Editorials

Whiplash after motor vehicle crashes

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5966 (Published 04 October 2013) Cite this as: BMJ 2013;347:f5966
  1. Les Barnsley, head of department of rheumatology
  1. 1Concord Hospital, Concord West, NSW 2139, Australia
  1. les.barnsley{at}sswahs.nsw.gov.au

Best approach mirrors that for acute low back pain—education, exercise, and return to usual activities

The debate over whiplash injuries over the past 20 years is reminiscent of incandescent globes, generating more heat than light and using important energy. We know that the overwhelming majority of patients with neck pain after motor vehicle crashes recover completely over a few weeks. The problem is the cohort with ongoing symptoms, which often extend beyond the neck and are not associated with clinical or radiological abnormalities. This group of patients are often inextricably involved with insurance claims, and this in itself attracts pejorative views from some practitioners.

Studies into the proportion of patients with chronic symptoms and the determinants of these symptoms have varied in design and execution, with a particular problem being the sampling point. Counting insurance claims is fraught with behavioural, motivational, and jurisdictional confounders. Identifying patients as they present to hospital risks including only those with more severe initial symptoms. Police records depend on complete and accurate reporting. Mindful of these limitations, the cohort followed robustly by Gargan and colleagues over 30 years shows that more than a third of patients still have …

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