Natural course of symptoms after rear-end car collisions – adapted from the Lancet 1996;347:1207-11 – Tips from Other Journals
Chronic whiplash injury, comprising a cluster of persistent symptoms dominated by neck and head pain, has been controversial since it was first described in 1928. Studies have reported that symptoms persist for several months in up to 75 percent of persons injured in rear-end vehicle collisions, but these studies are subject to bias because of patient selection and secondary gain from compensation. Schrader and colleagues sought to overcome such biases by interviewing persons in a Lithuanian city who had been injured but had no familiarity with whiplash syndrome and little motivation for secondary gain. In Lithuania, few car drivers and passengers are covered by insurance, and there is little awareness in the general public about the potentially disabling consequences of a whiplash injury.
Police records were used to identify persons injured one to three years previously in significant rear-end impact accidents. Of 240 persons involved in such accidents, 202 (157 men and 45 women) completed a health questionnaire that incorporated questions about headache, neck pain and low back pain, as well as other symptoms and diseases. Subjects who reported neck pain or headache were asked to complete a second, more detailed questionnaire about the type, frequency and severity of the complaint and any chronic difficulties with concentration and memory disturbances. All of the 202 participants received a third questionnaire eliciting information about the circumstances of their accident, and this time they were told the real reason for the contact. A control group of sex- and age-matched subjects were selected from the community register. Any person in the control group who reported an involvement in a motor vehicle accident was excluded.
The mean time elapsed since the accident was 21.7 months. Just over one-half (55 percent) of the accidents resulted in severe or moderate damage to the vehicle. Seat belts were operating in 54 percent of cases, but only 22 percent of the vehicles had correctly positioned headrests. None of the 202 accident victims reported persistent or disabling symptoms. Neck pain was reported by a similar proportion of accident victims and control subjects (35.1 percent versus 33.2 percent). No statistically significant difference was demonstrated in the prevalence of headaches between accident victims and control subjects (53.0 percent versus 49.5 percent).
Of the participants who reported chronic neck pain or daily headache after the accident, substantial numbers had similar symptoms before the accident (seven of 17 persons reporting chronic pain and 10 of 12 persons reporting daily headache). The prevalence of symptoms was not related to collision speed, extent of damage to the vehicle, use of a headrest, use of seat belts, or time elapsed since the collision. The strongest determinant of both neck pain and headache was family history.
The authors conclude that their findings implicate societal beliefs and other factors as causes of persistent symptoms following rear-end collisions, rather than the impact itself. In a society with little awareness of the “whiplash syndrome” and no insurance or legal expectations of compensation, the late whiplash syndrome does not appear to exist. (Schrader H, et al. Natural evolution of late whiplash syndrome outside the medicolegal context. Lancet 1996;347:1207-11.)
COPYRIGHT 1996 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group