NATURAL EVOLUTION OF LATE WHIPLASH SYNDROME OUTSIDE THE MEDICOLEGAL CONTEXT

Background In Lithuania, few car drivers and passengers are covered by insurance and there is little awareness among the general public abou t the potentially disabling consequences of a whiplash injury. We took this opportunity to study the natural course of head and neck symptom s after rear-end car collisions.Methods In a retrospective questionnai re-based cohort study, 202 individuals (157 men; 45 women) were identi fied from the records of the traffic police department in Kaunas, Lith uania. These individuals were interviewed 1-3 years after experiencing a rear-end car collision. Neck pain, headache, subjective cognitive d ysfunction, psychological disorders, and low back pain in this group w ere compared with the same complaints in a sex-matched and age-matched control group of uninjured individuals selected randomly from the pop ulation register of the same geographic area. Findings Neck pain was r eported by 71 (35% [95% CI 29-42]) accident victims and 67 (33% [27-40 ]) controls. Headache was reported by 107 (53% [46-60]) accident victi ms and 100 (50% [42-57]) controls. Chronic neck pain and chronic heada che (more than 7 days per month) were also reported in similar proport ions (17 [8 . 4%; 5-13] vs 14 [6 . 9%; 4-12] and 19 [9 . 4%; 6-15] vs 12 [5 . 9%; 3-10]) by the two groups, Of those who reported chronic ne ck pain or daily headache after the accident, substantial proportions had had similar symptoms before the accident (7/17 for chronic neck pa in; 10/12 for daily headache). There was no significant difference fou nd. No one in the study group had disabling or persistent symptoms as a result of the car accident. There was no relation between the impact severity and degree of pain. A family history of neck pain was the mo st important risk factor for current neck symptoms in logistic regress ion analyses. Interpretation Our results suggest that chronic symptoms were not usually caused by the car accident. Expectation of disabilit y, a family history, and attribution of pre-existing symptoms to the t rauma may be more important for the evolution of the late whiplash syn drome.