The relation between initial symptoms and signs and the prognosis of whiplash

Whiplash, a common injury following motor vehicle crashes, is associated wi th high costs and a prognosis that is variable and difficult to predict. We studied the profile of recovery from whiplash and assessed whether present ing signs and symptoms directly after the crash were predictive of whiplash prognosis. We formed a population-based incident cohort of all 2627 indivi duals who sustained a whiplash injury resulting from a motor vehicle crash in the province of Quebec, Canada, in 1987, and followed these patients for up to 7 years. The data on signs and symptoms were obtained from the medic al charts kept by the universal automobile insurance plan (Societe de l'ass urance automobile du Quebec), which covers all 7 million residents of the p rovince, while data on the outcome - the recovery time from whiplash - was obtained from their databases. The median recovery time was 32 days, and 12 % of subjects had still not recovered after 6 months. The signs and symptom s that were found to be independently associated with a slower recovery fro m whiplash, besides female gender and older age, are neck pain on palpation , muscle pain, pain or numbness radiating from the neck to arms, hands or s houlders, and headache. Together, these factors in older females (age 60) p redicted a median recovery time of 262 days, compared with 17 days for youn ger males (age 20) who do not have this profile. III contrast, using a clas sification of injury severity previously proposed by the Quebec Whiplash As sociated Disorders Task Force, the median recovery time varied from 17 to o nly 123 days. We conclude that whiplash patients presenting with several sp ecific musculoskeletal and neurological signs and symptoms will have a long er recovery period. These patients can easily be identified and closely mon itored and targeted for the evaluation of early intervention programmes aim ed at managing whiplash patients with a poor prognosis.