The polytrauma clinical triad in patients with chronic pain after motor vehicle collision

Figures & data

Table 1 Descriptive statistics of the study population (n=71) and a subset of the sample composed of MVC patients with PCT (n=37)

Sample characteristics	Study sample (n=71)		PCT group (n=37)
	N	%	N	%
Age	Mean =43.3 years (SD=12.7)		Mean =42.6 years (SD=10.7)
Gender
Female	40	56.3	24	64.9
Male	31	43.7	13	35.1
Duration from MVC to intake assessment
Less than 12 months	22	31.0	13	35.1
Greater than 12 months	49	69.0	24	64.9
Driving demographics
In the driver seat at time of collision	51	71.8	27	73.0
Had other passengers in the car	26	36.6	15	40.5
Type of collision
Front impact	12	16.9	5	13.5
Rear impact	34	47.9	16	43.2
Side impact	13	18.3	7	18.9
Othera	12	16.8	9	24.3
Immediate to collision
Experienced loss of consciousness	13	18.3	9	24.3
Immediate symptoms of concussionb	54	76.1	32	86.5
Post-MVC emergency room patient care
Visited ER within 24 hours of MVC	53	74.6	25	67.6
Prescribed medications for pain by ER doctor	38	53.5	22	59.5
Image of head at ER visitc	22	31.0	11	29.7
Concussion diagnosis	19	26.8	10	27.0
Whiplash-associated disorder diagnosis	29	40.8	16	43.2
Current analgesic use	56	78.8	29	74.4
Prescription opioids	17	23.9	6	15.4
Over-the-counter analgesics onlyd	39	54.9	23	59.0

Notes:

a MVC involved patient being struck by a vehicle while being a pedestrian or cyclist.

b Immediate symptoms of concussion include experiencing confusion, dizziness, nausea, tinnitus, blurry/double vision, or difficulty concentrating.

c Images of head include either computed tomography scan or magnetic resonance imaging.

d Includes aceteminophen and over-the-counter nonsteroidal anti-inflammatory drugs such as acetylsalicylic acid, ibuprofen, and naproxen.

Abbreviations: ER, emergency room; MVC, motor vehicle collision; PCT, polytrauma clinical triad.

Table 2 Results of the Rivermead Post-Concussion Symptoms Questionnaire (n=71)

Measures	Item score frequency					Mean item(s) score	Prevalence of a high item score (%)a
	0	1	2	3	4
Headaches	1	2	5	13	50	3.535	88.7
Cognitive disturbances						3.061
Forgetfulness	3	3	7	27	31	3.127	81.7
Poor concentration	1	3	6	37	24	3.127	85.9
Thought processing	2	5	10	33	21	2.930	76.1
Mood disturbances						3.146
Irritability	2	3	12	29	25	3.014	76.1
Depressed mood	1	0	12	25	33	3.254	81.7
Frustration	2	1	7	34	27	3.169	85.9
Constitutional symptoms						3.174
Fatigue	1	0	1	23	46	3.592	93.0
Sleep quality	2	0	4	20	45	3.493	91.5
Restlessness	6	8	19	25	13	2.437	53.5
Visual disturbances						1.775
Blurred vision	20	4	21	19	7	1.845	36.6
Light sensitivity	11	3	15	23	19	2.507	59.2
Double vision	41	10	4	13	3	0.972	22.5
Vestibular disturbances						2.380
Dizziness	10	1	20	23	17	2.507	56.3
Nausea and/or vomiting	21	7	13	21	9	1.859	42.3
Noise sensitivity	10	3	10	18	30	2.775	67.6

Note:

a Defined by patients reporting a score of ≥3 on the corresponding Rivermead Post-Concussion Symptoms Questionnaire item measure.

Table 3 Comparison of PCS, PTSD, and PCT prevalence using different screening criteria for PCS in a sample of chronic pain patients after an MVC (n=71)

Disorder measure	RPQ	RPQ-6
Postconcussion syndrome
Mean RPQ score (SD)	44.14 (10.45)	12.47 (5.78)
Prevalence	100.0% (n=71)a	54.9% (n=39)b
Post-traumatic stress disorder
Mean PCL-5 score (SD)	56.90 (14.65)	56.90 (14.65)
Prevalencec	85.9% (n=61)	85.9% (n=61)
Polytrauma clinical triad
Prevalenced	85.9% (n=61)	52.1% (n=37)

Notes:

a Defined by patients meeting screening criteria for PCS established by Thompson et al²⁵: a total score of ≥16 on the Rivermead Post-Concussion Symptoms Questionnaire.¹⁴

b Defined by patients meeting screening criteria for PCS proposed in this study: a total score of ≥12 on the six items of the RPQ that relate to vestibular and visual symptoms of concussion.

c Defined by patients meeting screening criteria for PTSD: a total score of ≥44 on the Post-traumatic Stress Disorder checklist.

d Based on chronic pain patients screening positive for both PTSD and PCS.

Abbreviations: MVC, motor vehicle collision; PCL-5, post-traumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition; PCS, postconcussion syndrome; PCT, polytrauma clinical triad; PTSD, post-traumatic stress disorder; RPQ-6, six-item Rivermead Post-Concussion Symptoms Questionnaire.

Figure 1 The polytrauma clinical triad after MVC.

Notes: Distribution of patients with chronic pain, PCS, and PTSD in a sample of patients referred to The Seekers Center for chronic pain management following an MVC.
Abbreviations: MVC, motor vehicle collision; PCL-5, post-traumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition; PCS, postconcussion syndrome; PCT, polytrauma clinical triad; PTSD, post-traumatic stress disorder; RPQ, Rivermead Post-Concussion Symptoms Questionnaire.

Table 4 Independent samples, two-tailed Mann–Whitney U-test comparisons of headache, sleep quality, and pain outcomes in motor vehicle collision patients with and without PCT

Health outcomes	PCT sample (n=37)		Non-PCT sample (n=34)		P-value
	Mean	SD	Mean	SD
Headaches
Headaches per month	18.94	10.10	12.27	10.04	0.010
Baseline headache pain	7.24	1.80	5.41	3.01	0.007
Headache flare-up pain	9.48	0.68	8.42	1.69	0.016
Sleep quality
Pittsburgh Sleep Quality	17.17	5.50	14.20	5.65	0.033
Index Score
Pain
PainDETECT score	20.07	8.66	16.93	8.05	0.144
Baseline pain	7.54	1.50	5.94	2.40	0.003
Flare-up pain	9.38	0.80	8.85	0.95	0.025

Abbreviation: PCT, polytrauma clinical triad.

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