External Validation of a Clinical Prediction Rule to Predict Full Recovery and Ongoing Moderate/Severe Disability Following Acute Whiplash Injury

Abstract

Prognosis, level 1b.

Recovery Pathways and Prognosis After Whiplash Injury

“…External validation confirmed the reproducibility and accuracy of the whiplash CPR for individuals seeking health care for neck pain following an MVC, with a positive predictive value for the ongoing moderate/severe disability pathway of 90.9% (95% CI: 58.7%, 98.5%) and a positive predictive value for full recovery of 80% (95% CI: 62.5%, 91.7%). 37 Interestingly,…”

“…37,38 This CPR analyzed 8 previously identified predictor variables for poor recovery from 262 individuals who participated in 2 prospective, longitudinal studies. A dual-pathway CPR was derived using the Neck Disability Index (NDI) as the outcome measure that predicted ongoing moderate/severe disability and also predicted full recovery.…”

“…2,28 Only 3 of these CPRs have begun the validation process. 25,36,37 No prognostic CPRs have undergone impact analysis.…”

Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash?

“…35 Of note, the early and large expression of MFI has recently been shown to occur in those patients 35 at risk of poor recovery (higher painrelated disability, older age, and signs of hyperarousal). 101 While interesting, the precise mechanisms underlying muscular degeneration (leading to MFI), and their influence on recovery, remain largely unknown. There also remains equivocal evidence to suggest that changes in muscle cross-sectional area are not related to symptoms in the long term.…”

“…This includes not only acutely injured patients presenting to the emergency medicine department with concerns of significant pathology, but also those patients in whom the trajectory of recovery, based on known prognostic factors, is not consistent with a satisfactory outcome. 101 The primary guideline in the United States for diagnostic imaging is the American College of Radiology Appropriateness Criteria (ACR-AC). 2 The ACR-AC are a set of consensus-developed evidence-derived guidelines for health care providers to assist in decision making for imaging based on apparent health condition or potential condition requiring investigation.…”