ORIGINAL ARTICLE

Predictors of persistent neck pain after whiplash injury

K Atherton¹, N J Wiles⁴, F E Lecky³, S J Hawes⁵, A J Silman⁶, G J Macfarlane² and G T Jones³

¹ Institute of Child Health, University College London, London, UK
² Aberdeen Pain Research Collaboration, Epidemiology Group, University of Aberdeen, Aberdeen, UK
³ Unit of Chronic Disease Epidemiology, Division of Epidemiology and Health Sciences, University of Manchester, Manchester, UK
⁴ Academic Unit of Psychiatry, Department of Community Based Medicine, University of Bristol, Bristol, UK
⁵ Department of Emergency Medicine, Wythenshawe Hospital, Manchester, UK
⁶ Arthritis Research Campaign (ARC) Epidemiology Unit, Division of Epidemiology and Health Sciences, University of Manchester, Manchester, UK

Correspondence to:
Correspondence to:
Dr G Jones
Epidemiology Group, Department of Public Health University of Aberdeen, Polwarth building, Foresterhill, Aberdeen AB25 2ZD, UK; gareth.jones{at}abdn.ac.uk

Objective: To establish the aetiological influences of persistent neck pain following a motor vehicle collision and to construct a model for use in the emergency department for identifying patients at high risk of persistent symptoms.

Design: Prospective cohort study. Patients recruited from hospital emergency departments were sent a questionnaire to gather information on various exposures. They were followed up at 1, 3, and 12 months to identify those with persistent symptoms.

Main outcome measure: Persistent neck pain (pain at 1, 3, and 12 months after collision).

Results: The baseline survey included 765 patients. Subsequently, 480 completed a questionnaire at each follow up time point, of whom 128 (27%) reported neck pain on each occasion. Few collision specific factors predicted persistent neck pain. In contrast, a high level of general psychological distress, pre-collision history of widespread body pain, type of vehicle, whiplash associated symptoms, and initial neck disability best predicted the persistence of symptoms. Furthermore, these factors, in combination, accounted for more than a fivefold increase in the risk of persistent neck pain.

Conclusion: The greatest predictors of persistent neck pain following a motor vehicle collision relate to psychological distress and aspects of pre-collision health rather than to various attributes of the collision itself. With these factors, and those relating to initial injury severity, it is possible to identify a subgroup of patients presenting with neck pain with the highest risk of persistent symptoms. Thus, it is possible to identify whiplash patients with a poor prognosis and to provide closer follow up and specific attention to management in these individuals.

Abbreviations: GHQ, General Health Questionnaire; MSPQ, Modified Somatic Perceptions Questionnaire; VAS, visual analogue scale; WAD, whiplash associated disorder

Keywords: whiplash; prognosis; predictors; epidemiology

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