From the Guidelines
Outpatient treatment for Road Traffic Accidents (RTA) should prioritize nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults, with topical nonsteroidal anti-inflammatory drugs (NSAIDs) with or without menthol gel as first-line therapy. This approach is based on the strong recommendation from the American College of Physicians and American Academy of Family Physicians, as outlined in their 2020 clinical guideline 1. The guideline emphasizes the importance of considering costs and patient values and preferences when selecting a treatment approach.
Key considerations for outpatient treatment of RTA include:
- Assessing the severity of injuries and determining the need for immediate medical attention
- Providing pain management options, such as topical NSAIDs or oral NSAIDs, to reduce or relieve symptoms and improve physical function
- Considering alternative therapies, such as specific acupressure or transcutaneous electrical nerve stimulation, for patients who do not respond to first-line treatments
- Avoiding the use of opioids, including tramadol, due to the potential risks and low-certainty evidence supporting their effectiveness 1
It is essential to note that the treatment approach may vary depending on the specific circumstances of the RTA and the individual patient's needs. However, by prioritizing nonpharmacologic and pharmacologic management of acute pain, healthcare providers can help reduce morbidity, mortality, and improve quality of life for patients with RTA.
In terms of specific treatment options, the guideline recommends:
- Topical NSAIDs with or without menthol gel as first-line therapy
- Oral NSAIDs or oral acetaminophen as alternative options
- Specific acupressure or transcutaneous electrical nerve stimulation for patients who do not respond to first-line treatments
- Avoiding opioids, including tramadol, due to the potential risks and low-certainty evidence supporting their effectiveness 1
From the Research
Treatment Options for Road Traffic Accident (RTA) Victims
- Outpatient treatment for RTA victims may involve various approaches, including medication and therapy, to manage physical and psychological injuries 2, 3.
- A study on health care utilization after hospitalization following a road traffic accident found that patients had higher health care utilization during the first 6 months following hospitalization, compared with baseline care 4.
- For patients with soft tissue injuries, oral paracetamol and/or ibuprofen may be used to treat pain, with no significant difference in analgesic effects or side effects observed between the two medications or their combination 5.
Management of Poly-Trauma Patients
- The management of poly-trauma patients should start from the scene of the accident, during transportation, and finally in the hospital, using a multi-disciplinary approach 6.
- Timely diagnosis and proper management of poly-trauma patients can save lives, even in limited resource centers 6.
- A review of literature and case report on the management of a road traffic accident poly-trauma patient in a limited regional resource hospital setting in Tanzania highlights the importance of following principles of management to save lives 6.
Mental Health Care for RTA Victims
- Road traffic accidents can lead to posttraumatic stress disorder (PTSD), with about one in five RTA survivors susceptible to PTSD 2.
- A study on the treatment gap in mental health care for victims of road traffic accidents found that 26% of participants had utilized care from psychotherapy, pharmacotherapy, or support groups, with increased posttraumatic stress being the strongest correlate of mental health service use 2.
- Proposed management guidelines for PTSD in post-RTA hospitalized patients include establishing a coordinated triage, implementing a screening tool in the emergency department, and providing psychological counseling 3.