What are the post-accident instructions for a stable adult or adolescent patient with no pre-existing medical conditions after a motor vehicle accident, including when to follow up for reevaluation?

Post-Motor Vehicle Accident Patient Instructions and Follow-Up

Immediate Return to Emergency Department If Any of These Occur

Patients must return immediately to the emergency department if they develop any warning signs of serious injury, as delayed complications can occur even after initially appearing stable. 1

• Repeated vomiting or new onset vomiting 2
• Worsening or persistent headache beyond 24 hours 1, 2
• Increasing abdominal pain, lightheadedness, nausea 3
• Confusion, abnormal behavior, or altered mental status 1, 2
• Increased sleepiness or difficulty being aroused 1, 2
• Seizures 1, 2
• Focal neurologic deficits (weakness, numbness, vision changes) 1
• New or worsening dizziness 1

Critical High-Risk Patients Requiring Immediate Evaluation

Any patient on anticoagulants (warfarin, apixaban, rivaroxaban, dabigatran) or antiplatelet agents (clopidogrel, ticagrelor) must be evaluated immediately in the emergency department with CT imaging, regardless of how minor the accident appears, as delayed intracranial hemorrhage occurs in 0.6-6% of these patients. 1

• Patients over age 60-65 years require immediate emergency department evaluation 1
• Any loss of consciousness or amnesia necessitates immediate evaluation 1
• Patients with persistent headache, vomiting, or neurologic symptoms require immediate evaluation 1

Activity Restrictions During Recovery

Patients must avoid strenuous mental and physical activity until completely symptom-free, with mandatory 2-3 days off work or school for those experiencing any post-accident symptoms. 2

• Daily walking can be encouraged immediately in stable patients 3
• Early mobilization should be achieved in stable patients without complications 3
• Avoid remaining alone for long periods during the recovery phase 3

Return to Driving

Driving can begin 1 week after the accident if the patient is stable, has no ongoing symptoms, and complies with individual state motor vehicle laws. 3

• Patients should avoid stressful driving circumstances initially: rush hour, inclement weather, night driving, heavy traffic, and high speeds 3
• Patients with complicated injuries (requiring CPR, hypotension, serious arrhythmias, or heart failure) should delay driving 2-3 weeks after symptoms resolve 3
• Patients must check their state's Department of Motor Vehicles requirements, as criteria vary by state 3

Sexual Activity and Physical Activities

Sexual activity with the usual partner can be resumed within 1 week to 10 days in stable patients without complications. 3

• After moderate and severe injuries, patients may usually resume normal physical activities after 3-4 months 3
• Return to physically demanding activities should be guided by medical clearance and symptom resolution 3

Follow-Up Timing and Specialist Referral

Follow-up within 1 week is recommended to assess injury healing and ensure appropriate counseling has been arranged. 3

• Refer to a specialist when symptoms persist beyond 3 weeks, or earlier if the patient has identified risk factors for prolonged recovery 2
• Mandatory late follow-up imaging is not indicated unless clinical condition or new symptoms require it 3
• Additional follow-up at 2 weeks for reassessment of symptoms and emotional status 3

Thromboprophylaxis Considerations

In hospitalized trauma patients, mechanical prophylaxis should be considered immediately, and pharmacologic thromboprophylaxis should be started as soon as possible, as venous thromboembolism is the third leading cause of death in trauma patients. 3

• VTE rates increase over fourfold when prophylaxis is delayed beyond 72 hours 3
• Over 50% of patients without prophylaxis may develop deep vein thrombosis 3

Behavioral and Psychological Monitoring

Screen for chronic headaches, anxiety, memory problems, difficulty concentrating, sleep difficulties, and abnormal behavior, as 18.7% of patients report 3 or more persistent symptoms after motor vehicle accidents. 2

• High-risk patients include those with female gender, pre-existing psychiatric history, elevated anxiety, loss of consciousness, assault mechanism, or alcohol intoxication 2
• Anxiety symptoms are the strongest predictor of persistent symptoms at 3 months 2
• Assess need for social assistance including driving support, employment accommodations, and financial assistance 2

Common Pitfalls to Avoid

• Do not dismiss seemingly minor symptoms in anticoagulated patients, as they have a 3.9% risk of intracranial hemorrhage versus 1.5% in non-anticoagulated patients 1
• Do not delay specialist referral beyond 3 weeks of persistent symptoms, as early intervention improves outcomes 2
• Do not rely on home observation alone for patients with negative initial evaluation, as delayed complications can occur 2
• Do not assume patients understand verbal instructions alone—provide written discharge instructions at sixth- to seventh-grade reading level with font size ≥12 points 2