Whiplash Injury

Whiplash Injury:

More than 3 million Americans suffer whiplash each year, which now accounts for 45% of chronic neck pain in adults. New car design prevents fatal crashes with a reduction in injuries occurring at higher speeds.  Unfortunately, the increased the stiffness of cars in lower velocity crashes increased whiplash injuries.

Approximately 3 million people in the United States suffer from whiplash annually, resulting in an estimated $43 billion in comprehensive costs. Studies report rises in whiplash injuries from a low of 7.2% in 1982 to 30% by 1997. As the incidence of whiplash has increased, so have the rates of disability: whiplash may account for as much as 45% of chronic neck pain in adults.   A significant portion of people who suffer from whiplash injuries seek some form of compensation.

Seat belt and shoulder harness use provides life-saving protection in most crashes, but increase the risk for whiplash injury:

The rise in seatbelt use in the US since the introduction of primary- and secondary-use laws has contributed to the increased incidence of whiplash injury. Increased stiffness of seat backs also has been a contributing factor. The relative risk of being injured in a crash was related to model year, the risk of being injured in a 1990s era model was 2.7 times that of being injured in a 1980s model.

A significant factor in the increase in whiplash claims has been the automotive industry’s attempt to manage the increasing crash energy recommended by the National Highway Traffic Safety Administration’s (NHTSA) New Car Assessment Program (NCAP) and the Insurance Institute for Highway Safety’s (IIHS) 40% offset deformable barrier crash tests.   To perform well on these crash tests, manufacturers have increased the stiffness of passenger cars by using stronger alloys of steel and aluminum and made other structural modifications, vehicle stiffness has increased by approximately 34%. While this has led to a reduction in injuries occurring at higher speeds (30-40 mph), it has increased the stiffness of cars in lower velocity crashes translating to greater occupant force transmission.  Airbags do not have any effect on whiplash injuries caused by rear impact collisions; they only deploy in frontal- or side-impact (or roll-over) collisions.

On measuring a whiplash injury:
ROM is an important prognostic factor and that it correlates well with ongoing impairment:

Reduced ROM allowed differentiation between non-symptomatic and long-term whiplash victims, with a sensitivity of 86.2% and a specificity of 95.3%.   After whiplash injury, cervical ROM had predictive value for outcome and correlates with long-term disability.

Malingering:
The method recommended by the AMA Guides for detecting malingering is significantly less sensitive than the method of applying a coefficient of variation (CV) statistics

Medicolegal relevance:
The 1993 Supreme Court ruling (Daubert v Merrell Dow) defined the landscape of medicolegal testimony of experts, making trial judges the gatekeepers of scientific expert testimony on the basis on 4 criteria:

1. Whether the theory or technique can be, and has been, tested.
2. Whether the theory or technique has been subjected to peer review.
3. The known or potential rate of error of the method used.
4. The degree of the methods or conclusion’s acceptance within the relevant scientific community.

References:

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NSAIDS or nonsteroidal anti-inflammatory drugs are common medications that reduce inflammation and relieve fever and pain by blocking enzymes and proteins made by the body. They are usually available over the counter without a prescription. Given its relatively safe profile, NSAIDS have enjoyed widespread availability and consumer use. However, this does not mean NSAIDS are harmless.

In a study conducted by the Copenhagen University Hospital Gentofte, researchers have found a strong link between an increased risk of cardiac arrest and NSAID use. The researchers analyzed over 28,000 patients in Denmark who suffered a cardiac arrest within a 10 year period. The results were shocking. The patients who suffered an episode of a cardiac arrest showed a history of NSAID uses 30 days prior to the episode. Furthermore, the study broke down the kind of NSAID present before the episode and tallied the corresponding risk. In the study, Ibuprofen was linked to a 30 percent increase in cardiac arrest risk, while diclofenac was linked to a whopping 50 percent rise in the risk.

The researcher believe that there is a place for NSAIDS in the treatment of pain and inflammation but given the insidious risk involve in its use, patients should be extra cautious when considering taking it in the long run.

Common painkillers linked to greater risk of cardiac arrest

Common painkillers linked to greater risk of cardiac arrest