Open Access Study protocol

Using emergency department-based inception cohorts to determine genetic characteristics associated with long term patient outcomes after motor vehicle collision: Methodology of the CRASH study

Timothy F Platts-Mills12*, Lauren Ballina1, Andrey V Bortsov1, April Soward1, Robert A Swor3, Jeffrey S Jones4, David C Lee5, David A Peak6, Robert M Domeier7, Niels K Rathlev8, Phyllis L Hendry9 and Samuel A McLean12

Author Affiliations

1 Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA

2 Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina, USA

3 Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA

4 Department of Emergency Medicine, Spectrum Health - Butterworth Campus, Grand Rapids, Michigan, USA

5 Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, USA

6 Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA

7 Department of Emergency Medicine, St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA

8 Department of Emergency Medicine, Baystate Medical Center, Springfield, Massachusetts, USA

9 Department of Emergency Medicine and Pediatrics, University of Florida-Jacksonville, Jacksonville, Florida, USA

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BMC Emergency Medicine 2011, 11:14  doi:10.1186/1471-227X-11-14

Published: 26 September 2011

Abstract

Background

Persistent musculoskeletal pain and psychological sequelae following minor motor vehicle collision (MVC) are common problems with a large economic cost. Prospective studies of pain following MVC have demonstrated that demographic characteristics, including female gender and low education level, and psychological characteristics, including high pre-collision anxiety, are independent predictors of persistent pain. These results have contributed to the psychological and social components of a biopsychosocial model of post-MVC pain pathogenesis, but the biological contributors to the model remain poorly defined. Recent experimental studies indicate that genetic variations in adrenergic system function influence the vulnerability to post-traumatic pain, but no studies have examined the contribution of genetic factors to existing predictive models of vulnerability to persistent pain.

Methods/Design

The Project CRASH study is a federally supported, multicenter, prospective study designed to determine whether variations in genes affecting synaptic catecholamine levels and alpha and beta adrenergic receptor function augment social and psychological factors in a predictive model of persistent musculoskeletal pain and posttraumatic stress disorder (PTSD) following minor MVC. The Project CRASH study will assess pain, pain interference and PTSD symptoms at 6 weeks, 6 months, and 1 year in approximately 1,000 patients enrolled from 8 Emergency Departments in four states with no-fault accident laws.

Discussion

The results from this study will provide insights into the pathophysiology of persistent pain and PTSD following MVC and may serve to improve the ability of clinicians and researchers to identify individuals at high risk for adverse outcomes following minor MVC.