity could not be explained by varying mtDNA mutation loads. In search for a region-specific pathology in human individuals we determined the mtDNA/nDNA ratios along with the mutation loads in 43 different post mortem tissue samples of a 16-year-old female MERRF patient and in four previously healthy victims of motor vehicle accidents. In brain and muscle we further determined the quantity of mitochondrial proteins (COX subunits II and IV), transcription factors (NRF1 and TFAM), and VDAC1 (Porin) as a marker for the mitochondrial mass. In the patient the mutation loads varied merely between 89–100%. However, mtDNA copy numbers were increased 3–7 fold in predominantly affected brain areas (e.g. hippocampus, cortex and putamen) and in skeletal muscle. Similar increases were absent in unaffected tissues (e.g. heart, lung, kidney, liver, and gastrointestinal organs). Such mtDNA copy number increase was not paralleled by an augmentation of mitochondrial mass in some investigated tissues, predominantly in the most affected tissue regions of the brain. We thus conclude that “futile” stimulation of mtDNA replication per se or a secondary failure to increase the mitochondrial mass may contribute to the regionalized pathology seen in MERRF-syndrome.

Organ Donation and Suicide

For the period 1994-2005 in the U.S.A., suicides were less likely to be organ donors than were victims of homicide and motor vehicle accidents.

Prevention of severe injuries in preschool children: what are the priorities?

Injury is the leading cause of death in childhood. Most of these injuries are preventable events. With limited resources, strategies for prevention should target severe injuries and be based on...

Craniocervical junction trauma with occipital condyle fracture; case report

Authors present the case of a unilateral occipital condyle fracture diagnosed with computed tomography (CT) in a motor vehicle accident victim. Patient had unilateral occipital condyle fracture with inferomedially displaced bone fragment, a type 3 fracture according to the Anderson and Montesano classification of occipital condyle fractures, bilaterally widened occipitoatlantal joint space, and head mowed forward in relation to the cervical spine. Described pathologic changes clearly indicated craniocervical junction ligament lesions, distinctively unilateral alar ligament lesion, apical dental ligament, and tectorial membrane. Brain CT showed brain parenchymal edema and massive subarachnoidal hemorrhage with propagation of the blood in the ventricular system. Patient was admitted to the hospital unconscious, without spontaneous breathing and carotid pulse; Glasgow Coma Scale score was 3 and he did not recover during the 20-day-long treatment.

The epidemiology of BCVI at a single state trauma centre

Background Blunt carotid and vertebral artery injury (BCVI) is a relatively uncommon but potentially devastating injury. The aim of our study was to highlight the incidence, patterns, presentation and associations of BCVI at our institution. Methods Retrospective data between 1st January 2003 and 31st December 2006 was obtained from The Alfred Hospital's health information system, patient medical records and the Department of Neurosurgery's database. Injuries were graded using the Denver grading scale. Results 67 patients (0.64%) out of 10,417 minor and major trauma admissions, were diagnosed with BCVI. 33 (49%) sustained blunt carotid and 34 (51%) sustained blunt vertebral injuries. Motor vehicle accident (MVA) was the cause in 43 out of 67. 35% had associated head injury whilst 57% had concurrent cervical spine fractures. Odds ratio analysis showed that MVA victims with concomitant upper cervical spine injury were 22.9 times more likely to suffer BCVI than those without such risk factors. Approximately 50% of patients had a Glasgow coma score of 14 or less (GCS ≤ 14). Grade 4 BCVI was most common. Stroke occurred in 22 (32%) and mortality in 14 (20%). Conclusion BCVI although infrequent, is a serious injury. Our study suggests that MVA patients with cervical spine fractures especially of the upper C-spine are at much higher risk of BCVI than those without such injuries.

Positive “Water Test”—An External Indicator of Base of Skull Hinge‐Ring Fracture

Despite having significant internal injuries, victims of motor vehicle accidents may have surprisingly few external manifestations of trauma. The water test describes a technique whereby water placed in an upwardly facing ear results in drainage from the nose and opposite ear, thus demonstrating transcranial passage of water. This sign can be demonstrated in cases of blunt cranial trauma where there is a "hinge" fracture involving the petrous temporal bones bilaterally associated with a ring fracture extending around the foramen magnum posteriorly. Such a fracture results in separation of the posterior and middle cranial fossae providing a track for water to traverse. The water test provides a quick and noninvasive method for demonstrating the presence of a particular type of skull fracture.

Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system

Separation of the acromioclavicular joint (ACJ) is a common orthopaedic injury among athletes involved in contact sports and victims of motor vehicle accidents, particularly motorcycle crashes. High-grade ACJ disruptions (type IV-VI) are managed surgically through a variety of procedures. These range from simple plate and screw fixation to more complex procedures involving ligament repair, transfer, and reconstruction. This paper describes a new technique utilizing a direct subacromial arthroscopic approach to performing a reconstruction of the ruptured coracoclavicular ligaments. The appropriately over-engineered fixation device is made up of a subcoracoid button secured via nonabsorbable sutures to a special clavicular washer and augmented by a centrally placed soft tissue graft. To date, the senior author has performed 10 cases on both acute and chronic high-grade ACJ separations. All patients greater than 6 months out from surgery have returned to their normal pre-injury level of activity. No complications (infection, hardware, or graft failure) have been documented, and all have maintained the interoperative reduction of the acromioclavicular joint and coracoclavicular space. The arthroscopic reconstruction of the AC separation is a low-morbidity, safe, and reproducible operation that provides adequate fixation and stability combined with the use of a soft tissue graft to promote sound biologic healing.

Experimental studies of forensic odontology to aid in the identification process

The importance of dental identification is on the increase year after year. With the passage of time, the role of forensic odontology has increased as very often teeth and dental restorations are the only means of identification. Forensic odontology has played a key role in identification of persons in mass disasters (aviation, earthquakes, Tsunamis), in crime investigations, in ethnic studies, and in identification of decomposed and disfigured bodies like that of drowned persons, fire victims, and victims of motor vehicle accidents. The various methods employed in forensic odontology include tooth prints, radiographs, photographic study, rugoscopy, cheiloscopy and molecular methods. Investigative methods applied in forensic odontology are reasonably reliable, yet the shortcomings must be accounted for to make it a more meaningful and relevant procedure. This paper gives an overview of the various experimental studies to aid in the identification processes, discussing their feasibilities and limitations in day-to-day practice.

Is Lymphocytic (Hashimoto) Thyroiditis Associated With Suicide?

The histologic diagnosis of lymphocytic (Hashimoto) thyroiditis requires lymphocytic inflammation of the thyroid gland in combination with Hourthle cell metaplasia of follicular epithelial cells. Clinically, this autoimmune process has been associated with hypothyroidism and psychiatric conditions including depression. This retrospective study was designed to quantify the incidence and severity of lymphocytic thyroiditis in a series of nonconsecutive suicides compared with a cohort of motor vehicle accident victim controls. Eighty-one suicide victims (61 male, 20 female; age range 13-79 years, average 43) were compared with 88 age and gender matched controls (64 males, 24 females; age range 19-85 years, average 36). The degree of lymphocytic inflammation of the thyroid gland was graded on a scale of 0 to 3 (0 = no inflammation, 1 = mild inflammation, 2-3 moderate-to-marked inflammation with Hourthle cell metaplasia). Slides from each case were reviewed while blinded to the cause and manner of death in each case. Of these 169 total cases, 8 (4.7%) received a score of 3, whereas additional 7 (4.1%) received a grade of 2. Eighty-six percent of all of the cases showed no significant inflammation and recorded a score of 0. Of the 81 suicides, 3 had a score of 3, and 3 had a score of 2 (combined incidence of 7.4%). Within the control group, 5 of 88 cases scored 3 and another 4 scored 2 (combined incidence = 10.2%). Three males and 5 females scored 3 with an age range of 23 to 63 years, average 42. Incidental data tabulated showed that 19% of suicide victims were on psychoactive medications compared with 6% in the motor vehicle accident control group. No one on this study was on thyroid hormone replacement therapy. Depression is strongly linked to suicide and lymphocytic thyroiditis may be a cause of depression. Based on this study, however, the presence of lymphocytic thyroiditis cannot be used as a histologic adjunct to discriminate between suicide and accident in problematic cases (ie, overdose deaths). This diagnosis is rendered with essentially equal frequency in suicide victims versus controls.

Development and persistence of posttraumatic stress disorder and the 5‐HTTLPR polymorphism

Association between 5-HTTLPR polymorphism and development of acute and persistence of chronic posttraumatic stress disorder (PTSD) was prospectively investigated. DNA was extracted from 41 motor-vehicle accident victims evaluated for development and persistence of PTSD, 1 and 12 months posttrauma. At Time 1, a nonsignificant trend for higher acute PTSD rate in ll homozygotes (82%) was observed compared to those with ss and sl genotypes (50%). At Time 2, higher chronic PTSD rate was found in ll homozygotes (55%) compared to those with ss and sl genotypes (20%), with an odds ratio of 4.8 (95% CI = 1.09-21.22). Contrary to previous findings, these data are suggestive of a protective role for the s allele of 5-HTTLPR in chronic PTSD.

Effects of early nightmares on the development of sleep disturbances in motor vehicle accident victims

The present study prospectively examined the extent to which trauma-related nightmares affected the subsequent development of insomnia symptoms in 314 motor vehicle accident (MVA) victims. Participants were assessed in-hospital and at 2 weeks, 6 weeks, 3 months, and 1 year post-MVA. Hierarchical linear regression analyses showed that 6-week PTSD symptoms (PTSS) and 3-month nightmares, but not 2-week nightmares were positively associated with sleep onset and maintenance problems reported at 3-month post-MVA. Nightmares reported at 3-months post-MVA were positively associated with 1-year sleep maintenance problems. These findings highlight the dynamic relationship between PTSS and sleep problems as well as the potential importance of early intervention for trauma-related nightmares as a means to prevent sleep problems after a traumatic experience.

Unilateral occipital condylar fracture presenting as neck pain and restriction of neck movements— Report of a case and review of literature

Occipital condylar fractures (OCFs) once rare injuries are not so at present. A young male, victim of motor vehicle accident, presented with severe high cervical pain and restriction of neck movements without any focal neurological deficit, with normal cervical spine x-rays and computerized tomography (CT) scans brain. CT scan and magnetic resonance (MR) imaging of the craniovertebral junction (CVJ) area revealed a retro-pulsed segment in the cervical spinal canal with no cord compression or ligament injury. Patient improved with immobilization of neck. Patients with severe high cervical pain and restricted head movements OCF should be suspected and patient should be evaluated further. Majority of stable OCF improve with immobilization only.

Functional health status in subjects after a motor vehicle accident, with emphasis on whiplash associated disorders: design of a descriptive, prospective inception cohort study

BackgroundThe clinical consequences of whiplash injuries resulting from a motor vehicle accident (MVA) are poorly understood. Thereby, there is general lack of research on the development of disability in patients with acute and chronic Whiplash Associated Disorders.Methods/DesignThe objective is to describe the design of an inception cohort study with a 1-year follow-up to determine risk factors for the development of symptoms after a low-impact motor vehicle accident, the prognosis of chronic disability, and costs. Victims of a low-impact motor vehicle accident will be eligible for participation. Participants with a Neck Disability Index (NDI) score of 7 or more will be classified as experiencing post-traumatic neck pain and will enter the experimental group. Participants without complaints (a NDI score less than 7) will enter the reference group. The cohort will be followed up by means of postal questionnaires and physical examinations at baseline, 3 months, 6 months, and 12 months. Recovery from whiplash-associated disorders will be measured in terms of perceived functional health, and employment status (return to work). Life tables will be generated to determine the 1-year prognosis of whiplash-associated disorders, and risk factors and prognostic factors will be assessed using multiple logistic regression analysis.DiscussionLittle is known about the development of symptoms and chronic disability after a whiplash injury. In the clinical setting, it is important to identify those people who are at risk of developing chronic symptoms.This inception prospective cohort study will provide insight in the influence of risk factors, of the development of functional health problems, and costs in people with whiplash-associated disorders.

Trauma history characteristics and subsequent PTSD symptoms in motor vehicle accident victims

The present study examined the relationship between trauma history characteristics (number and type of traumas, age at first trauma, and subjective responses to prior traumas) and the development of posttraumatic stress disorder (PTSD) symptoms following a motor vehicle accident (MVA). One hundred eighty-eight adult MVA victims provided information about prior traumatization and were evaluated for PTSD symptoms 6 weeks and one year following the MVA. Results indicated that after controlling for demographics and depression, prior trauma history characteristics accounted for a small, but significant amount of the variance in PTSD symptoms. Distress from prior trauma and number of types of prior traumas were the most meaningful trauma history predictors. Results encourage further evaluation of trauma history as a multifaceted construct.

Association of objective measures of trauma exposure from motor vehicle accidents and posttraumatic stress symptoms

Associations of objective measures of trauma exposure with psychological sequelae following motor vehicle accidents (MVA) were examined in a Japanese population. Impact and injury severity of 93 MVA victims was assessed using on-the-scene in-depth investigations measured by the Injury Severity Score (ISS), barrier equivalent speed (BES), and change in velocity during the impact (Delta-v). Results showed that ISS, BES, and Delta-v were not related to posttraumatic stress symptoms (PTSS) or psychiatric symptoms at 5 and 14 months after the MVA. Subjective measures (e.g., perceived life risk, persistent medical problems) were significantly related to psychological sequelae. These findings suggest that the objective measures of trauma exposure are not associated directly with PTSS or psychiatric symptoms after an MVA.

Genital and Anal Injuries Requiring Surgical Repair in Females Less Than 21 Years of Age

Study Objective The injuries of sexually abused and assaulted girls seldom require surgical repair, and genital and anal injuries due to other causes appear to require repair uncommonly. We sought to determine the causes of genital and anorectal injuries requiring surgical repair in relation to such variables as injury sites and severity. Design Retrospective study Setting A large tertiary care children's hospital Participants Forty-four girls less than 21 years of age who required surgical repair of genital injuries between June 1986 and April 2007 were identified. Main Outcome Measures Information collected included the victims' ages, trauma mechanisms, and sites and severity of injuries. Results Injuries requiring repair of the genital and anal areas were uncommon in the 20 year period of this study. Although most injuries were due to straddle and impalement mechanisms, sexual abuse or assault was identified in 25% of the girls. The remaining 11% were victims of motor vehicle accidents. Straddle/impalement injuries involved only the external genitalia, vestibule, perineum, or posterior fourchette of 21 of the 28 girls (76%) with those injuries. The injuries of 9 of the 11 sexually abused/assaulted girls (82%) also involved the hymen, vagina, anus, or rectum. Injuries due to sexual abuse/assault and motor vehicle accidents (MVA) had average severity scores of 2.1 and 2.2, respectively, while straddle injuries had an average severity score of 1.4. (Exact Pearson chi-square P < 0.003.) The ages of the girls were unrelated to the severity of their injuries. Conclusions Although straddle/impalement was the most commonly found mechanism of genital and anorectal injury requiring surgical repair, sexual abuse or assault was identified in 25% of the girls. Sexual abuse and assault should always be considered and assessed appropriately when such injuries are found. Consultation of a social worker or child abuse specialist may be appropriate, especially when injuries clearly not due to an MVA involve the vagina or anorectum. A suspicion of sexual abuse or assault should be reported to the legally mandated state agency in accordance with the laws of state.

Gastrointestinal perforation following blunt abdominal trauma

To highlight the pertinent management problems of bowel perforation following blunt abdominal trauma. A prospective descriptive study. Hospital-based cohort over a nine year period in Jos University Teaching Hospital, Jos, Nigeria. A total of 23 patients with bowel perforation out of 8,970 trauma victims with a mean age of 28.5 years. Exploratory laparotomy, drainage of septic peritoneal fluid and wound saline lavage and closure of perforations were performed in all the 23 patients with clinical features and imaging signs suggestive of bowel perforation following blunt abdominal trauma. Femoral fractures were splinted and tube thoracostomy were carried out in four and two patients respectively. There is an apparent delay in presentation and diagnosis of traumatic bowel perforation following blunt abdominal trauma. Signs of peritoneal sepsis remain the most consistent findings in our environment. The morbidity and mortality following blunt abdominal trauma and bowel perforation are high because of established peritonitis. Delayed presentation or large leakage of bowel content into the peritoneal cavity and the attendant ease with which peritonitis develops in the latter are factors responsible. Delayed presentation (mean 3.05 days) was observed in seven of 23 patients. Eight patients had concomitant injuries; two to the head, four had right femoral fracture and two blunt chest injury. Features of peritonitis were present at initial evaluation in 19 patients. Seventeen patients were victims of motor vehicle accident. Radiological evidence of perforation (pneumoperitoneum) was present in only two of four patients with difficult diagnosis. Free peritoneal fluid without solid organ injury was detected in two patients with ultrasound. Diagnostic peritoneal lavage was, therefore, not used in any of our patients. The mean time from admission to laparotomy was six hours. Sites of perforations were: stomach (2), jejunum (9), ileum (8), jejunum/ileum (2) and colon (2). Sepsis originating from the perforated bowel was responsible for mortality in our patients who died in the perioperative period with concomitant injury playing significant role in three of 11 patients with such injuries. Peritonitis following a bowel perforation after blunt abdominal trauma is often present at the time of presentation and diagnosis is usually made. In the few doubtful cases, often in patients presenting soon after trauma, X-ray and trans-abdominal ultrasonography will assist in making a diagnosis. Delayed presentation still accounts for a high mortality in bowel perforation following blunt abdominal trauma.