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A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study.

ABSTRACT: An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented.The design was an observational prospective study of risk factors embedded in a randomised controlled study.Acute whiplash patients from units, general practitioners in four Danish counties were referred to two research centres.During a 2-year inclusion period, acute consecutive whiplash-injured (age 18-70 years, rear-end or frontal-end car accident and WAD (whiplash-associated disorders) grades I-III, symptoms within 72 h, examination prior to 10 days postinjury, capable of written/spoken Danish, without other injuries/fractures, pre-existing significant somatic/psychiatric disorder, drug/alcohol abuse and previous significant pain/headache). 688 (438 women and 250 men) participants were interviewed and examined by a study nurse after 5 days; 605 were completed after 1 year. A risk score which included items of initial neck pain/headache intensity, a number of non-painful complaints and active neck mobility was applied. The primary outcome parameter was 1-year work disability.The risk score and number of sick-listing days were related (Kruskal-Wallis, p<0.0001). In stratum 1, less than 4%, but in stratum 7, 68% were work-disabled after 1 year. Early work assessment (p<0.0001), impact of the event questionnaire (p<0.0006), psychophysical pain measures being McGill pain questionnaire parameters (p<0.0001), pressure pain algometry (p<0.0001) and palpation (p<0.0001) showed a significant relationship with risk stratification.Findings confirm previous studies reporting intense neck pain/headache and distress as predictors for work disability after whiplash. Neck-mobility was a strong predictor in this study; however, it was a more inconsistent predictor in other studies.Application of the risk assessment score and use of the risk strata system may be beneficial in future studies and may be considered as a valuable tool to assess return-to-work following injuries; however, further studies are needed.

SUBMITTER: Kasch H

PROVIDER: S-EPMC3563124 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study.

Kasch Helge H Kongsted Alice A Qerama Erisela E Bach Flemming W FW Bendix Tom T Jensen Troels Staehelin TS

BMJ open 20130130 1

<h4>Objectives</h4>An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented.<h4>Design</h4>The design was an observational prospective study of risk factors embedded in a randomised controlled study.<h4>Setting</h4>Acute whiplash patients from units, general practitioners in four Danish counties were referred to two research centres.<h4>Participants</h4>During a 2-year inclusion period, acute consecutive whi ...[more]

PMID: 23370009

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Project description:BackgroundIndividuals' expectations on returning to work after an injury have been shown to predict the duration of time that a person with work-related low back pain will remain on benefits; individuals with lower recovery expectations received benefits for a longer time than those with higher expectations. The role of expectations in recovery from traumatic neck pain, in particular whiplash-associated disorders (WAD), has not been assessed to date to our knowledge. The aim of this study was to investigate if expectations for recovery are a prognostic factor after experiencing a WAD.Methods and findingsWe used a prospective cohort study composed of insurance claimants in Sweden. The participants were car occupants who filed a neck injury claim (i.e., for WAD) to one of two insurance companies between 15 January 2004 and 12 January 2005 (n = 1,032). Postal questionnaires were completed shortly (average 23 d) after the collision and then again 6 mo later. Expectations for recovery were measured with a numerical rating scale (NRS) at baseline, where 0 corresponds to "unlikely to make a full recovery" and 10 to "very likely to make a full recovery." The scale was reverse coded and trichotomised into NRS 0, 1-4, and 5-10. The main outcome measure was self-perceived disability at 6 mo postinjury, measured with the Pain Disability Index, and categorised into no/low, moderate, and high disability. Multivariable polytomous logistic regression was used for the analysis. There was a dose response relationship between recovery expectations and disability. After controlling for severity of physical and mental symptoms, individuals who stated that they were less likely to make a full recovery (NRS 5-10), were more likely to have a high disability compared to individuals who stated that they were very likely to make a full recovery (odds ratio [OR] 4.2 [95% confidence interval (CI) 2.1 to 8.5]. For the intermediate category (NRS 1-4), the OR was 2.1 (95% CI 1.2 to 3.2). Associations between expectations and disability were also found among individuals with moderate disability.ConclusionsIndividuals' expectations for recovery are important in prognosis, even after controlling for symptom severity. Interventions designed to increase patients' expectations may be beneficial and should be examined further in controlled studies.

Project description:ObjectiveOur aim was to develop a risk stratification model to predict the presence of a potentially more sinister injury in patients exposed to a whiplash trauma.MethodsThe study base comprised of 3,115 residents who first sought healthcare contact within one week after being exposed to a whiplash trauma between 1999-2008, from within a defined geographical area, Skaraborg County in south-western Sweden. Information about gender, age, time elapsed prior to seeking care, type of health care contact, and hospitalisation was retrieved. Seventeen potential risk factors were identified and evaluated using multivariable logistic regression.ResultsOf 3,115 patients, 215 (6.9%) required hospital admission so theoretically 93% could have been initially assessed by primary health care. However, only 46% had their first contact in primary health care. All patients had symptoms resulting in a diagnosis of whiplash injury. Four risk factors were found to be associated with hospital admission: commotio cerebri (OR 31, 19-51), fracture / luxation (OR 11, 5.1-22), serious injury (OR 41, 8.0-210), and the patient sought care during the same day as the trauma (OR 5.9, 3.7-9.5). These four risk factors explained 27% of the variation for hospital admission and the area under curve (AUC) was 0.77 (0.74-0.80). Ninety-six percent of patients (2,985) had only a whiplash injury with no other injury. These could be split into those attending health care the same day as the trauma, 1,737 (56%) with a 7.1% risk for hospital admission, and those attending health care later, 1,248 (40%) with a 1.3% risk for hospital admission.ConclusionPatients with no signs of commotio cerebri, no fracture/luxation injury, no serious injury, comprising 96% of all patients exposed to a whiplash trauma can initially be referred to primary health care for initial assessment. However, those contacting the health care the same day as the trauma should be referred to a hospital for evaluation if they can't get an appointment with a general practitioner the same day.

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A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study.

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A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study.

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