ORIGINAL ARTICLE

Whiplash associated disorder: incidence and natural history over the first month for patients presenting to a UK emergency department

R Crouch¹, R Whitewick¹, M Clancy¹, P Wright¹, P Thomas²

¹ Emergency Department, Southampton General Hospital, Southampton, Hampshire, UK
² Dorset Research and Development Support Unit Poole Hospital NHS Trust, Poole, Dorset, UK

Correspondence to:
Correspondence to:
Dr R Crouch
Emergency Department, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD, UK; Robert.Crouch{at}suht.swest.nhs.uk

Objectives: To describe the epidemiology, process of care, and outcomes at 4–6 weeks after injury among patients with whiplash associated disorder attending a UK emergency department.

Methods: All patients presenting during the study period with neck pain following a road traffic accident who met the inclusion criteria were assessed. Patients were followed up with a telephone interview at 4–6 weeks after attendance using the Neck Disability Index (NDI). The patient’s general practitioner (GP) was contacted post attendance to ascertain subsequent healthcare use.

Results: A total of 200 patients were recruited to the study, of which 30 were lost to follow up. Four variables, midline tenderness (p = 0.008; 95% CI 0.9 to 6.1), x ray request (p = 0.004; 0.9 to 6.1), wearing a seat belt (p = 0.038; 0.2 to 6.2), and having seen their GP post injury (p = 0.001; CI –10.5 to 6.6), were found to be associated with a higher NDI score at follow up. Significant correlation was identified with a high pain score and an increasing age of patient and high NDI scores. No correlation was found between the impact speed, speed of vehicle struck, or time since incident with the NDI. Two thirds of patients had some disability at 4–6 weeks after injury; 91 patients (54.5%) saw their GP in the intervening period between attending the department and telephone follow up, and 87/170 patients had no idea about their prognosis.

Conclusions: This study identifies that there is significant disability associated with whiplash associated disorder. Clear prognostic information would be a useful development.

Abbreviations: ADL, activities of daily living; GP, general practitioner; NDI, Neck Disability Index; RTA, road traffic accident

Keywords: neck pain; whiplash associated disorder

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