PRESENTING SYMPTOMS AND SIGNS AFTER WHIPLASH INJURY - THE INFLUENCE OF ACCIDENT MECHANISMS

Objective: To assess the relationship between accident mechanisms and initial findings after whiplash injury. Design: Cohort study. Setting: Outpatient department, Department of Neurology, University of Berne, Switzerland. Patients: A population-based sample of 137 consecutive pa tients referred by primary care physicians. Fractures or dislocations of the cervical spine, head trauma, and preexisting neurologic disorde rs were exclusion criteria. Main outcome measures: Patients were inter viewed and examined within 7.2 days (SD, 3.9 days) after trauma. Analy zed accident features were position in the car, use of seat belt, head restraint and its point of head contact, damage to seat, head positio n and state of preparedness at the moment of impact, and type of colli sion. Analyzed symptoms were intensity and onset delay of post-traumat ic head and neck pain; pain in the shoulders, back, and anterior neck; symptoms of neurologic dysfunction according to presumed origin-crani al nerve or brainstem, radicular or myelopathic; and a score of multip le symptoms. Analyzed signs were neck muscle tenderness and restricted neck movement, and signs of cranial nerve, brainstem, or radicular dy sfunction. Results: Passenger position in the car, use of seat belt, a nd the presence of a head restraint showed no significant relationship with findings. Rotated or inclined head position at the moment of imp act was associated with a higher frequency of multiple symptoms (p = 0 .045 and 0.008) with more severe symptoms and signs of musculoligament al cervical strain (p = 0.048 and 0.038) and of neural, particularly r adicular (p = 0.031 and 0.019), damage. Unprepared occupants had a hig her frequency of multiple symptoms (p = 0.031) and more severe headach e (p = 0.046). Rear-end collision was associated with a higher frequen cy of multiple symptoms (p = 0.006), especially of cranial nerve or br ainstem dysfunction (p = 0.00003). Conclusion: Three features of accid ent mechanisms were associated with more severe symptoms: an unprepare d occupant; rear-end collision, with Or without subsequent frontal imp act; and rotated or inclined head position at the moment of impact.