Long-Term Outcome after Whiplash Injury: A 2-Year Follow-Up Considering Features of Injury Mechanism and Somatic, Radiologic, and Psychosocial Findings

Abstract

With the increased incidence of whiplash injury following the introduction of compulsory car seat belts, a large number of reports have dealt with the aftermath of this condition. Previous studies, however, focused on somatic symptoms on the one hand or considered only psychological or neuropsychological variables on the other hand, often in loosely defined or selected groups of patients. No study so far has analyzed the long-term outcome in a nonselected group of patients using a clear injury definition considering patient history; somatic, radiologic, and neuropsychological findings; and features of the injury mechanisms assessed soon after trauma and during follow-up. the present investigation was designed to assess these combined factors. According to a strict definition of whiplash injury, we assessed a consecutive nonselected sample of 117 patients with recent injury who had similar sociocultural and educational backgrounds. The patients had been in automobile crashes and were all equally covered by accident insurance according to the country-wide scheme. Initial examination was performed 7.2 +/- 4.2 days after trauma, and follow-up examinations 3, 6, 12, and 24 months later. At baseline, features of injury mechanism, subjective complaints, and different aspects of patient history were documented and cervical spine X rays performed. At all examinations patients underwent neurologic examination and cognitive and psychosocial factor assessment. At 2 years, patients were divided into symptomatic and asymptomatic groups and then compared with regard to the initial findings. In addition, symptomatic patients who were disabled at the 2-year follow-up examination and symptomatic patients not disabled (that is, they were able to work at the pretraumatic level) were compared regarding initial and 2-year findings. At 2 years, 18% of patients still had injury-related symptoms. With regard to baseline findings the following significant differences were found: Symptomatic patients were older, had higher incidence of rotated or inclined head position at the time of impact, had higher prevalence of pretraumatic headache, showed higher intensity of initial neck pain and headache, complained of a greater number of symptoms, had a higher incidence of symptoms of radicular deficit and higher average scores on a multiple symptom analysis, and displayed more degenerative signs (osteoarthrosis) on X ray. In addition, symptomatic patients scored higher with regard to impaired well-being and performed worse on tasks of attentional functioning and showed more concern with regard to long-term suffering and disability.(ABSTRACT TRUNCATED AT 400 WORDS)

Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up

“…Our results were not in line with the prior studies' observations of pre-existing degenerative findings being related to a poor prognosis [5,31]. Signs of disc degeneration considered to be pre-existing were frequent but not related to more intense pain at neither baseline nor followup.…”

Neck pain and disability following motor vehicle accidents?a cohort study

“…In the acute stage the neck pain is attributed to soft-tissue injuries to the cervical region [18,24]. Neck pain and headache are the most frequently reported features of the condition [16], termed whiplash associated disorder (WAD) [20].…”

Neither the WAD-classification nor the Quebec Task Force follow-up regimen seems to be important for the outcome after a whiplash injury. A prospective study on 186 consecutive patients

“…The QTF-cohort study [20] found chronic symptoms in 13%, 6 months after MVA. In an other study [19], 18% of WAD cases still had complaints after 2 years, while yet another study [18] reported a recovery rate at 66% after 18 months. Female gender was a risk factor for injury to the neck in two studies [9,16].…”

“…Studies on the recovery rate in WAD has shown variable results; 13-66% of recovery [13,[18][19][20]. The QTF-cohort study [20] found chronic symptoms in 13%, 6 months after MVA.…”