THE EFFECT OF ACCIDENT MECHANISMS AND INITIAL FINDINGS ON THE LONG-TERM COURSE OF WHIPLASH INJURY

The aim of this study was to assess the relationships between accident mechanisms as well as initial findings and the long-term course of wh iplash injury. A representative sample of 117 consecutive patients ref erred by primary care physicians was followed-up over 12 months. Fract ures or dislocations of the cervical spine, head trauma and pre-existi ng neurological disorders were exclusion criteria. The interval betwee n the accident and the baseline examination was 7.4 days (SD 4.2 days) . Assessment included accident features (e.g. passenger position in th e car, head restraint, head position, type of collision), initial symp toms (e.g. intensity and onset of pain, symptoms of neurological dysfu nction, multiple symptom score), and signs (restricted neck movement, neurological deficits). At the 1-year examination, patients were divid ed into an asymptomatic and a symptomatic group and were compared with respect to accident features and baseline findings. Twenty-four perce nt of patients were still symptomatic after 1 year. Analysing accident mechanisms separately, rotated or inclined head position was the prim ary feature related to symptom persistence (P = 0.005). The symptomati c group scored higher at baseline on the multiple symptom rating (P = 0.004) and had a higher incidence of initial headache (P = 0.004) and neurological symptoms (P = 0.008) together with a higher intensity of headache (P = 0.0002) and neck pain (P = 0.0009). The following set of initial variables predicted persistence of symptoms at 1 year (logist ic regression): intensity of neck pain (P = 0.001) and headache (P = 0 .009), rotated or inclined head position (P = 0.02), unpreparedness at the time of impact (P = 0.01) and car stationary when hit (P = 0.01). In conclusion, accident mechanisms and initial findings suggestive of more severe injury were significantly related to longterm persistence of symptoms after whiplash injury.