From the Guidelines
For a comprehensive Motor Vehicle Accident (MVA) evaluation, I recommend a systematic approach that prioritizes immediate assessment of vital signs and level of consciousness, as outlined in the guidelines for field triage of injured patients 1. This approach should include:
- Measurement of vital signs, such as systolic blood pressure, respiratory rate, and Glasgow Coma Scale score, to identify patients who require immediate transport to a trauma center.
- Assessment of the mechanism of injury, including factors such as intrusion, ejection, and death in the same passenger compartment, to determine the risk of severe injury.
- Evaluation of special patient or system considerations, such as older adults, children, and patients with anticoagulants or bleeding disorders.
- Consideration of imaging studies, such as CT or MRI, based on clinical findings and validated clinical decision rules, such as the Canadian CT Head Rule or the New Orleans Criteria 1.
- A stepwise approach to pain management, starting with acetaminophen or NSAIDs and progressing to muscle relaxants if needed.
- Early initiation of physical therapy, focusing on gentle range of motion exercises and gradually advancing to strengthening.
- Psychological assessment and documentation of pre-existing conditions and functional limitations.
Key considerations in the evaluation of MVA patients include:
- The importance of rollover crashes as a predictor of severe injury, with a risk of ISS >15 injury associated with roof intrusion of 24 inches or more, and any ejection (partial or full) 1.
- The need for a thorough physical examination, including assessment of the cervical spine, back, and extremities, to identify signs of whiplash, fractures, or soft tissue injuries.
- The role of clinical decision rules in determining the need for imaging studies, such as CT or MRI, and the importance of considering factors such as coagulopathy and minimal head trauma 1.
Overall, a comprehensive MVA evaluation should prioritize a systematic approach that addresses both the immediate physical injuries and potential long-term complications of MVAs, with consideration of the latest evidence-based guidelines and clinical decision rules.
From the Research
Evaluation of Motor Vehicle Accident (MVA)
The evaluation of a Motor Vehicle Accident (MVA) involves various factors, including occupant characteristics, pre-MVC factors, and MVC-related factors 2. The goal of the evaluation is to identify potential injuries and provide appropriate care.
Factors to Consider
- Occupant characteristics: age, height, weight, sex, bone mineral density, and pre-existing medical and musculoskeletal conditions 2
- Pre-MVC factors: awareness of the impending crash, occupant position, usage of and position of the seatbelt and head restraint, and vehicle specifications 2
- MVC-related factors: crash orientation, vehicle dynamics, type of active or passive safety systems, and occupant kinematic response 2
Common Injuries
- Head and spinal injuries, including odontoid fractures 3
- Alar ligament laxity, particularly in patients whose head was in flexion and rotation during the accident 4
- Injuries resulting from blunt impact and/or inertial loading 2
Evaluation and Treatment
- Prehospital and emergency department care, including differential diagnosis and imaging modalities 5
- Triage of injured patients to an appropriate trauma center, using guidelines such as the 2012 national field triage guidelines for motor vehicle crashes 6
- Consideration of transport to a trauma center for elderly patients and drivers with steering wheel collapse 6
- Aggressive workup for infants who become airborne in a car that is extensively damaged 3