motor vehicle accident (MVA)

Etiology

Risk factors:

• 5 to 10 times more common in patients with sleep apnea
• use of cell phones associated with 4-fold increased risk
• drivers over 75 years of age
  • twice the crash rate per mile driven relative to drivers 25-54 years
  • drive fewer miles, thus have among the lowest crash rates of any age group
  • are less likely to survive a crash than younger drivers
  • tend to drive less at night, during adverse weather conditions, or on congested roads
• MVA/million miles traveled
  • age 16-19: 26.8
  • age 40-45: 3.7*
  • age 80-85: 15.1
  • age 85+: 38.8
• other risk factors
  • dementia
  • depression
  • stroke
  • syncope
    • risk of motor vehicle accident following emergency department visit for syncope is not increased in the following year
  • seizures, including subtle hard-to-detect focal seizures
  • sleep deprivation
  • cataracts

* lowest accident rate by age group

Epidemiology

• elderly account for 14% of vehicle occupant fatalities & 18% of pedestrian fatalities (2008)

Clinical manifestations

• Waddell's triad (pedestrian child struck by motor vehicle)
  • femur fracture (femoral shaft)
  • intra-abdominal or intrathoracic injury
  • contralateral head injury

Management

• physician warnings to potentially unfit drivers may reduce motor vehicle accidents (MVA)
  • risk of MVA reduced but still elevated
  • warning patients not to drive may compromise doctor- patient relationship
  • depression common among warned drivers
• correction of visual impairment
  • cataract surgery of small benefit

More general terms

• accident

Additional terms

• assessment of older drivers
• head injury
• whiplash (neck hyperextension)