In a prospective study, over 277 patients were followed within 1 week after whiplash at set intervals for 2 years. Most recovered by 6 months, but about 20% had pain 2 years later. Baseline physical - not emotional - factors predicted poor outcome.
Abstract
Records of 277 patients presenting for medicolegal reporting following isolated whiplash injury were studied retrospectively. A range of pre-accident, accident and response variables were recorded. Multivariate analysis was used to determine the main factors that predict physical and psychological outcome after whiplash injury. The factors that showed significant association with poor outcome on both physical and psychological outcome scales were pre-injury back pain, high frequency of General Practitioner attendance, evidence of pre-injury depression or anxiety symptoms, front position in the vehicle and pain radiating away from the neck after injury. The strongest associations were with factors that are present before impact. In this selected cohort of patients, there is a physical and a psychological vulnerability that may explain the widely varied response to low violence indirect neck injury.
Results
There were 97 males and 180 females, of mean age 39.9 years (range 15–81). The reports were completed between 9 months and 5 years after injury (average 21 months). There was no association between elapsed time and outcome.
The results of individual factor analysis (ANOVA testing) are shown in Table 2. Multivariate analysis determined the individual variables that most strongly predict a poor outcome (Table 3). Many of these were present before the accident. The factors that showed significant association with poor outcome on all three scales were pre-injury back pain, high frequency of GP attendance, evidence of pre-injury attendances to the GP for depressive or anxiety symptoms, front position in the vehicle and pain radiating away from the neck after injury.
Individual factor analysis
Females visited the GP more frequently in the 5-years prior to injury (Females mean 8.3±6.6 visits per annum, Males mean 5.0±3.8 visits per annum, P<0.05). When stratified by gender and age group, the mean number of GP attendances prior to injury only differed from the UK population average for certain groups (males between 35 years and 44 years and the females between 35 years and 64 years old). These groups had more consultations than expected (Table 4) [33].
Females were more likely than males to have documented pre-accident psychological or anxiety complaints (Females 51%, Males 34%, P<0.05). On multivariate analysis, this was the factor most strongly predictive of poor outcome on all three scales. At the time of medicolegal reporting, 64% of females and 62% of males had abnormal GHQ scores suggestive of a diagnosable psychiatric disorder (≥6).
