CERVICAL WHIPLASH 1997-8
Article References & Abstracts
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PROGNOSIS
Article References & Abstracts
 
17.  AUTHOR  Freeman MD; Croft AC; Rossignol AM
INSTITUTION Department of Public Health and Preventive Medicine, Oregon Health Sciences University School of Medicine, Portland, USA.
TITLE  "Whiplash associated disorders: redefining whiplash and its management" by the Quebec Task Force. A critical evaluation.
SOURCE  Spine 1998 May 1;23(9):1043-9 ISSN 0362-2436 
ABSTRACT STUDY DESIGN: The two publications of the Quebec Task Force on Whiplash-Associated Disorders were evaluated by the authors of this report for methodologic error and bias. OBJECTIVES: To determine whether the conclusions and recommendations of the Quebec Task Force on Whiplash-Associated Disorders regarding the natural history and epidemiology of whiplash injuries are valid. SUMMARY OF THE BACKGROUND DATA: In 1995, the Quebec Task Force authored a text (published by the Societe de l'Assurance Automobile du Quebec) and a pullout supplement in Spine entitled "Whiplash-Associated Disorders: Redefining Whiplash and its Management." The Quebec Task Force concluded that whiplash injuries result in "temporary discomfort," are "usually self-limited," and have a "favorable prognosis," and that the "pain [resulting from whiplash injuries] is not harmful." METHODS: The authors of the current report reviewed the text and the supplement for methodologic flaws that may have threatened the validity of the conclusions and recommendations of the Quebec Task Force. RESULTS: Five distinct and significant categories of methodologic error were found. They were: selection bias, information bias, confusing and unconventional use of terminology, unsupported conclusions and recommendations, and inappropriate generalizations from the Quebec Cohort Study. CONCLUSION: The validity of the conclusions and recommendations of the Quebec Task Force regarding the natural course and epidemiology of whiplash injuries is questionable. This lack of validity stems from the presence of bias, the use of unconventional terminology, and conclusions that are not concurrent with the literature the Task Force accepted for review. Although the Task Force set out to redefine whiplash and its management, striving for the desirable goal of clarification of the numerous contentious issues surrounding the injury, its publications instead have confused the subject further.

18.  AUTHOR  Harder S; Veilleux M; Suissa S
INSTITUTION Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
TITLE  The effect of socio-demographic and crash-related factors on the prognosis of whiplash
SOURCE  J Clin Epidemiol 1998 May;51(5):377-84 ISSN 0895-4356
ABSTRACT Whiplash injury, common after a motor vehicle crash, has a variable prognosis that is difficult to predict. To assess the role of various factors on this prognosis, we assembled a historical cohort of 3014 individuals who sustained a whiplash injury resulting from a motor vehicle crash in the Province of Quebec, Canada, in 1987 and were followed for 6 years. The data were obtained from the computerized databases created by the province's universal automobile insurance plan and police accident reports. The recovery time from whiplash, as measured by duration of compensation, was the primary outcome. Socio-demographic and crash-related factors measured at the time of the crash were investigated. The median recovery time for the cohort was 31 days, with 22% recovering within a week and 3% still not recovered after 1 year. For the 1551 subjects with a whiplash injury only, the socio-demographic factors that were found to be independently associated with a slower recovery from whiplash in this cohort are female gender, older age, having dependents, and not having full-time employment. The significant crash-related factors are occupancy in a truck or bus, being a passenger in the vehicle, colliding with a moving object, and being in a head-on or perpendicular collision. We classified the subjects according to a prediction score ranging from 0 to 11, devised from these factors. Subjects with a score of 0 to 2, that is those who had at most two risk factors present, had the fastest median recovery time of 19 days compared with 71 days for subjects who had a score of 6 or more. We conclude that several sociodemographic and crash-related factors are independently associated with a slow and costly recovery from whiplash injury. They are easily measurable at the time of the crash and combined so as to be simply incorporated in intervention programs aimed at early identification and management of whiplash patients with a poor prognosis.

19.  AUTHOR  Dolinis
INSTITUTION Department of Community Medicine, University of Adelaide, Australia.
TITLE  Risk factors for 'whiplash' in drivers: a cohort study of rear-end traffic crashes.
SOURCE  Injury 1997 Apr;28(3):173-9 ISSN 0020-1383
ABSTRACT 'Whiplash' injuries are a common cause of road traffic accident (RTA) related morbidity. However, few epidemiological studies have investigated risk factors associated with the occurrence of such injuries. The purpose of this study was to examine relationships between vehicle and occupant factors and the incidence of 'whiplash' in drivers with recent experience of a rear-end impact in an RTA. A cohort of 246 car drivers with recent experience of a rear-end impact in the Adelaide metropolitan area was recruited. Structured telephone interviews were used to obtain information about driver demographics, the circumstances of the crash, and injuries resulting from the crash. Two factors were identified as independent risk factors for 'whiplash' injury: a history of neck injury (adjusted odds ratio = 4.50, 95 per cent confidence interval 1.97-10.28) and female sex (adjusted odds ratio = 2.08, 95 per cent confidence interval 1.13-3.82). The relative weight of the striking vehicle to the driver's vehicle was also positively associated with risk of 'whiplash' injury. There was no evidence that the driver's occupation or level of education are predictors of occurrence. Methodological aspects of the study which might have resulted in bias are discussed and suggestions are given for overcoming these in future work.

20.  AUTHOR  Gargan M; Bannister G; Main C; Hollis S
INSTITUTION Southmead Hospital, Westbury-on-Trym, Bristol, England.
TITLE  The behavioural response to whiplash injury [see comments]
SOURCE  J Bone Joint Surg Br 1997 Jul;79(4):523-6 ISSN 0301-620X 
ABSTRACT We studied 50 consecutive patients presenting at an accident department after rear-end vehicle collisions and recorded symptoms and psychological test scores within one week of injury, at three months and at two years. The range of neck movement was noted at three months. Within one week of injury, psychological test scores were normal in 82% of the group but became abnormal in 81% of the patients with intrusive or disabling symptoms at over three months (p 0.001) and remained abnormal in 69% at two years. The clinical outcome after two years could be predicted at three months with 76% accuracy by neck stiffness, 74% by psychological score and 82% by a combination of these variables. The severity of symptoms after a whiplash injury is related both to the physical restriction of neck movement and to psychological disorder. The latter becomes established within three months of the injury.

21.  AUTHOR  Wallis BJ; Lord SM; Barnsley L; Bogduk N
INSTITUTION Cervical Spine Research Unit, Faculty of Medicine and Health Sciences, The University of Newcastle, NSW, Australia.
TITLE  The psychological profiles of patients with whiplash-associated headache.
SOURCE  Cephalalgia 1998 Mar;18(2):101-5; discussion 72-3 ISSN 0333-1024 
ABSTRACT Headache often compounds chronic neck pain following whiplash injury. To better understand post-traumatic headache, the SCL-90-R symptom checklist was used to determine the psychological profiles of patients with whiplash-associated headache and of patients with whiplash-associated neck pain without headache. The psychological profiles of these patients were compared with previously published SCL-90-R profiles of patients with post-traumatic and nontraumatic headache, and of the normal population. Patients with whiplash-associated headache were not significantly different from those with other forms of post-traumatic headache or with whiplash-associated neck pain without headache. However, when patients with whiplash-associated headache and patients with nontraumatic headache were compared to normal data, significant differences emerged. Patients with nontraumatic headache exhibited higher scores on all subscales, whereas patients with whiplash-associated headache differed from the normal sample only on somatization, obsessive-compulsive, depression and hostility subscales, and the global severity index. These differences imply that patients with whiplash-associated headache suffer psychological distress secondary to chronic pain and not from tension headache and generalized psychological distress.
 
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