A prospective study of 39 patients with whiplash injury

DEFF Research Database (Denmark)

Karlsborg, M; Smed, A; Jespersen, H

1997-01-01

INTRODUCTION: The acute symptoms after whiplash traumas can be explained by the neck sprain, but the pathogenesis of the 'late whiplash syndrome' and the reason why only some people have persistent symptoms more than 6 months is still unknown. MATERIAL AND METHODS: Thirty-four consecutive cases...... of whiplash injury were examined clinically three times; within 14 days, after 1 month and finally 7 months postinjury. In addition, MRI of the brain and the cervical spine, neuropsychological tests and motor evoked potentials (MEP) were done one month postinjury and repeated after 6 months, if abnormalities...

A Test-Retest Reliability Study of the Whiplash Disability Questionnaire in Patients With Acute Whiplash-Associated Disorders

DEFF Research Database (Denmark)

Stupar, Maja; Côté, Pierre; Beaton, Dorcas E

2015-01-01

OBJECTIVE: The purpose of this study was to determine the test-retest reliability and the Minimal Detectable Change (MDC) of the Whiplash Disability Questionnaire (WDQ) in individuals with acute whiplash-associated disorders (WADs). METHODS: We performed a test-retest reliability study. We includ...

Acute headache attributed to whiplash in arcuate foramen and non-arcuate foramen subjects.

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Ríos, Luis; Mata-Escolano, Federico; Blanco-Pérez, Esther; Llidó, Susanna; Bastir, Markus; Sanchis-Gimeno, Juan A

2017-04-01

To test the association between arcuate foramen (AF) in the first cervical vertebra with acute headache attributed to whiplash. Retrospective study of 128 patients that suffered a whiplash. The presence or absence of AF was recorded after a radiographic study, as well as the presence or absence of acute headache after the whiplash. The frequency of AF was 17.2%. Patients with bilateral AF presented a significant (p = 0.000, Fisher's test) increase in the frequency of acute headache (90.9%) in comparison with the non-AF group (5.7%). The ratio between the presence and absence of acute headache was 166.6 times higher (IC 95% 18.2-1526.22) in subjects with bilateral AF in comparison with non-AF subjects. The presence of bilateral AF is associated to an increased frequency of acute headache after suffering a whiplash, information of interest for the attention to these patients.

The Risk Assessment Score in acute whiplash injury predicts outcome and reflects bio-psycho-social factors

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Kasch, Helge; Qerama, Erisela; Kongsted, Alice

2011-01-01

One-year prospective study of 141 acute whiplash patients (WLP) and 40 acute ankle-injured controls.......One-year prospective study of 141 acute whiplash patients (WLP) and 40 acute ankle-injured controls....

Postural control deficit in acute QTF grade II whiplash injuries.

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Dehner, Christoph; Heym, Birgit; Maier, Dirk; Sander, Silvia; Arand, Markus; Elbel, Martin; Hartwig, Erich; Kramer, Michael

2008-07-01

Experimental in vivo study. The objective was to investigate the balance control in patients with acute QTF grade II whiplash injuries of the cervical spine. Tetra-ataxiametric posturography in chronic pain patients after whiplash injuries of the cervical spine has revealed an impaired regulation of balance. However, so far it is unclear if this is caused by the accident or other factors that are associated with the pain chronification process. 40 patients with acute QTF grade II whiplash injuries and 40 healthy matched controls were examined on a posturography platform. The stability index ST(Sigma) and the Fourier analysis FA(Sigma) (0.10-1.00Hz) were established for eight standing positions and sum scores were calculated. The pain index was established using a visual analog scale ranging from 0 to 100. A follow-up examination was conducted for the patients after 2 months. The patients with acute whiplash injuries of the cervical spine achieved significantly poorer results for both ST(Sigma) and FA(Sigma) than the healthy controls. There were no differences between the eight standing positions for both ST(Sigma) and FA(Sigma). After 2 months, 17 patients had no change in the pain development, 21 patients showed an improvement in pain intensity and 2 patients had deteriorated. The subgroup of patients with improvement in pain intensity showed a significant improvement in balance control concerning the FA(Sigma) compared to patients with unchanged pain intensity. Patients with acute whiplash injuries have a reduced balance control as compared to matched controls. This study gives an indication that post-traumatic neck pain is associated with impairments of postural control.

Definition, klassifikation og epidemiologi ved whiplash

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Jensen, Troels Staehelin; Kasch, Helge; Bach, Flemming Winther

2010-01-01

A whiplash trauma is caused by an acceleration-deceleration force transferring its energy to the cervical spine. Whiplash-associated disorder (WAD) refers to the symptoms that develop after a whiplash injury. The prognosis is favorable with recovery in over 90% of the injured subjects. In a fract......A whiplash trauma is caused by an acceleration-deceleration force transferring its energy to the cervical spine. Whiplash-associated disorder (WAD) refers to the symptoms that develop after a whiplash injury. The prognosis is favorable with recovery in over 90% of the injured subjects....... In a fraction of patients, long-term symptoms with pain and cognitive and emotional symptoms may occur, causing long-term disability. The pathophysiology is unclear. Most research groups favor a multifactorial pathophysiology similar to that observed for other chronic pain conditions without a clear nociceptive...

Structural and construct validity of the Whiplash Disability Questionnaire in adults with acute whiplash-associated disorders

DEFF Research Database (Denmark)

Stupar, Maja; Côté, Pierre; Beaton, Dorcas E

2015-01-01

BACKGROUND CONTEXT: Few instruments are available to measure disability associated with whiplash-associated disorders (WAD). The Whiplash Disability Questionnaire (WDQ) was developed to measure disability resulting from WAD, but its validity is unknown for acute WAD. PURPOSE: The aim...... included insurance claimants who were aged 18 years or older and diagnosed with acute WAD Grades I to III. All participants completed the WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability). We assessed the factor structure of the WDQ and tested its construct validity...... against self-perceived recovery, neck pain (Numerical Rating Scale [NRS]), neck disability (Neck Disability Index [NDI] and Neck Bournemouth Questionnaire), health-related quality of life (36-Item Short Form Health Survey [SF-36]), and depressive symptoms (Center for Epidemiologic Studies Depression Scale...

Definition, klassifikation og epidemiologi ved whiplash

DEFF Research Database (Denmark)

Jensen, Troels Staehelin; Kasch, Helge; Bach, Flemming Winther

2010-01-01

A whiplash trauma is caused by an acceleration-deceleration force transferring its energy to the cervical spine. Whiplash-associated disorder (WAD) refers to the symptoms that develop after a whiplash injury. The prognosis is favorable with recovery in over 90% of the injured subjects...

Chronic whiplash pain.

Science.gov (United States)

Seroussi, Richard; Singh, Virtaj; Fry, Adrielle

2015-05-01

Although most patients recover from acute whiplash injuries, those with chronic whiplash syndrome develop signs of central nervous system (CNS) amplification of pain and have a poor prognosis. In this context, specific pain generators from acute whiplash have been identified through clinical, biomechanical, and animal studies. This article gives a clinical perspective on current understanding of these pain generators, including the phenomenon of CNS sensitization. Copyright © 2015 Elsevier Inc. All rights reserved.

Cervical Muscle Dysfunction in Chronic Whiplash-Associated Disorder Grade 2: The Relevance of the Trauma

NARCIS (Netherlands)

Nederhand, Marcus Johannes; Hermens, Hermanus J.; IJzerman, Maarten Joost; Turk, Dennis C.; Zilvold, Gerrit

2002-01-01

Study Design. Surface electromyography measurements of the upper trapezius muscles were performed in patients with a chronic whiplash-associated disorder Grade 2 and those with nonspecific neck pain. Objective. To determine the etiologic relation between acceleration–deceleration trauma and the

Whiplash injuries.

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Malanga, Gerard; Peter, Jason

2005-10-01

Whiplash injuries are very common and usually are associated with rear-end collisions. However, a whiplash injury can be caused by any event that results in hyperextension and flexion of the cervical spine. These injuries are of serious concern to all consumers due to escalating cost of diagnosis, treatment, insurance, and litigation. Most acute whiplash injury cases respond well to conservative treatments, which result in resolution of symptoms usually within weeks to a few months after the injury occurred. Chronic whiplash injuries often are harder to diagnose and treat and often result in poor outcomes. Current research shows that various structures in the cervical spine receive nociceptive innervation and potentially may be the cause of chronic pain symptoms. One potential pain generator showing promise is the facet or zygapophyseal joints. Various researchers have proven that these joints are injured during whiplash injuries and that diagnosis and temporary pain relief can be obtained with facet joint injections. The initial evaluation of any patient should follow an organized and stepwise approach, and more serious causes of neck pain must first be ruled out through the history, physical examination, and diagnostic testing. Treatment regimens should be evidence-based, focusing on treatments that have proven to be effective in treating acute and chronic whiplash injuries.

Smertetilstand og psykologisk distress før uheldet praedikterer gener efter whiplash-traume--sekundaerpublikation

DEFF Research Database (Denmark)

Carstensen, Tina Birgitte Wisbech; Frostholm, Lisbeth; Ørnbøl, Eva

2009-01-01

Patients with acute whiplash trauma were followed to examine if pre-collision pain and psychological distress were associated with reduced work capability and neck pain at 12 month follow-up. Pre-collision unspecified pain was associated with reduced work capability, and neck pain and pre-collisi...

Patterns of acute whiplash-associated disorder in the Lithuanian population after road traffic accidents.

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Pajediene, Evelina; Janusauskaite, Jolita; Samusyte, Gintaute; Stasaitis, Kestutis; Petrikonis, Kestutis; Bileviciute-Ljungar, Indre

2015-01-01

To investigate acute whiplash-associated disorder in the Lithuanian population who are unaware of the phenomenon. Controlled cohort study. Seventy-one patients were enrolled from the emergency departments of the Kaunas region of Lithuania following road traffic accidents, examined within 3-14 days after the accident, and compared with 53 matched controls. Clinical neurological examination, including range of motion and motion-evoked pain or stiffness in the neck; spontaneous pain and pain pressure threshold. Questionnaires: Quebec Task Force questionnaire (QTFQ); Disability Rating Index (DRI); Cognitive Failures Questionnaire (CFQ); Hospital Anxiety and Depression Scale (HADS) and health perception. Sixty-six of 71 (93%) patients developed acute symptoms. The most frequent symptoms found after road traffic accidents were neck or shoulder pain; reduced or painful neck movements, including decreased range of motion; multiple subjective symptoms according to QTFQ and significantly reduced pain threshold. Perceived health status was decreased and DRI was increased, while HADS showed a significantly higher risk of developing anxiety. Higher grade whiplash-associated disorder was linked with a greater reduction in range of motion and more prominent neck pain. Road traffic accidents induce whiplash-associated disorder in patients who seek help, but who are unaware of the condition whiplash-associated disorder. Whiplash-associated disorder should be considered and treated as an entity per se.

Magnetic resonance tomography for trauma of the cervical spine

International Nuclear Information System (INIS)

Meydam, K.; Sehlen, S.; Schlenkhoff, D.; Kiricuta, J.C.; Beyer, H.K.

1986-01-01

Twenty patients who had suffered spinal trauma were examined by magnetic resonance tomography. Fifteen patients with first degree trauma in Erdmann's classification showed no abnormality. Magnetic resonance tomography of the cervical spine appears to be a suitable method for investigating patients with whiplash injuries. It is indicated following severe flexion injuries with subluxations and neurological symptoms, since it is the only method that can demonstrate the spinal cord directly and completely and show the extent of cord compression. For patients with thoracic trauma and rapidly developing neurological symptoms, magnetic resonance tomography is ideal for showing post-traumatic syringomyelia. Magnetic resonance tomography following whiplash injuries is recommended if plain films of the cervical spine show any abnormalities, as well as for the investigation of acute or sub-acute neurological abnormalities. The various findings are discussed. (orig.) [de

Magnetic resonance tomography for trauma of the cervical spine

Energy Technology Data Exchange (ETDEWEB)

Meydam, K.; Sehlen, S.; Schlenkhoff, D.; Kiricuta, J.C.; Beyer, H.K.

1986-12-01

Twenty patients who had suffered spinal trauma were examined by magnetic resonance tomography. Fifteen patients with first degree trauma in Erdmann's classification showed no abnormality. Magnetic resonance tomography of the cervical spine appears to be a suitable method for investigating patients with whiplash injuries. It is indicated following severe flexion injuries with subluxations and neurological symptoms, since it is the only method that can demonstrate the spinal cord directly and completely and show the extent of cord compression. For patients with thoracic trauma and rapidly developing neurological symptoms, magnetic resonance tomography is ideal for showing post-traumatic syringomyelia. Magnetic resonance tomography following whiplash injuries is recommended if plain films of the cervical spine show any abnormalities, as well as for the investigation of acute or sub-acute neurological abnormalities. The various findings are discussed.

Gender, age and ethnicity influence on pain levels and analgesic use in the acute whiplash injury.

Science.gov (United States)

Koren, L; Peled, E; Trogan, R; Norman, D; Berkovich, Y; Israelit, S

2015-06-01

Initial pain level in the acute whiplash injury is the most consistent predictor of transformation to a chronic pain syndrome. The risk factors for those early pain levels were, to our knowledge, scarcely evaluate to this date. We set to evaluate whether gender, age or ethnicity comprise a risk factor for those initial pain levels. Further, gender, age and ethnicity have been shown to be bias factors in pain management. We investigated if gender, age or ethnicity are bias factor in pain management in the face of a standardized pain treatment protocol in the acute whiplash injury. We reviewed 2,538 patients with acute whiplash injury that were treated at our emergency department (ED). Gender, age and ethnicity were investigated as risk factors for elevated visual analog scale (VAS) scores. Those factors were also investigated as bias in pain medication administration in the face of a standardized analgesic protocol. Women had significantly higher VAS scores (p = 0.009). Age and ethnicity did not influence pain levels. There was no influence of gender or age on pain medication administration. The Jewish patients (the majority in Israel) were administered fewer pain medication (p whiplash injury. Age and ethnicity have less impact on those pain levels. A pain management protocol might reduce bias in pain management in the acute whiplash injury in the ED. The Jewish population tends to be less receptive to pain medication administration.

An Attempt of Early Detection of Poor Outcome after Whiplash

Science.gov (United States)

Laporte, Sebastien; Wang, Danping; Lecompte, Jennyfer; Blancho, Sophie; Sandoz, Baptiste; Feydy, Antoine; Lindberg, Pavel; Adrian, Julien; Chiarovano, Elodie; de Waele, Catherine; Vidal, Pierre-Paul

2016-01-01

The main concern with whiplash is that a large proportion of whiplash patients experience disabling symptoms or whiplash-associated disorders (WAD) for months if not years following the accident. Therefore, identifying early prognostic factors of WAD development is important as WAD have widespread clinical and economic consequences. In order to tackle that question, our study was specifically aimed at combining several methods of investigation in the same WAD patients at the acute stage and 6 months later. Our longitudinal, open, prospective, multi-center study included 38 whiplash patients, and 13 healthy volunteers matched for age, gender, and socio-economic status with the whiplash group. Whiplash patients were evaluated 15–21 days after road accident, and 6 months later. At each appointment, patients underwent a neuropsychological evaluation, a full clinical neurological examination, neurophysiological and postural tests, oto-neurological tests, cervical spine cord magnetic resonance imaging (MRI) with tractography (DTI). At 6 months, whiplash patients were categorized into two subgroups based on the results of the Diagnostic and Statistical Manual of Mental Disorders as having either favorable or unfavorable progression [an unfavorable classification corresponding to the presence of post-concussion symptom (PCS)] and we searched retrospectively for early prognostic factors of WAD predicting the passage to chronicity. We found that patients displaying high level of catastrophizing at the acute stage and/or post-traumatic stress disorder associated with either abnormalities in head or trunk kinematics, abnormal test of the otolithic function and at the Equitest or a combination of these syndromes, turned to chronicity. This study suggests that low-grade whiplash patients should be submitted as early as possible after the trauma to neuropsychological and motor control tests in a specialized consultation. In addition, they should be evaluated by a neuro

Initial Assessment of Whiplash Patients

Directory of Open Access Journals (Sweden)

R Gunzburg

2003-01-01

Full Text Available The article looks at how for severe trauma, the outcome of treatment depends on the initial medical care. This has now also been accepted for whiplash associated disorders, underlining the importance of a proper initial assessment. Once major injury has been excluded and the diagnosis of whiplash associated disorder has been established, the initial treatment of whiplash in the emergency room can be started. The four key points to remember are described, including reassuring the patient about evolution, no soft collar, nonsteroidal anti-inflammatory drugs and early mobilisation.

Temporomandibular disorders after whiplash injury

DEFF Research Database (Denmark)

Kasch, Helge; Hjorth, Tine; Svensson, Peter

2002-01-01

Aims: Whiplash injury to the neck, is often considered a significant risk factor for development of temporomandibular disorders (TMD), and has been proposed to produce internal derangements of the temporomandibular joint (TMJ). Few studies however have examined TMD-related pain in acute whiplash...... patients compared with a matched control group. The aim of the present study was to assess pain and sensorimotor function in the craniofacial region in an unselected group of patients sustaining a motor vehicle accident involving a rear collision. Methods: Prospectively, 19 acute whiplash patients exposed...... obtained at each visit. Results: One whiplash patient and I ankle-injury patient bad jaw pain at the first visit. Palpation scores of the TMJ and the summated palpation scores only tended to be higher in patients sustaining a whiplash injury than in ankle-injury controls at the first visit. However, MPQ...

Vestibular and stabilometric findings in whiplash injury and minor head trauma.

Science.gov (United States)

Nacci, A; Ferrazzi, M; Berrettini, S; Panicucci, E; Matteucci, J; Bruschini, L; Ursino, F; Fattori, B

2011-12-01

Vertigo and postural instability following whiplash and/or minor head injuries is very frequent. According to some authors, post-whiplash vertigo cannot be caused by real injury to vestibular structures; other authors maintain that vestibular damage is possible even in the case of isolated whiplash, with vascular or post-traumatic involvement. Furthermore, many of the balance disorders reported after trauma can be justified by post-traumatic modification to the cervical proprioceptive input, with consequent damage to the vestibular spinal reflex. The aim of this study was to evaluate the vestibular condition and postural status in a group of patients (Group A, n = 90) affected with balance disorders following whiplash, and in a second group (Group B, n = 20) with balance disorders after minor head injury associated with whiplash. Both groups were submitted to videonystagmography (VNG) and stabilometric investigation (open eyes - O E, closed eyes - CE, closed eyes with head retroflexed - CER) within 15 days of their injuries and repeated within 10 days after conclusion of cervical physiotherapy treatment. The VNG tests revealed vestibulopathy in 19% of cases in Group A (11% peripheral, 5% central, 3% in an undefined site) and in 60% of subjects in Group B (50% peripheral, 10% central). At the follow-up examination, all cases of non-compensated labyrinth deficit showed signs of compensation, while there were two cases (2%) in Group A and one case (5%) in Group B of PPV. As far as the altered posturographic recordings are concerned, while there was no specific pattern in the two groups, they were clearly pathologic, especially during CER. Both in OE and in CE there was an increase in the surface values and in those pertaining to shifting of the gravity centre on the sagittal plane, which was even more evident during CER. In Group A, the pre-post-physiotherapy comparison of CER results showed that there was a statistically significant improvement in the majority of the

Acute stress response and recovery after whiplash injuries. A one-year prospective study.

Science.gov (United States)

Kongsted, Alice; Bendix, Tom; Qerama, Erisela; Kasch, Helge; Bach, Flemming W; Korsholm, Lars; Jensen, Troels S

2008-05-01

Chronic whiplash-associated disorder (WAD) represents a major medical and psycho-social problem. The typical symptomatology presented in WAD is to some extent similar to symptoms of post traumatic stress disorder. In this study we examined if the acute stress reaction following a whiplash injury predicted long-term sequelae. Participants with acute whiplash-associated symptoms after a motor vehicle accident were recruited from emergency units and general practitioners. The predictor variable was the sum score of the impact of event scale (IES) completed within 10 days after the accident. The main outcome-measures were neck pain and headache, neck disability, general health, and working ability one year after the accident. A total of 737 participants were included and completed the IES, and 668 (91%) participated in the 1-year follow-up. A baseline IES-score denoting a moderate to severe stress response was obtained by 13% of the participants. This was associated with increased risk of considerable persistent pain (OR=3.3; 1.8-5.9), neck disability (OR=3.2; 1.7-6.0), reduced working ability (OR=2.8; 1.6-4.9), and lowered self-reported general health one year after the accident. These associations were modified by baseline neck pain intensity. It was not possible to distinguish between participants who recovered and those who did not by means of the IES (AUC=0.6). In conclusion, the association between the acute stress reaction and persistent WAD suggests that post traumatic stress reaction may be important to consider in the early management of whiplash injury. However, the emotional response did not predict chronicity in individuals.

Smertetilstand og psykologisk distress før uheldet prædikterer gener efter whiplash-traume - sekundærpublikation

DEFF Research Database (Denmark)

Carstensen, Tina Birgitte; Frostholm, Lisbeth; Ørnbøl, Eva

2009-01-01

Patients with acute whiplash trauma were followed to examine if pre-collision pain and psychological distress were associated with reduced work capability and neck pain at 12 month follow-up. Pre-collision unspecified pain was associated with reduced work capability, and neck pain and pre-collisi...

Neck ligament strength is decreased following whiplash trauma

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Rubin Wolfgang

2006-12-01

Full Text Available Abstract Background Previous clinical studies have documented successful neck pain relief in whiplash patients using nerve block and radiofrequency ablation of facet joint afferents, including capsular ligament nerves. No previous study has documented injuries to the neck ligaments as determined by altered dynamic mechanical properties due to whiplash. The goal of the present study was to determine the dynamic mechanical properties of whiplash-exposed human cervical spine ligaments. Additionally, the present data were compared to previously reported control data. The ligaments included the anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. Methods A total of 98 bone-ligament-bone specimens (C2–C3 to C7-T1 were prepared from six cervical spines following 3.5, 5, 6.5, and 8 g rear impacts and pre- and post-impact flexibility testing. The specimens were elongated to failure at a peak rate of 725 (SD 95 mm/s. Failure force, elongation, and energy absorbed, as well as stiffness were determined. The mechanical properties were statistically compared among ligaments, and to the control data (significance level: P Results For all whiplash-exposed ligaments, the average failure elongation exceeded the average physiological elongation. The highest average failure force of 204.6 N was observed in the ligamentum flavum, significantly greater than in middle-third disc and interspinous and supraspinous ligaments. The highest average failure elongation of 4.9 mm was observed in the interspinous and supraspinous ligaments, significantly greater than in the anterior longitudinal ligament, middle-third disc, and ligamentum flavum. The average energy absorbed ranged from 0.04 J by the middle-third disc to 0.44 J by the capsular ligament. The ligamentum flavum was the stiffest ligament, while the interspinous and supraspinous ligaments were most flexible. The whiplash

An attempt of early detection of poor outcome after whiplash

Directory of Open Access Journals (Sweden)

Sebastien LAPORTE

2016-10-01

Full Text Available The main concern with whiplash is that a large proportion of whiplash patients experience disabling symptoms or whiplash associated disorders (WAD for months if not years following the accident. Therefore, identifying early prognostic factors of WAD development is important as WAD have widespread clinical and economic consequences.In order to tackle that question, our study was specifically aimed at combining several methods of investigation in the same WAD patients at the acute stage and six months later. Our longitudinal, open, prospective, multi-center study included 38 whiplash patients, and 13 healthy volunteers matched for age, gender, and socio-economic status with the whiplash group. Whiplash patients were evaluated 15 to 21 days after road accident, and 6 months later. At each appointment, patients underwent a neuropsychological evaluation, a full clinical neurological examination, neurophysiological and postural tests, oto-neurological tests, cervical spine cord Magnetic Resonance Imaging (MRI with tractography (DTI. At 6-month, whiplash patients were categorized into two subgroups based on the results of the Diagnostic and Statistical Manual of Mental Disorders as having either favourable or unfavourable progression (an unfavourable classification corresponding to the presence of Post-Concussion Symptom PCS and we searched retrospectively for early prognostic factors of WAD predicting the passage to chronicity. We found that patients displaying high level of catastrophizing at the acute stage and /or post-traumatic stress disorder associated with either abnormalities in head or trunk kinematics, abnormal test of the otolithic function and at the Equitest or a combination of these syndromes, turned to chronicity. That is, the association of a neuropsychological disorder with a somatic one was sufficient to explain the passage to chronicity. This study suggests that low-grade whiplash patients should be submitted as early as possible

Deep muscle pain, tender points and recovery in acute whiplash patients: a 1-year follow-up study.

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Kasch, Helge; Qerama, Erisela; Kongsted, Alice; Bach, Flemming W; Bendix, Tom; Jensen, Troels S

2008-11-15

Local sensitization to noxious stimuli has been previously described in acute whiplash injury and has been suggested to be a risk factor for chronic sequelae following acute whiplash injury. In this study, we prospectively examined the development of tender points and mechano-sensitivity in 157 acute whiplash injured patients, who fulfilled criteria for WAD grade 2 (n=153) or grade 3 (n=4) seen about 5 days after injury (4.8+/-2.3) and who subsequently had or had not recovered 1 year after a cervical sprain. Tender point scores and stimulus-response function for mechanical pressure were determined in injured and non-injured body regions at specific time-points after injury. Thirty-six of 157 WAD grade 2 patients (22.9%) had not recovered, defined as reduced work capacity after 1 year. Non-recovered patients had higher total tender point scores after 12 (pwhiplash injury and the development of further sensitization in patients with long-term disability.

Initial healthcare and coping preferences are associated with outcome 1 year after whiplash trauma: a multicentre 1-year follow-up study.

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Myrtveit, Solbjørg Makalani; Carstensen, Tina; Kasch, Helge; Ørnbøl, Eva; Frostholm, Lisbeth

2015-03-20

Individuals exposed to whiplash collisions have to cope with the stressful event as well as early physical symptoms. As in other chronic pain conditions, coping has been associated with outcome after whiplash. In this study, our aim was to examine whether initial coping preferences were associated with the development of chronic whiplash. Prospective study. Primary care. 740 acute whiplash patients were recruited from emergency units and general practitioners after car collisions in Denmark. Within 10 days postinjury, participants were asked what they believed could help them get better. At 12-month follow-up, the level of neck pain and capability to work was obtained. Whether coping preferences (baseline) were associated with outcome was investigated using multiple regression analyses. Persistent neck pain was most strongly associated with preferring medications (mean difference=1.24 (95% CI 0.67 to 1.82)) and sickness absence (mean difference=1.18 (95% CI 0.53 to 1.82)). Reduced work capability was most strongly associated with preferring medications (OR=3.53 (95% CI 2.13 to 5.86)), sickness absence (OR=3.05 (95% CI 1.80 to 5.17)) and being referred to a physiotherapist/chiropractor (OR=3.03 (95% CI 1.33 to 6.91)). Active coping was associated with better outcomes: Participants preferring to change their lifestyle were protected against reduced work capability (OR=0.11 (95% CI 0.01 to 0.78)). Individuals who wanted to keep living as usual only (no other preference reported) were protected against neck pain (mean difference -1.62 (95% CI -2.39 to -0.84)) and reduced work capability (OR=0.09 (95% CI 0.01 to 0.64)). A simple nine-item measure of coping preferences is associated with the development of chronic neck pain and reduced capability to work following whiplash trauma and may be used to identify individuals at risk of poor recovery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

MRI in acute phase of whiplash injury

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Fagerlund, M. [Dept. of Diagnostic Radiology, Univ. Hospital of Northern Sweden, Umeaa (Sweden); Bjoernebrink, J. [Dept. of Diagnostic Radiology, Univ. Hospital of Northern Sweden, Umeaa (Sweden); Pettersson, K. [Dept. of Orthopaedic Surgery, Univ. Hospital of Northern Sweden, Umeaa (Sweden); Hildingsson, C. [Dept. of Orthopaedic Surgery, Univ. Hospital of Northern Sweden, Umeaa (Sweden)

1995-11-01

A prospective MRI study of 39 whiplash patients was performed and the results were compared with the clinical findings within 15 days after trauma. The MRI parameters included disc bulging either with impingement on the anterior epidural space or with medullary compression, foraminal stenosis, dorsal ligament thickening, osteophyte extension and intramedullary or paravertebral soft tissue injury. All changes were graded visually on a four-point scale (no, some, moderate or extensive changes). After the MRI evaluation was made the clinical findings were analysed by two orthopaedic surgeons using a specially designed protocol. With MRI 29 patients (74 %) showed no or only slight changes, and were thus regarded as normal variations. Of these, 10 of 29 patients (34 %) had as the only symptom pain in the head or in the neck, 19 of 29 patients (66 %) showed neurological changes, either paresthesias, sensory deficits or weakness of upper extremities. In 10 (26 %) patients with moderate or extensive MRI changes, 3 of 10 (33 %) had only head or neck pain, or both, and 7 of 10 (66 %) had neurological changes. Use of MRI in whiplash injury is helpful, but it is not the first-choice radiological examination method. Despite neurological changes, the frequency of true traumatic lesions is low. There is no clear correlation between the patients` subjective symptoms or clinical signs and the findings with MRI. However, MRI can be used to find patients with disk herniation that can be treated surgically. (orig.)

MRI in acute phase of whiplash injury

International Nuclear Information System (INIS)

Fagerlund, M.; Bjoernebrink, J.; Pettersson, K.; Hildingsson, C.

1995-01-01

A prospective MRI study of 39 whiplash patients was performed and the results were compared with the clinical findings within 15 days after trauma. The MRI parameters included disc bulging either with impingement on the anterior epidural space or with medullary compression, foraminal stenosis, dorsal ligament thickening, osteophyte extension and intramedullary or paravertebral soft tissue injury. All changes were graded visually on a four-point scale (no, some, moderate or extensive changes). After the MRI evaluation was made the clinical findings were analysed by two orthopaedic surgeons using a specially designed protocol. With MRI 29 patients (74 %) showed no or only slight changes, and were thus regarded as normal variations. Of these, 10 of 29 patients (34 %) had as the only symptom pain in the head or in the neck, 19 of 29 patients (66 %) showed neurological changes, either paresthesias, sensory deficits or weakness of upper extremities. In 10 (26 %) patients with moderate or extensive MRI changes, 3 of 10 (33 %) had only head or neck pain, or both, and 7 of 10 (66 %) had neurological changes. Use of MRI in whiplash injury is helpful, but it is not the first-choice radiological examination method. Despite neurological changes, the frequency of true traumatic lesions is low. There is no clear correlation between the patients' subjective symptoms or clinical signs and the findings with MRI. However, MRI can be used to find patients with disk herniation that can be treated surgically. (orig.)

Late whiplash syndrome: a clinical science approach to evidence-based diagnosis and management.

Science.gov (United States)

Poorbaugh, Keith; Brismée, Jean-Michel; Phelps, Valerie; Sizer, Phillip S

2008-01-01

The purpose of this article is to narrow the gap that exists in the clinical application of scientific research and empiric evidence for the evaluation and management of late whiplash. Considering that 14% to 42% of patients are left with chronic symptoms following whiplash injury, it is unlikely that only minor self-limiting injuries result from the typical rear-end impact. As psychosocial issues play a role in the development of persistent whiplash symptoms, discerning the organic conditions from the biopsychosocial factors remains a challenge to clinicians. The term "whiplash" represents the multiple factors associated with the event, injury, and clinical syndrome that are the end-result of a sudden acceleration-deceleration trauma to the head and neck. However, contentions surround the nature of soft-tissue injuries that occur with most motor vehicle accidents and whether these injuries are significant enough to result in chronic pain and limitations. The stark contrast in litigation for whiplash that exists among industrialized nations and less developed countries suggests another factor that could influence one's interpretation of symptoms' chronicity associated with Late Whiplash Syndrome. There are no gold standard tests or imaging techniques that can objectify whiplash-associated disorders. A lack of supporting evidence and disparity in medico-legal issues have created distinct camps in the scientific interpretations and clinical management of late whiplash. It is likely that efforts in research and/or clinical practice will begin to explain the disparity between acute and chronic whiplash syndrome. Recent evidence suggests that Late Whiplash Syndrome should be considered from a different context. The purpose of this article is to expound on several of the significant findings in the literature and offer clinical applications for evaluation and management of Late Whiplash Syndrome.

Assessing the existence of dissociative PTSD in sub-acute patients of whiplash

DEFF Research Database (Denmark)

Hansen, Maj; Hyland, Philip; Armour, Cherie

2018-01-01

-acute patients of whiplash and associated risk factors. The results of LCA showed a three-class solution primarily distributed according to PTSD symptom severity and thus no indication of D-PTSD. Dissociative symptoms, psychological distress (i.e. anxiety/depression), and pain severity significantly predicted...

Some observations on whiplash injuries.

Science.gov (United States)

Evans, R W

1992-11-01

Motor vehicle accidents with a whiplash mechanism of injury are one of the most common causes of neck injuries, with an incidence of perhaps 1 million per year in the United States. Proper adjustment of head restraints can reduce the incidence of neck pain in rear-end collisions by 24%. Persistent neck pain is more common in women by a ratio of 70:30. Whiplash injuries usually result in neck pain owing to myofascial trauma, which has been documented in both animal and human studies. Headaches, reported in 82% of patients acutely, are usually of the muscle contraction type, often associated with greater occipital neuralgia and less often temporomandibular joint syndrome. Occasionally migraine headaches can be precipitated. Dizziness often occurs and can result from vestibular, central, and cervical injury. More than one third of patients acutely complain of paresthesias, which frequently are caused by trigger points and thoracic outlet syndrome and less commonly by cervical radiculopathy. Some studies have indicated that a postconcussion syndrome can develop from a whiplash injury. Interscapular and low back pain are other frequent complaints. Although most patients recover within 3 months after the accident, persistent neck pain and headaches after 2 years are reported by more than 30% and 10% of patients. Risk factors for a less favorable recovery include older age, the presence of interscapular or upper back pain, occipital headache, multiple symptoms or paresthesias at presentation, reduced range of movement of the cervical spine, the presence of an objective neurologic deficit, preexisting degenerative osteoarthritic changes; and the upper middle occupational category. There is only a minimal association of a poor prognosis with the speed or severity of the collision and the extent of vehicle damage. Whiplash injuries result in long-term disability with upward of 6% of patients not returning to work after 1 year. Although litigation is very common and always

StressModEx--Physiotherapist-led Stress Inoculation Training integrated with exercise for acute whiplash injury: study protocol for a randomised controlled trial.

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Ritchie, Carrie; Kenardy, Justin; Smeets, Rob; Sterling, Michele

2015-07-01

Whiplash associated disorders are the most common non-hospitalised injuries following a road traffic crash. Up to 50% of individuals who experience a whiplash injury will not fully recover and report ongoing pain and disability. Most recovery, if it occurs, takes place in the first 2-3 months post injury, indicating that treatment provided in the early stages is critical to long-term outcome. However, early management approaches for people with acute whiplash associated disorders are modestly effective. One reason may be that the treatments have been non-specific and have not targeted the processes shown to be associated with poor recovery, such as post-traumatic stress symptoms. Targeting and modulating these early stress responses in the early management of acute whiplash associated disorders may improve health outcomes. Early aggressive psychological interventions in the form of psychological debriefing may be detrimental to recovery and are now not recommended for management of early post-traumatic stress symptoms. In contrast, Stress Inoculation Training (SIT) is a cognitive behavioural approach that teaches various general problem-solving and coping strategies to manage stress-related anxiety (ie, relaxation training, cognitive restructuring and positive self-statements) and provides important information to injured individuals about the impact of stress on their physical and psychological wellbeing. While referral to a psychologist may be necessary in some cases where acute stress disorder or other more significant psychological reactions to stress are evident, in the case of acute whiplash injuries, it is neither feasible nor necessary for a psychologist to deliver the early stress modulation intervention to all injured individuals. The feasibility of using other specially trained health professionals to deliver psychological interventions has been explored in conditions such as chronic low back pain, chronic whiplash and cancer, but few trials have studied

Do X-ray-occult fractures play a role in chronic pain following a whiplash injury?

DEFF Research Database (Denmark)

Hertzum-Larsen, Rasmus; Petersen, Henrik; Kasch, Helge

2014-01-01

symptoms following an MVA was invited to have a cervical SPECT shortly post injury and again 6 months later. Associations between occult fractures and pain levels at baseline, 6 and 12 months of follow-up were analyzed. Eighty-eight patients had baseline SPECT performed at median 15 days (range 3-28) post......Whiplash trauma in motor vehicle accidents (MVA) may involve various painful soft tissue damages, but weeks/months later a minority of victims still suffers from various long-lasting and disabling symptoms, whiplash-associated disorders (WAD). The etiology is currently unknown, but X......-ray-occult fractures may be one cause in some cases. The purpose of this prospective study was to examine the association between occult fractures, as seen on bone single photon emission computed tomography (SPECT), with neck-, head- and arm pain. An inception cohort of 107 patients presenting with acute whiplash...

Acute stress response and recovery after whiplash injuries. A one-year prospective study

DEFF Research Database (Denmark)

Kongsted, Alice; Bendix, Tom; Montvilas, Erisela Qerama

2008-01-01

Chronic whiplash-associated disorder (WAD) represents a major medical and psycho-social problem. The typical symptomatology presented in WAD is to some extent similar to symptoms of post traumatic stress disorder. In this study we examined if the acute stress reaction following a whiplash injury...... were modified by baseline neck pain intensity. It was not possible to distinguish between participants who recovered and those who did not by means of the IES (AUC=0.6). In conclusion, the association between the acute stress reaction and persistent WAD suggests that post traumatic stress reaction may...... outcome-measures were neck pain and headache, neck disability, general health, and working ability one year after the accident. A total of 737 participants were included and completed the IES, and 668 (91%) participated in the 1-year follow-up. A baseline IES-score denoting a moderate to severe stress...

Acute stress response and recovery after whiplash injuries. A one-year prospective study

DEFF Research Database (Denmark)

Kongsted, Alice; Bendix, Tom; Montvilas, Erisela Qerama

2008-01-01

outcome-measures were neck pain and headache, neck disability, general health, and working ability one year after the accident. A total of 737 participants were included and completed the IES, and 668 (91%) participated in the 1-year follow-up. A baseline IES-score denoting a moderate to severe stress...... were modified by baseline neck pain intensity. It was not possible to distinguish between participants who recovered and those who did not by means of the IES (AUC=0.6). In conclusion, the association between the acute stress reaction and persistent WAD suggests that post traumatic stress reaction may......Chronic whiplash-associated disorder (WAD) represents a major medical and psycho-social problem. The typical symptomatology presented in WAD is to some extent similar to symptoms of post traumatic stress disorder. In this study we examined if the acute stress reaction following a whiplash injury...

Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma.

Science.gov (United States)

Uhrenholt, Lars; Freeman, Michael D; Webb, Alexandra L; Pedersen, Michael; Boel, Lene Warner Thorup

2015-12-01

Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to

Trauma-focused cognitive behaviour therapy and exercise for chronic whiplash: protocol of a randomised, controlled trial

Directory of Open Access Journals (Sweden)

Letitia Campbell

2015-10-01

Discussion: This study will provide a definitive evaluation of the effects of adding trauma-focused cognitive behaviour therapy to physiotherapy exercise for individuals with chronic WAD and PTSD. This study is likely to influence the clinical management of whiplash injury and will have immediate clinical applicability in Australia, Denmark and the wider international community. The study will also have implications for both health and insurance policy makers in their decision-making regarding treatment options and funding.

Persistent pseudomyopia following a whiplash injury in a previously emmetropic woman

OpenAIRE

Hughes, Fintan E.; Treacy, Maxwell P.; Duignan, Emma S.; Mullaney, Paul B.

2017-01-01

Purpose: Accommodative spasm, which manifests as ciliary muscle spasm, convergent strabismus or miosis, is a recognised consequence of head trauma. In whiplash cases, cervical spine hyperextension poses a risk of contra-coup injury and brainstem trauma, and is known to affect the visual system. However, to date, no cases of accommodative spasm due to whiplash injury have been reported. Observations: We present the case of a 34-year-old female who developed sudden onset blurred distance vis...

Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability.

Science.gov (United States)

Maujean, Annick; Gullo, Matthew J; Andersen, Tonny Elmose; Ravn, Sophie Lykkegaard; Sterling, Michele

2017-11-01

The presence of post-traumatic stress disorder (PTSD) symptoms has been found to be associated with an increased risk of persisting neck pain and disability in motor vehicle crash (MVC) survivors with whiplash injuries. The findings are mixed as to which PTSD symptom(s) best predicts recovery in this population. The aims were (1) to explore the factor structure of the Post-traumatic Stress Diagnostic Scale (PDS) in a sample of acute whiplash-injured individuals following a MVC and (2) to identify the PTSD-symptom clusters that best predict long-term neck pain-related disability in this population as measured by the Neck Pain Disability Index (NDI). A sample (N = 146) of whiplash-injured individuals completed the NDI and the PDS at baseline (whiplash-injured individuals following a MVC.

A Test-Retest Reliability Study of the Whiplash Disability Questionnaire in Patients With Acute Whiplash-Associated Disorders.

Science.gov (United States)

Stupar, Maja; Côté, Pierre; Beaton, Dorcas E; Boyle, Eleanor; Cassidy, J David

2015-01-01

The purpose of this study was to determine the test-retest reliability and the Minimal Detectable Change (MDC) of the Whiplash Disability Questionnaire (WDQ) in individuals with acute whiplash-associated disorders (WADs). We performed a test-retest reliability study. We included insurance claimants from Ontario who were at least 18 years of age, within 21 days of their motor vehicle collision and diagnosed as having acute WAD grades I to III. The WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability), was administered to all participants at baseline and by telephone 3 days later. We computed the intraclass correlation coefficient (model 2,1) and the MDC with 95% confidence intervals (CIs; MDC95). The mean (SD) age of the 66 participants was 41.6 (12.7) years and 71.2% were female. Twenty-nine percent had WAD I and 71.2% had WAD II. Time since injury ranged from 0 to 19 days. The mean (SD) baseline WDQ score was 49.3 (28.8) and 46.5 (29.8) 3 days later. The intraclass correlation coefficient for the WDQ total score was 0.89 (95% CI, 0.85-0.92) in the entire sample and 0.83 (95% CI, 0.69-0.93) for the 15 participants reporting no change in neck pain. The MDC95 of the WDQ was 21.4 (SD = 14.9) for participants reporting no change. The WDQ was reliable in individuals with acute WAD. There is 95% confidence that a change of approximately one-sixth of the total score is beyond the daily variation of a stable condition. This level of measurement error must be taken into consideration when interpreting change in WDQ scores. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

A 10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in northern Sweden.

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Styrke, Johan; Stålnacke, Britt-Marie; Bylund, Per-Olof; Sojka, Peter; Björnstig, Ulf

2012-10-01

To examine the annual incidence of acute whiplash injuries after road traffic crashes in a geographic catchment area in Northern Sweden during the period 2000-2009. Descriptive epidemiology determined by prospectively collected data from a defined population. The study was conducted at a public hospital in Sweden. The population of the hospital's catchment area (136,600 inhabitants in 1999 and 144,500 in 2009). At the emergency department, all injured persons (approximately 11,000 per year) were asked to answer a questionnaire about the injury incident. Data from the medical records also were analyzed. From 2000-2009, 15,506 persons were injured in vehicle crashes. Persons who were subject to an acute neck injury within whiplash-associated disorder grades 1-3 were included. The overall and annual incidences were calculated as incidence. Age, gender, type of injury event, and direction of impact were described. The incidences were compared with national statistics on insurance claims from 2003, 2007, and 2008 to detect changes in the proportions of claims. The annual incidence of acute whiplash injuries. Secondary outcome measures were types of injury events, age and gender distribution, changes in the proportion of rear-end crashes during 2000-2009, and changes in the proportion of insurance claims during 2003-2008. During 2000-2009, 3297 cases of acute whiplash injury were encountered. The overall incidence was 235/100,000/year. The average yearly increase in incidence was 1.0%. Women comprised 51.9% and men 48.1% of the injured. Car occupants (86.4%) and bicycle riders (6.1%) were most frequently injured. The proportion of rear-end crashes decreased from 55% to 45% from 2000-2009. The proportion of insurance claims significantly decreased between 2003 and 2008 (P whiplash injuries after road traffic crashes have been relatively stable during the past decade in our area, except in 2007 and 2008, when a peak occurred. Copyright © 2012 American Academy of Physical

Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability

OpenAIRE

Annick Maujean; Matthew J. Gullo; Tonny Elmose Andersen; Sophie Lykkegaard Ravn; Michele Sterling

2017-01-01

Abstract. Introduction:. The presence of post-traumatic stress disorder (PTSD) symptoms has been found to be associated with an increased risk of persisting neck pain and disability in motor vehicle crash (MVC) survivors with whiplash injuries. The findings are mixed as to which PTSD symptom(s) best predicts recovery in this population. Objectives:. The aims were (1) to explore the factor structure of the Post-traumatic Stress Diagnostic Scale (PDS) in a sample of acute whiplash-injured in...

Whiplash headache is transitory worsening of a pre-existing primary headache.

Science.gov (United States)

Stovner, L J; Obelieniene, D

2008-07-01

Acute and chronic whiplash headache are new diagnostic entities in the ICHD-2 (5.3, 5.4). In a prospective cohort study, 210 rear-end collision victims were identified consecutively from police records and asked about head and neck pain in questionnaires after 2 weeks, 3 months and 1 year. The results were compared with those of matched controls who were also followed for 1 year. Of 210 accident victims, 75 developed headache within 7 days. Of these, 37 had also neck pain and complied with the criteria for acute whiplash headache. These 37 had the same headache diagnoses, headache features, accompanying symptoms and long-term prognosis as the 38 without initial neck pain who therefore did not comply with the acute whiplash headache diagnosis. Previous headache was a major risk factor for headache both in the acute and chronic stage. Compared with the non-traumatized controls, headache in the whiplash group had the same prevalence, the same diagnoses and characteristic features, and the same prognosis. Both acute and chronic whiplash headache lack specificity compared with the headache in a control group, and have the same long-term prognosis, indicating that such headaches are primary headaches, probably elicited by the stress of the situation.

External validation of a clinical prediction rule to predict full recovery and ongoing moderate/severe disability following acute whiplash injury.

Science.gov (United States)

Ritchie, Carrie; Hendrikz, Joan; Jull, Gwendolen; Elliott, James; Sterling, Michele

2015-04-01

Retrospective secondary analysis of data. To investigate the external validity of the whiplash clinical prediction rule (CPR). We recently derived a whiplash CPR to consolidate previously established prognostic factors for poor recovery from a whiplash injury and predicted 2 recovery pathways. Prognostic factors for full recovery were being less than 35 years of age and having an initial Neck Disability Index (NDI) score of 32% or less. Prognostic factors for ongoing moderate/severe pain and disability were being 35 years of age or older, having an initial NDI score of 40% or more, and the presence of hyperarousal symptoms. Validation is required to confirm the reproducibility and accuracy of this CPR. Clinician feedback on the usefulness of the CPR is also important to gauge acceptability. A secondary analysis of data from 101 individuals with acute whiplash-associated disorder who had previously participated in either a randomized controlled clinical trial or prospective cohort study was performed using accuracy statistics. Full recovery was defined as NDI score at 6 months of 10% or less, and ongoing moderate/severe pain and disability were defined as an NDI score at 6 months of 30% or greater. In addition, a small sample of physical therapists completed an anonymous survey on the clinical acceptability and usability of the tool. Results The positive predictive value of ongoing moderate/severe pain and disability was 90.9% in the validation cohort, and the positive predictive value of full recovery was 80.0%. Surveyed physical therapists reported that the whiplash CPR was simple, understandable, would be easy to use, and was an acceptable prognostic tool. External validation of the whiplash CPR confirmed the reproducibility and accuracy of this dual-pathway tool for individuals with acute whiplash-associated disorder. Further research is needed to assess prospective validation, the impact of inclusion on practice, and to examine the efficacy of linking treatment

Structural and construct validity of the Whiplash Disability Questionnaire in adults with acute whiplash-associated disorders.

Science.gov (United States)

Stupar, Maja; Côté, Pierre; Beaton, Dorcas E; Boyle, Eleanor; Cassidy, J David

2015-11-01

Few instruments are available to measure disability associated with whiplash-associated disorders (WAD). The Whiplash Disability Questionnaire (WDQ) was developed to measure disability resulting from WAD, but its validity is unknown for acute WAD. The aim was to determine the structural and construct validity of the WDQ in individuals with acute WAD. This was a cohort study. Ontario adults with WAD were enrolled within 3 weeks of their motor vehicle collision. The outcome measure was the WDQ. We included insurance claimants who were aged 18 years or older and diagnosed with acute WAD Grades I to III. All participants completed the WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability). We assessed the factor structure of the WDQ and tested its construct validity against self-perceived recovery, neck pain (Numerical Rating Scale [NRS]), neck disability (Neck Disability Index [NDI] and Neck Bournemouth Questionnaire), health-related quality of life (36-Item Short Form Health Survey [SF-36]), and depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]). The mean age of the 130 participants was 42.1 years (standard deviation [SD]=13.2), and 70% were women. Twenty-six percent had WAD I, 73.1% had WAD II, and 0.8% had WAD III. Mean time since injury was 6.5 days (SD=4.9). The mean WDQ score was 49.8 (SD=29.1). Our analysis suggested that the WDQ includes two factors: daily activities and emotional status. This factor structure remained stable in sensitivity analyses (eg, zeros imputed for missing values, and the item with the most missing values or resulting in complex loading excluded). Strong correlations were found between the total WDQ score and the NDI, the Bournemouth questionnaire, the SF-36 physical function, and the NRS (for the neck, shoulder, mid and low back pain) satisfying a priori hypotheses. We found a priori hypothesized moderate correlations between the WDQ, and the CES-D and SF-36 mental function

Altered cerebral blood flow in chronic neck pain patients but not in whiplash patients: a 99mTc-HMPAO rCBF study

OpenAIRE

Sundström, Torbjörn; Guez, Michel; Hildingsson, Christer; Toolanen, Göran; Nyberg, Lars; Riklund, Katrine

2006-01-01

A cross-sectional study to investigate regional cerebral blood flow (rCBF) in patients with chronic whiplash syndrome and chronic neck pain patients without previous history of trauma along with a healthy control group. Chronic neck pain is a common disorder and a history of cervical spine injury including whiplash trauma constitute a risk factor for persistent neck pain. The aetiology of the late whiplash syndrome is unknown with no specific diagnostic criteria based on imaging, physiologica...

[Whiplash lesions and temporomandibular joint disorders].

Science.gov (United States)

Gola, R; Richard, O; Guyot, L; Cheynet, F

2004-11-01

Attributing dysfunction of the temporomandibular joint (TMJ) to whiplash injury is a difficult problem to solve. TMJ disorders do not seem to be secondary to direct articular trauma but rather caused by a postural disorder of the cervical spine. Occlusal disorders and stress further complicate the picture. Four clinical cases illustrate a new hypothetical approach.

A Review of Traumatic Axonal Injury following Whiplash Injury As Demonstrated by Diffusion Tensor Tractography

Directory of Open Access Journals (Sweden)

Sung Ho Jang

2018-02-01

Full Text Available Whiplash is a bony or soft tissue injury resulting from an acceleration–deceleration energy transfer in the neck. Although patients with whiplash injury often complain of cerebral symptoms, and previous studies have reported evidence indicating brain injury, such an association has not been clearly elucidated. Traumatic axonal injury (TAI is tearing of axons due to indirect shearing forces during acceleration, deceleration, and rotation of the brain or to direct head trauma. Diffusion tensor imaging (DTI has a unique advantage to detect TAI in patients whose conventional brain CT or magnetic resonance imaging (MRI results were negative following head trauma. Since the introduction of DTI, six studies using diffusion tensor tractography (DTT based on DTI data have reported TAI in patients with whiplash injury, even though conventional brain CT or MRI results were negative. A precise TAI diagnosis in whiplash patients is clinically important for proper management and prognosis. Among the methods employed to diagnose TAI in the six previous studies, the common diagnostic approach for neural tract TAI in individual patients with whiplash injury were (1 whiplash injury history due to car accident; (2 development of new clinical symptoms and signs after whiplash injury; (3 evidence of neural tract TAI in DTT results, mainly via configurational analysis; and (4 coincidence of newly developed clinical manifestations and the function of injured neural tracts. All six studies were individual patient case studies; therefore, further prospective studies involving larger number of subjects should be encouraged.

Temporomandibular disorders after whiplash injury: a controlled, prospective study.

Science.gov (United States)

Kasch, Helge; Hjorth, Tine; Svensson, Peter; Nyhuus, Lone; Jensen, Troels S

2002-01-01

Whiplash injury to the neck is often considered a significant risk factor for development of temporomandibular disorders (TMD), and has been proposed to produce internal derangements of the temporomandibular joint (TMJ). Few studies, however, have examined TMD-related pain in acute whiplash patients compared with a matched control group. The aim of the present study was to assess pain and sensorimotor function in the craniofacial region in an unselected group of patients sustaining a motor vehicle accident involving a rear collision. Prospectively, 19 acute whiplash patients exposed to a motor vehicle accident involving a rear collision participated in a study of TMD. The control group consisted of 20 age- and gender-matched ankle-injury patients. Participants were seen within 4 weeks and again at 6 months post-injury. The masticatory system was examined in accordance with the research diagnostic criteria. Participants underwent structured interviews, filled out the McGill Pain Questionnaire (MPQ), and had their masticatory system examined by a trained dentist, blinded to their diagnosis. Pain detection threshold (PDT) to pressure stimuli, and maximal voluntary occlusal force (MVOF) were obtained at each visit. One whiplash patient and 1 ankle-injury patient had jaw pain at the first visit. Palpation scores of the TMJ and the summated palpation scores only tended to be higher in patients sustaining a whiplash injury than in ankle-injury controls at the first visit. However, MPQ, TMD symptoms and signs, MVOF and PDT were not significantly different in whiplash-injury and ankle-injury patients after 4 weeks and 6 months. TMD pain after whiplash injury and ankle injury is rare, suggesting that whiplash injury is not a major risk factor for the development of TMD problems. Further studies are needed to identify which other factors may contribute to TMD pain.

Factors predicting outcome in whiplash injury: a systematic meta-review of prognostic factors.

Science.gov (United States)

Sarrami, Pooria; Armstrong, Elizabeth; Naylor, Justine M; Harris, Ian A

2017-03-01

Whiplash injuries are among the leading injuries related to car crashes and it is important to determine the prognostic factors that predict the outcome of patients with these injuries. This meta-review aims to identify factors that are associated with outcome after acute whiplash injury. A systematic search for all systematic reviews on outcome prediction of acute whiplash injury was conducted across several electronic databases. The search was limited to publications in English, and there were no geographical or time of publication restrictions. Quality appraisal was conducted with A Measurement Tool to Assess Systematic Reviews. The initial search yielded 207 abstracts; of these, 195 were subsequently excluded by topic or method. Twelve systematic reviews with moderate quality were subsequently included in the analysis. Post-injury pain and disability, whiplash grades, cold hyperalgesia, post-injury anxiety, catastrophizing, compensation and legal factors, and early healthcare use were associated with continuation of pain and disability in patients with whiplash injury. Post-injury magnetic resonance imaging or radiographic findings, motor dysfunctions, or factors related to the collision were not associated with continuation of pain and disability in patients with whiplash injury. Evidence on demographic and three psychological factors and prior pain was conflicting, and there is a shortage of evidence related to the significance of genetic factors. This meta-review suggests an association between initial pain and anxiety and the outcome of acute whiplash injury, and less evidence for an association with physical factors. Level 1.

Disc pathology after whiplash injury. A prospective magnetic resonance imaging and clinical investigation.

Science.gov (United States)

Pettersson, K; Hildingsson, C; Toolanen, G; Fagerlund, M; Björnebrink, J

1997-02-01

This study was used to evaluate the relationship between magnetic resonance imaging findings and clinical findings after whiplash injury. To identify initial soft-tissue damage after whiplash injury, the development of disc pathology, and the relationship of disc pathology to clinical findings. Although a few studies have reported pathological magnetic resonance imaging findings after whiplash injuries, there is no prospective study published to our knowledge. Thirty-nine patients, 20 women and 19 men with a mean age of 32 years, were treated for whiplash injury. Magnetic resonance imaging and clinical examination were performed in a blinded manner at a mean of 11 days after trauma. The procedure was repeated at a 2-year follow-up visit. Two patients could not be examined with the second magnetic resonance imaging because of claustrophobia and pregnancy, respectively. The authors found 13 patients (33%) with disc herniations with medullary (six cases) or dura (seven cases) impingement over the 2-year follow-up period. At the follow-up examination all patients with medullary impingement had persistent or increased symptoms, and three of 27 patients (11%) with no or slight changes on magnetic resonance imaging had persistent symptoms. No ligament injuries were diagnosed. Although disc pathology seems to be one contributing factor in the development of chronic symptoms after whiplash injury, it may be unnecessary to examine these patients in the acute phase with magnetic resonance imaging; correlating initial symptoms and signs to magnetic resonance imaging findings is difficult because of the relatively high proportion of false-positive results. Magnetic resonance imaging is indicated later in the course of treatment in patients with persistent arm pain, neurologic deficits or clinical signs of nerve root compression to diagnose disc herniations requiring surgery.

The relationship between chronic whiplash-associated disorder and post-traumatic stress: attachment-anxiety may be a vulnerability factor

OpenAIRE

Andersen, Tonny Elmose; Elklit, Ask; Vase, Lene

2011-01-01

Background: In more than 90% of whiplash accidents a good explanation regarding the association between trauma mechanism, organic pathology, and persistent symptoms has failed to be provided. Objective: We predicted that the severity of chronic whiplash-associated disorder (WAD), measured as number of whiplash symptoms, pain duration, pain-related disability, and degree of somatisation would be associated with the number of post-traumatic stress disorder symptoms (PTSD). Secondly, we expected...

Altered cerebral blood flow in chronic neck pain patients but not in whiplash patients: a 99mTc-HMPAO rCBF study.

Science.gov (United States)

Sundström, Torbjörn; Guez, Michel; Hildingsson, Christer; Toolanen, Göran; Nyberg, Lars; Riklund, Katrine

2006-08-01

A cross-sectional study to investigate regional cerebral blood flow (rCBF) in patients with chronic whiplash syndrome and chronic neck pain patients without previous history of trauma along with a healthy control group. Chronic neck pain is a common disorder and a history of cervical spine injury including whiplash trauma constitute a risk factor for persistent neck pain. The aetiology of the late whiplash syndrome is unknown with no specific diagnostic criteria based on imaging, physiological, or psychological examination. Earlier studies indicate a parieto-occipital hypoperfusion but it is unclear if the hypoperfusion represents a response to chronic pain. The rCBF was monitored in 45 patients with chronic neck pain: 27 cases with chronic whiplash syndrome and 18 age and gender matched cases with non-traumatic chronic neck pain. The rCBF was estimated with single-photon emission computed tomography (SPECT) using technetium-99m hexamethylpropylene amine oxime (HMPAO). The non-traumatic patients displayed rCBF changes in comparison with the whiplash group and the healthy control group. These changes included rCBF decreases in a right temporal region close to hippocampus, and increased rCBF in left insula. The whiplash group displayed no significant differences in rCBF in comparison with the healthy controls. The present study suggests different pain mechanisms in patients with chronic neck pain of non-traumatic origin compared to those with chronic neck pain due to a whiplash trauma.

Management of Acute Skin Trauma

Institute of Scientific and Technical Information of China (English)

Joel W. Beam

2010-01-01

@@ Acute skin trauma (ie, abrasions, avulsions, blisters, incisions, lacerations, and punctures) is common among individuals involved in work, recreational, and athletic activities. Appropriate management of these wounds is important to promote healing and lessen the risk of cross-contamination and infection. Wound management techniques have undergone significant changes in the past 40 years but many clinicians continue to manage acute skin trauma with long-established, traditional techniques (ie, use of hydrogen peroxide, adhesive strips/patches, sterile gauze, or no dressing) that can delay healing and increase the risk of infection. The purpose of this review is to discuss evidence-based cleansing, debridement, and dressing techniques for the management of acute skin trauma.

Chronic Neck Pain and Whiplash: A Case-Control Study of the Relationship between Acute Whiplash Injuries and Chronic Neck Pain

Directory of Open Access Journals (Sweden)

Michael D Freeman

2006-01-01

Full Text Available The authors undertook a case-control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain.

[Whiplash injury as a function of the accident mechanism. Neuro-otological differential diagnostic findings].

Science.gov (United States)

Geiger, G; Aliyev, R M

2012-07-01

Depending on the type of collision, car occupants who are involved in traffic accidents are often exposed to the unexpected effects on the cervical spine of traumatic stimuli from different directions. In a rear-end collision or a frontal collision of the car it is most likely that there is an effect of linear acceleration and a lateral or side impact acceleration of axial rotation on the cervical spine. The neuro-otological manifestations of whiplash injuries that can occur in response to various trauma mechanisms have not yet been sufficiently investigated. Data from 64 patients who suffered a whiplash injury were selected for analysis. In 32 patients the trauma mechanism was a sudden action on the cervical spine from a linear impulse caused by a head-on collision of cars or rear-end collision. In the other 32 patients the trauma mechanism was a sudden action of an axial neck rotation at a side impact collision or a cross collision. The study compared the results of neuro-otological findings between the two patient groups. A comparison of the neuro-otological examination data of 64 patients revealed that there were 32 patients who had a sudden injury mechanism of cervical axial rotation, the prevalence of central vestibular and sensory impairments, such as pathological central nystagmus disinhibition, pathological changes in the auditory brainstem evoked potentials (ABEP), the auditory evoked cortical potentials (ALEP) and visual evoked potentials (VEP). In the second group of patients where the injury mechanism consisted of an unexpected linear momentum, peripheral vestibular and sensory disorders were predominant. The observed differences in neuro-otological manifestations of whiplash trauma, which occur depending on the trauma mechanism, can be used for differential diagnostic purposes. The whiplash injuries of the cervical spine induced by an axial rotation acceleration showed a prevalence of central vestibular and sensory disturbances, while the whiplash

A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study

DEFF Research Database (Denmark)

Kasch, Helge; Kongsted, Alice; Qerama, Erisela

2013-01-01

OBJECTIVES: An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented. DESIGN: The design was an observational prospective study of risk factors embedded in a randomised controlled study. SETTING: Acute whiplash...... patients from units, general practitioners in four Danish counties were referred to two research centres. PARTICIPANTS: During a 2-year inclusion period, acute consecutive whiplash-injured (age 18-70 years, rear-end or frontal-end car accident and WAD (whiplash-associated disorders) grades I-III, symptoms...... and examined by a study nurse after 5 days; 605 were completed after 1 year. A risk score which included items of initial neck pain/headache intensity, a number of non-painful complaints and active neck mobility was applied. The primary outcome parameter was 1-year work disability. RESULTS: The risk score...

The association between anxiety and chronic pain after whiplash injury: gender-specific effects.

Science.gov (United States)

Elklit, Ask; Jones, Allan

2006-06-01

There is increasing evidence to suggest that anxiety is related more strongly to chronic pain experience in men relative to women. The aim of the present study was to examine for the first time gender-specific associations between anxiety and chronic pain experience in men and women exposed to whiplash trauma. One thousand seven hundred and nine people with whiplash (1349 women, 360 men) belonging to the Danish Society for Polio, Traffic, and Accident Victims completed a battery of questionnaires measuring demographic, psychologic, and pain-related factors (including frequency of painful episodes, level of pain interference, number of anatomic regions in which pain was felt, and the level of general disability). Anxiety was found to be positively related to the level of general disability to a significantly stronger magnitude in men compared with women. A trend difference in correlation magnitude was also found between men and women when comparing anxiety with pain frequency, with the magnitude of correlation being higher in men. The stronger association between anxiety and symptoms of whiplash trauma in men compared with women may be due to gender differences in the attribution of anxiety-related autonomic arousal as symptoms of whiplash injury. Alternatively, anxiety may differentially affect the willingness of men and women to report pain and other health indices. Anxiety is an important factor in understanding gender differences in whiplash-related symptoms such as chronic pain and disability, and requires further investigation.

Economic and Health-Related Quality of Life Outcomes of Whiplash Associated Disorders.

Science.gov (United States)

Pink, Joshua; Petrou, Stavros; Williamson, Esther; Williams, Mark; Lamb, Sarah E

2016-09-01

This study examines the links between severity of whiplash associated disorder and costs and health outcomes. The study aims to estimate the economic costs and health-state utilities associated with disability levels and recovery trajectories after acute whiplash injury. Data used were from the Managing Injuries of the Neck Trial, which collected information on 3851 people over a 12-month period after acute whiplash injury. Effects of whiplash associated disorder severity on economic costs (measured from a societal perspective and separately from a health and personal social services perspective) were estimated using two-part regression models, comprising probability of incurring a cost and the total cost, given one was incurred. Effects on health-state utilities (measured using the EQ-5D and SF-6D) were estimated using ordinary least squares regression, and two-part models as for costs. There was a direct relationship between severity of disability after acute whiplash injury and economic costs. Between baseline and 4 months, average societal costs for those with no disability were £99.55 (UK£, 2009 prices), increasing to £668.53 for those with complete disability. Average societal costs for the whole sample were £234.15 over the first 4 months, decreasing to £127.51 between 8 and 12 months. Conversely, utility scores decreased with increased disability. The average EQ-5D utility score was 0.934 at 4 months for those with no disability, decreasing to 0.033 for those with complete disability. The average EQ-5D utility score for the whole sample increased from 0.587 immediately post-injury to 0.817 at 12 months. Relative costs and disutilities generated by the multivariate models are also presented by disability level and recovery trajectory. These results provide estimates of the costs and health-state utilities associated with disability levels and recovery trajectories after acute whiplash injury. They can be used to inform estimates of the cost

Whiplash-associated disorder: musculoskeletal pain and related clinical findings

Science.gov (United States)

Sterling, Michele

2011-01-01

The aim of this paper was to review the physical and psychological processes associated with whiplash-associated disorders. There is now much scientific data available to indicate the presence of disturbed nociceptive processing, stress system responses, muscle and motor changes as well as psychological factors in both acute and chronic whiplash-associated disorders. Some of these factors seem to be associated with the transition from acute to chronic pain and have demonstrated prognostic capacity. Further investigation is required to determine if these processes can be modified and if modification will lead to improved outcomes for this condition. The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. The understanding of processes underlying this condition is improving and this lays the foundation for the development of more effective management approaches. PMID:23115472

Evidence for cervical muscle morphometric changes on magnetic resonance images after whiplash: A systematic review and meta-analysis.

Science.gov (United States)

Owers, Daniel S; Perriman, Diana M; Smith, Paul N; Neeman, Teresa; Webb, Alexandra L

2018-02-01

Morphometric changes to cervical musculature in whiplash associated disorder have been reported in several studies with varying results. However, the evidence is not clear because only a limited number of cohorts have been studied and one cohort has been reported in multiple publications. The aim of this study was to assess the evidence for cervical muscle morphometric changes on magnetic resonance (MR) images after whiplash using a systematic review with meta-analysis. PubMed, MEDLINE and Cochrane Library were searched without language restriction using combinations of the MeSH terms "muscles", "whiplash injuries", and "magnetic resonance imaging". Studies of acute and chronic whiplash were included if they compared whiplash and control cervical spine muscle morphometry measurements from MR images. The search identified 380 studies. After screening, eight studies describing five cohorts (one acute, three chronic, one both acute and chronic) met the inclusion criteria. Participant characteristics and outcome measures were extracted using a standard extraction format. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale. Muscle cross-sectional area (CSA) and fat infiltrate (MFI) for acute and chronic whiplash cohorts were compared using mean difference and 95% confidence intervals. Meta-analysis models were created when data from more than two eligible cohorts was available, using inverse-variance random-effects models (RevMan5 version 5.3.5). Quality assessment was uniformly good but only two studies blinded the assessor. Analysis of the acute cohorts revealed no consensus with respect to CSA. MFI was not measured in the acute cohorts. Analysis of the chronic cohorts revealed CSA is probably increased in some muscles after whiplash but there is insufficient evidence to confirm whether MFI is also increased. Because the available data were limited, meta-analyses of only multifidus were performed. In chronic whiplash multifidus CSA was

[Preliminary study on syndrome differentiation types and acupuncture for whiplash injuries].

Science.gov (United States)

Chen, Ye-meng; Li, Hui; Zheng, Xin; Zhang, Qun-ce; Wang, Tian-fang

2011-04-01

Whiplash injury is a relatively common injury of clinical acupuncture and moxibustion in the United States. The mechanism and clinical manifestation of whiplash injuries as well as its pathogenesis described in TCM were analyzed in this present article. The authors introduced the TCM syndrome differentiation of whiplash injuries and claimed that both the location and the stage of disease should be considered. For the different injury locations, the meridian musculature differentiation was applied to classify the whiplash injuries as Taiyang, Yangming, Shaoyang and Shaoyin Meridian syndromes. Considering the duration of the injury, qi stagnation and blood stasis types were classified in the acute stage and phlegm accumulation, insufficiency of the liver and kidney and qi and blood deficiencies types were classified during the chronic stage. An acupuncture protocol for whiplash injuries and typical cases were also introduced.

A cross-cultural comparison between Canada and Germany of symptom expectation for whiplash injury.

Science.gov (United States)

Ferrari, Robert; Lang, Christoph

2005-02-01

Symptom expectation for whiplash injury has been shown to be low in countries with low rates of chronic whiplash when compared with countries like Canada, where chronic whiplash is common. The objective of the current study is to compare the frequency and nature of expected "whiplash" symptoms in Germany with that in Canada. A symptom checklist was administered to two subject groups selected from local companies in Germany and Canada. Subjects were asked to imagine having suffered a neck sprain (whiplash injury) with no loss of consciousness in a motor vehicle collision and to check which, of a variety of symptoms, they would expect might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist. In both groups, the pattern of acute symptoms anticipated closely resembled the symptoms of acute whiplash victims, but 50% of Canadians also anticipated symptoms to last months or years, whereas few German subjects selected any symptoms as likely to persist. In Germany, despite the documented occurrence of neck sprain symptoms in individuals following motor vehicle collisions, there is a very low rate of expectation of any sequelae from this injury. The current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Germany may, in part, determine the low prevalence of the chronic whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the chronic whiplash syndrome are needed.

Acute appendicitis after blunt abdominal trauma

Directory of Open Access Journals (Sweden)

Marjan Joudi

2012-02-01

Full Text Available Appendecitis is one of the most frequent surgeries. Inflammation of appendix may be due to variable causes such as fecalit, hypertrophy of Peyer’s plaques, seeds of fruits and parasites. In this study we presented an uncommon type of appendicitis which occurred after abdominal blunt trauma. In this article three children present who involved acute appendicitis after blunt abdominal trauma. These patients were 2 boys (5 and 6-year-old and one girl (8-year-old who after blunt abdominal trauma admitted to the hospital with abdominal pain and symptoms of acute abdomen and appendectomy had been done for them.Trauma can induce intramural hematoma at appendix process and may cause appendicitis. Therefore, physicians should be aware of appendicitis after blunt abdominal trauma

Otological and vestibular symptoms in patients with low grade (Quebec grades one and two) whiplash injury.

Science.gov (United States)

Rowlands, R G; Campbell, I K; Kenyon, G S

2009-02-01

To establish the prevalence of new vestibular and otological symptoms in a group of patients who had sustained a low grade (Quebec grades one or two) whiplash injury. A retrospective review of the case records of 109 patients undergoing assessment by a single practitioner for the purposes of compiling a medicolegal report on their whiplash injury. Four patients complained of short-lived, non-specific dizziness symptoms in the acute phase following their original injury. There were no reports of vertigo, tinnitus or hearing loss after a mean period of 149 days following the whiplash injury. No patients reported otological or persistent vestibular symptoms in the acute phase following their whiplash injury. This suggests that caution should be exercised when attributing these symptoms to such an injury. Before whiplash injuries are admitted as an aetiological factor in the development of such symptoms, other causes should be excluded.

Persistent pseudomyopia following a whiplash injury in a previously emmetropic woman.

Science.gov (United States)

Hughes, Fintan E; Treacy, Maxwell P; Duignan, Emma S; Mullaney, Paul B

2017-12-01

Accommodative spasm, which manifests as ciliary muscle spasm, convergent strabismus or miosis, is a recognised consequence of head trauma. In whiplash cases, cervical spine hyperextension poses a risk of contra-coup injury and brainstem trauma, and is known to affect the visual system. However, to date, no cases of accommodative spasm due to whiplash injury have been reported. We present the case of a 34-year-old female who developed sudden onset blurred distance vision after a rear impact car crash, having previously been emmetropic. Her unaided distance visual acuity was 20/70 in the right eye and 20/20 in the left. Best-corrected visual acuity in the right eye was 20/20 with a correction that progressed from -1.75 to -3.50 DS over the 12 months following the accident.This patient's sudden unilateral myopia, with unilaterally increased amplitude of accommodation suggests pseudomyopia due to accommodative spasm. Magnetic resonance imaging showed no evidence of injury to her brain stem, frontal lobes or oculomotor nerve. The patient is now well adjusted with a -3.50DS corrective lens for the right eye. The accommodation reflex is susceptible to injury at the occipital lobe, frontal eye fields, Edinger-Westphal nuclei and oculomotor nerves. As such it should be examined in patients who present with visual disturbances following whiplash injury.It is important that such cases are identified at presentation, as early intervention can improve outcomes in accommodative spasm and reduce the long term psychological effects often associated with whiplash injuries.

The fear-avoidance model in whiplash injuries.

Science.gov (United States)

Nieto, Rubén; Miró, Jordi; Huguet, Anna

2009-05-01

The aim of this work was to study whether fear of movement, and pain catastrophizing predict pain related-disability and depression in sub-acute whiplash patients. Moreover, we wanted to test if fear of movement is a mediator in the relation between catastrophizing and pain-related disability/depression as has been suggested by the fear-avoidance model [Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995;62:363-72]. The convenience sample used was of 147 sub-acute whiplash patients (pain duration less than 3 months). Two stepwise regression analyses were performed using fear of movement and catastrophizing as the independent variables, and disability and depression as the dependent variables. After controlling for descriptive variables and pain characteristics, catastrophizing and fear of movement were found to be predictors of disability and depression. Pain intensity was a predictor of disability but not of depression. The mediation effect of fear of movement in the relationships between catastrophizing and disability, and between catastrophizing and depression was also supported. The results of this study are in accordance with the fear-avoidance model, and support a biopsychosocial perspective for whiplash disorders.

Delayed onset of fatal basilar thrombotic embolus after whiplash injury

DEFF Research Database (Denmark)

Viktrup, L; Knudsen, G M; Hansen, S H

1995-01-01

in a collision. CASE DESCRIPTION: After whiplash trauma in a car accident, a 50-year-old taxi driver suffered from headache and episodic visual disturbances. Two months after the accident he suddenly lost consciousness and was admitted to the hospital. A CT scan performed at that time was indicative of basilar...

Assessing the existence of dissociative PTSD in sub-acute patients of whiplash.

Science.gov (United States)

Hansen, Maj; Hyland, Philip; Armour, Cherie; Andersen, Tonny E

2018-03-16

Numerous studies investigating dissociative posttraumatic stress disorder (D-PTSD) have emerged. However, there is a lack of studies investigating D-PTSD following a wider range of traumatic exposure. Thus, the present study investigates D-PTSD using latent class analysis (LCA) in sub-acute patients of whiplash and associated risk factors. The results of LCA showed a three-class solution primarily distributed according to posttraumatic stress disorder (PTSD) symptom severity and thus no indication of D-PTSD. Dissociative symptoms, psychological distress (i.e. anxiety/depression), and pain severity significantly predicted PTSD severity. Combined, the results support the component model of dissociation and PTSD, while still stressing the importance of dissociative symptoms when planning treatment for PTSD.

A three-group study, internet-based, face-to-face based and standard- management after acute whiplash associated disorders (WAD – choosing the most efficient and cost-effective treatment: study protocol of a randomized controlled trial

Directory of Open Access Journals (Sweden)

Bring Annika

2009-07-01

Full Text Available Abstract Background The management of Whiplash Associated Disorders is one of the most complicated challenges with high expenses for the health care system and society. There are still no general guidelines or scientific documentation to unequivocally support any single treatment for acute care following whiplash injury. The main purpose of this study is to try a new behavioural medicine intervention strategy at acute phase aimed to reduce the number of patients who have persistent problems after the whiplash injury. The goal is also to identify which of three different interventions that is most cost-effective for patients with Whiplash Associated Disorders. In this study we are controlling for two factors. First, the effect of behavioural medicine approach is compared with standard care. Second, the manner in which the behavioural medicine treatment is administered, Internet or face-to-face, is evaluated in it's effectiveness and cost-effectiveness. Methods/Design The study is a randomized, prospective, experimental three-group study with analyses of cost-effectiveness up to two-years follow-up. Internet – based programme and face-to-face group treatment programme are compared to standard-treatment only. Patient follow-ups take place three, six, twelve and 24 months, that is, short-term as well as long-term effects are evaluated. Patients will be enrolled via the emergency ward during the first week after the accident. Discussion This new self-help management will concentrate to those psychosocial factors that are shown to be predictive in long-term problems in Whiplash Associated Disorders, i.e. the importance of self-efficacy, fear of movement, and the significance of catastrophizing as a coping strategy for restoring and sustaining activities of daily life. Within the framework of this project, we will develop, broaden and evaluate current physical therapy treatment methods for acute Whiplash Associated Disorders. The project will

Chronic Neck Pain and Whiplash: A Case-Control Study of the Relationship between Acute Whiplash Injuries and Chronic Neck Pain

OpenAIRE

Freeman, Michael D; Croft, Arthur C; Rossignol, Annette M; Centeno, Christopher J; Elkins, Whitney L

2006-01-01

The authors undertook a case-control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain.Four hundred nineteen patients and 246 controls were randomly enrolled. Patients were defined as individuals with chronic neck pain, and controls as those with chronic back pain. The two groups were surveyed for cause of chronic pain as w...

Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study.

Science.gov (United States)

Wiangkham, Taweewat; Duda, Joan; Haque, M Sayeed; Rushton, Alison

2016-09-14

To develop an active behavioural physiotherapy intervention (ABPI) for managing acute whiplash-associated disorder (WAD) II using a modified Delphi method to develop consensus for the basic features of the ABPI. Modified Delphi study. Our systematic review and meta-analysis evaluating conservative management for acute WADII found that a combined ABPI may be a useful intervention to prevent patients progressing to chronicity. No previous research has considered a combined behavioural approach and active physiotherapy in the management of acute WADII patients. The ABPI was therefore developed using a rigorous consensus method using international research and local clinical whiplash experts. Descriptive statistics were used to assess consensus in each round. Online international survey. A purposive sample of 97 potential participants (aiming to recruit n=30) consisting of international research whiplash experts, UK private physiotherapists and UK postgraduate musculoskeletal physiotherapy students were invited to participate via electronic mail with an attached participant information sheet and consent form. 36 individuals signed and returned the consent form. In round 1, 32/36 participants (response rate=89%, mean age±SD=36.03±13.22 years) across 8 countries (Australia, Finland, Greece, India, Netherlands, Norway, Sweden and UK) contributed to round 1 questionnaire. Response rates were 78% and 75% for rounds 2 and 3, respectively. Following round 3, 12 underlying principles (eg, return to normal function as soon as possible, pain management, encouragement of self-management, reduce fear avoidance and anxiety) achieved consensus. The treatment components reaching consensus included behavioural (eg, education, reassurance, self-management) and physiotherapy components (eg, exercises for stability and mobility). No passive intervention achieved consensus. Experts suggested and agreed the underlying principles and treatment components of the ABPI for the management

Acute coagulopathy of trauma

DEFF Research Database (Denmark)

Johansson, P I; Ostrowski, S R

2010-01-01

Acute coagulopathy of trauma predicts a poor clinical outcome. Tissue trauma activates the sympathoadrenal system resulting in high circulating levels of catecholamines that influence hemostasis dose-dependently through immediate effects on the two major compartments of hemostasis, i.......e., the circulating blood and the vascular endothelium. There appears to be a dose-dependency with regards to injury severity and the hemostatic response to trauma evaluated in whole blood by viscoelastic assays like thrombelastography (TEG), changing from normal to hypercoagulable, to hypocoagulable and finally......, is an evolutionary developed response that counterbalances the injury and catecholamine induced endothelial activation and damage. Given this, the rise in circulating catecholamines in trauma patients may favor a switch from hyper- to hypocoagulability in the blood to keep the progressively more procoagulant...

Protocol for an economic evaluation alongside the University Health Network Whiplash Intervention Trial: cost-effectiveness of education and activation, a rehabilitation program, and the legislated standard of care for acute whiplash injury in Ontario

Science.gov (United States)

2011-01-01

Background Whiplash injury affects 83% of persons in a traffic collision and leads to whiplash-associated disorders (WAD). A major challenge facing health care decision makers is identifying cost-effective interventions due to lack of economic evidence. Our objective is to compare the cost-effectiveness of: 1) physician-based education and activation, 2) a rehabilitation program developed by Aviva Canada (a group of property and casualty insurance providers), and 3) the legislated standard of care in the Canadian province of Ontario: the Pre-approved Framework Guideline for Whiplash developed by the Financial Services Commission of Ontario. Methods/Design The economic evaluation will use participant-level data from the University Health Network Whiplash Intervention Trial and will be conducted from the societal perspective over the trial's one-year follow-up. Resource use (costs) will include all health care goods and services, and benefits provided during the trial's 1-year follow-up. The primary health effect will be the quality-adjusted life year. We will identify the most cost-effective intervention using the incremental cost-effectiveness ratio and incremental net-benefit. Confidence ellipses and cost-effectiveness acceptability curves will represent uncertainty around these statistics, respectively. A budget impact analysis will assess the total annual impact of replacing the current legislated standard of care with each of the other interventions. An expected value of perfect information will determine the maximum research expenditure Canadian society should be willing to pay for, and inform priority setting in, research of WAD management. Discussion Results will provide health care decision makers with much needed economic evidence on common interventions for acute whiplash management. Trial Registration http://ClinicalTrials.gov identifier NCT00546806 [Trial registry date: October 18, 2007; Date first patient was randomized: February 27, 2008] PMID

Protocol for an economic evaluation alongside the University Health Network Whiplash Intervention Trial: cost-effectiveness of education and activation, a rehabilitation program, and the legislated standard of care for acute whiplash injury in Ontario

Directory of Open Access Journals (Sweden)

van der Velde Gabrielle

2011-07-01

Full Text Available Abstract Background Whiplash injury affects 83% of persons in a traffic collision and leads to whiplash-associated disorders (WAD. A major challenge facing health care decision makers is identifying cost-effective interventions due to lack of economic evidence. Our objective is to compare the cost-effectiveness of: 1 physician-based education and activation, 2 a rehabilitation program developed by Aviva Canada (a group of property and casualty insurance providers, and 3 the legislated standard of care in the Canadian province of Ontario: the Pre-approved Framework Guideline for Whiplash developed by the Financial Services Commission of Ontario. Methods/Design The economic evaluation will use participant-level data from the University Health Network Whiplash Intervention Trial and will be conducted from the societal perspective over the trial's one-year follow-up. Resource use (costs will include all health care goods and services, and benefits provided during the trial's 1-year follow-up. The primary health effect will be the quality-adjusted life year. We will identify the most cost-effective intervention using the incremental cost-effectiveness ratio and incremental net-benefit. Confidence ellipses and cost-effectiveness acceptability curves will represent uncertainty around these statistics, respectively. A budget impact analysis will assess the total annual impact of replacing the current legislated standard of care with each of the other interventions. An expected value of perfect information will determine the maximum research expenditure Canadian society should be willing to pay for, and inform priority setting in, research of WAD management. Discussion Results will provide health care decision makers with much needed economic evidence on common interventions for acute whiplash management. Trial Registration http://ClinicalTrials.gov identifier NCT00546806 [Trial registry date: October 18, 2007; Date first patient was randomized: February

Why blame is a factor in recovery from whiplash injury.

Science.gov (United States)

Ferrari, R; Russell, A S

2001-03-01

The biopsychosocial model of chronic whiplash continues to evolve. An aspect of the medicolegal and social dilemma of whiplash that has been largely unresearched is the impression in clinical practice of how seldom drivers who caused the collision present with chronic whiplash symptoms. There are potential biological (injury threshold and mechanism), psychological, and social explanations for this observation, and these flow from the same biopsychosocial model that addresses the progression from acute to chronic pain. This article explores each of these factors as they relate to the disparate experiences of the driver at-fault ('blamed') for the collision, and the not-at-fault driver ('innocent victim'). Recent research lends further support to the hypothesis that a biopsychosocial model best explains this phenomenon. Copyright DUMMY.

Whiplash and prevention.

NARCIS (Netherlands)

2008-01-01

A whiplash is caused by a sudden and violent movement of the head in relation to the torso. Whiplash injury is a combination of pain in the neck, pain in the head, and other health complaints. Annually, an estimated 30,000 to 50,000 people in the Netherlands incur whiplash due to a traffic crash,

PTSD Symptoms Mediate the Effect of Attachment on Pain and Somatisation after Whiplash Injury.

Science.gov (United States)

Andersen, Tonny Elmose; Elklit, Ask; Brink, Ole

2013-01-01

The development of persistent pain post-whiplash injury is still an unresolved mystery despite the fact that approximately 50% of individuals reporting whiplash develop persistent pain. There is agreement that high initial pain and PTSD symptoms are indicators of a poor prognosis after whiplash injury. Recently attachment insecurity has been proposed as a vulnerability factor for both pain and PTSD. In order to guide treatment it is important to examine possible mechanisms which may cause persistent pain and medically unexplained symptoms after a whiplash injury. The present study examines attachment insecurity and PTSD symptoms as possible vulnerability factors in relation to high levels of pain and somatisation after sub-acute whiplash injury. Data were collected from 327 patients (women = 204) referred consecutively to the emergency unit after acute whiplash injury. Within 1-month post injury, patients answered a questionnaire regarding attachment insecurity, pain, somatisation, and PTSD symptoms. Multiple mediation analyses were performed to assess whether the PTSD symptom clusters mediated the association between attachment insecurity, pain, and somatisation. A total of 15% fulfilled the DSM-IV symptom cluster criteria for a possible PTSD diagnosis and 11.6% fulfilled the criteria for somatisation. PTSD increased the likelihood of belonging to the moderate-severe pain group three-fold. In relation to somatisation the likelihood of belonging to the group was almost increased four-fold. The PTSD symptom clusters of avoidance and hyperarousal mediated the association between the attachment dimensions, pain, and somatisation. Acknowledging that PTSD is part of the aetiology involved in explaining persistent symptoms after whiplash, may help sufferers to gain early and more suited treatment, which in turn may prevent the condition from becoming chronic.

HYPERTRANSLATION OF THE HEAD BACKWARDS - PART OF THE MECHANISM OF CERVICAL WHIPLASH INJURY

NARCIS (Netherlands)

PENNING, L

Based upon a review of the literature, a theory is developed that in whiplash injury the primary mechanism of the trauma is not hyperretroflexion but hypertranslation of the head backwards. Thus a hyperanteflexion (not hyperretroflexion) of the upper cervical spine, probably especially of the

How Do We Meet the Challenge of Whiplash?

Science.gov (United States)

Elliott, James M; Walton, David M

2017-07-01

A previous special issue of JOSPT (October 2016) discussed whiplash in terms of the clinical problems and current research surrounding prevention, biomechanics of injury, emergent care, imaging advancements, recovery pathways and prognosis, pathogenesis of posttrauma pain, acute and chronic management, and new predictive clinical tools. While great strides have been made in the field of whiplash and are continuing in earnest, a key group of clinicians and academics have recognized that inconsistent outcomes in published literature hamper our ability to meaningfully synthesize research findings, leading to results of systematic reviews that provide very few concrete clinical recommendations. We are optimistic that improved outcomes for people with whiplash-associated disorder (WAD) are attainable in the near future, as interdisciplinary research efforts continue to align internationally, new mechanisms are identified and explored, and advanced statistical techniques allow complex questions to be answered in clinically meaningful ways. J Orthop Sports Phys Ther 2017;47(7):444-446. doi:10.2519/jospt.2017.0106.

Vestibular Rehabilitation in a Patient with Whiplash-associated Disorders

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Kwo-Shieng Tuo

2006-12-01

Full Text Available Whiplash-associated disorders are characterized by multiple physical complaints after a flexion-extension trauma to the neck. They are difficult to treat, and they often result in great impact on the patient's quality of life. In this paper, the comprehensive treatment of a patient with whiplash-associated disorders is presented. The purpose is to highlight the importance of accurate diagnosis and appropriate treatment plans to improve patients' quality of life. This 23-year-old woman experienced a traffic accident which caused severely painful neck disability, numbness over bilateral upper limbs, dizziness, double vision and loss of balance. Among these symptoms, dizziness was the problem that bothered the patient most. She received a comprehensive rehabilitation program including physical modalities, trigger point injections for relief of pain, as well as a vestibular rehabilitation program, which included exercises challenging and improving her balance function, head-eye coordination exercise, visual-ocular control exercise and sensory substitution-promoting exercises. She resumed her previous full-time work after 3 weeks of treatment. This successfully treated case illustrates the importance of correct diagnosis and appropriate treatment for patients who suffer from whiplash-associated disorders.

Late whiplash syndrome: a clinical and magnetic resonance imaging study.

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Bonuccelli, U; Pavese, N; Lucetti, C; Renna, M R; Gambaccini, G; Bernardini, S; Canapicchi, R; Carrozzi, L; Murri, L

1999-01-01

Cervical hyperextension injuries are common and are associated with significant morbidity. Clinically two syndromes are described: "acute" whiplash syndrome and "late" whiplash syndrome (in which the patients are still symptomatic after six months despite normal physical and radiological examination). In order to clarify the pathology of the persistent pain in late whiplash syndrome we performed a cervical spine magnetic resonance imaging (MRI) in 33 consecutive patients suffering from this condition. Twenty-six patients (78.8%) showed MRI abnormalities, the most common MRI finding (57.6%) was pre-existent spondylosis. Indeed, the group of patients with spondylosis and other MRI changes had higher clinical scores than those without MRI abnormalities as measured by a three-point grading system based upon the symptoms and signs shown. Several MRI changes, most of them already demonstrable by standard X-ray were seen among 33 patients suffering from late whiplash syndrome. Although no one of these findings appears to be specific and certainly related to the previous neck injury, they could represent a risk factor for a longer pain duration.

MR imaging evaluation of the temporomandibular joint following cervical extension-flexion injury (whiplash)

International Nuclear Information System (INIS)

Shellock, F.G.; Pressman, B.D.; Schames, J.; Schames, M.; Meeks, T.

1990-01-01

To determine abnormalities of the temporomandibular joint (TMJ) associated with cervical extension-flexion injury (whiplash) with use of MR imaging. Sixteen patients (32 joints) with TMJ syndrome-related symptoms after whiplash injuries from automobile accidents were evaluated by MR imaging. None of the patients had direct trauma to the jaw, mouth, or face. T1-weighted closed- and opened-mouth views were obtained in the sagittal plane, and closed-mouth views were obtained in the coronal plane. T2-weighted closed-mouth views obtained in the sagittal plane were also obtained to optimize identification of fluid/edema. Fourteen (87%) of 16 patients had one or more of the following TMJ abnormalities: 11 (34%) had anterior displacement of the disk with reduction and 2 (6%) had anterior displacement of the disk without reduction. On T2-weighted images, 17 TMJs (53%) had joint fluid and 5 (16%) had fluid localized to the capsule and/or pterygoid muscle. These data demonstrated a high incidence of TMJ abnormalities related to whiplash injury. The predominant finding was associated fluid/edema, suggesting that T2-weighted images are particularly useful for the evaluation of patients who present with whiplash injury

Telephone versus usual care in management of acute whiplash ...

African Journals Online (AJOL)

Whiplash associated disorder (WAD) is a common and costly condition, and recommended management includes advice to “act as usual” and exercise. Providing this treatment through a telephonic intervention may help to improve access to care, and reduce costs. This pilot study assessed: (1) the effectiveness of a ...

Subacromial impingement in patients with whiplash injury to the cervical spine

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Giddins Grey E

2008-06-01

Full Text Available Abstract Background Impingement syndrome and shoulder pain have been reported to occur in a proportion of patients following whiplash injuries to the neck. In this study we aim to examine these findings to establish the association between subacromial impingement and whiplash injuries to the cervical spine. Methods and results We examined 220 patients who had presented to the senior author for a medico-legal report following a whiplash injury to the neck. All patients were assessed for clinical evidence of subacromial impingement. 56/220 patients (26% had developed shoulder pain following the injury; of these, 11/220 (5% had clinical evidence of impingement syndrome. Only 3/11 patients (27% had the diagnosis made prior to evaluation for their medico-legal report. In the majority, other clinicians had overlooked the diagnosis. The seatbelt shoulder was involved in 83% of cases (p Conclusion After a neck injury a significant proportion of patients present with shoulder pain, some of whom have treatable shoulder pathology such as impingement syndrome. The diagnosis is, however, frequently overlooked and shoulder pain is attributed to pain radiating from the neck resulting in long delays before treatment. It is important that this is appreciated and patients are specifically examined for signs of subacromial impingement after whiplash injuries to the neck. Direct seatbelt trauma to the shoulder is one possible explanation for its aetiology.

Location of whiplash pain (image)

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Whiplash is an injury to the soft tissues of the neck. Whiplash injury strains the muscles and ligaments of the ... neck for the first few days following a whiplash injury. The pain can also be felt in ...

The relationship between chronic whiplash-associated disorder and post-traumatic stress: attachment-anxiety may be a vulnerability factor.

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Andersen, Tonny Elmose; Elklit, Ask; Vase, Lene

2011-01-01

In more than 90% of whiplash accidents a good explanation regarding the association between trauma mechanism, organic pathology, and persistent symptoms has failed to be provided. We predicted that the severity of chronic whiplash-associated disorder (WAD), measured as number of whiplash symptoms, pain duration, pain-related disability, and degree of somatisation would be associated with the number of post-traumatic stress disorder symptoms (PTSD). Secondly, we expected attachment-anxiety to be a vulnerability factor in relation to both PTSD and WAD. Data were collected from 1,349 women and 360 men suffering from WAD from the Danish Society for Polio, Traffic, and Accident Victims. The PTSD symptoms were measured by the Harvard Trauma Questionnaire. All three core PTSD clusters were included: re-experiencing, avoidance, and hyperarousal. Attachment security was measured along the two dimensions, attachment-anxiety and attachment-avoidance, by the Revised Adult Attachment Scale. PTSD symptoms were significantly related to the severity of WAD. In particular, the PTSD clusters of avoidance and hyperarousal were associated with the number of whiplash symptoms, disability, and somatisation. Attachment-anxiety was significantly related to PTSD symptoms and somatisation but not to pain and disability. A co-morbidity of 38.8% was found between the PTSD diagnosis and WAD, and about 20% of the sample could be characterised as securely attached. The PTSD clusters of avoidance and hyperarousal were significantly associated with severity of WAD. The study emphasises the importance of assessing PTSD symptomatology after whiplash injury. Furthermore, it highlights that attachment theory may facilitate the understanding of why some people are more prone to develop PTSD and WAD than others.

A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study

DEFF Research Database (Denmark)

Kasch, Helge; Kongsted, Alice; Qerama, Erisela

2013-01-01

within 72 h, examination prior to 10 days postinjury, capable of written/spoken Danish, without other injuries/fractures, pre-existing significant somatic/psychiatric disorder, drug/alcohol abuse and previous significant pain/headache). 688 (438 women and 250 men) participants were interviewed......OBJECTIVES: An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented. DESIGN: The design was an observational prospective study of risk factors embedded in a randomised controlled study. SETTING: Acute whiplash...... and number of sick-listing days were related (Kruskal-Wallis, p

Whiplash Injuries: An Update

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Robert W Teasell

1998-01-01

Full Text Available Whiplash injuries remain a significant public health problem throughout the developed industrialized world, with significant socioeconomic consequences. Studies looking at the natural history of whiplash injuries have suffered from problems of selection bias, retrospective reviewing and unclear outcomes. Etiology continues to be controversial, largely because of the misconception that all soft tissue injuries heal within six weeks. Recent studies have implicated the cervical facet joint as a cause of whiplash injury pain. A recent treatment study that successfully eliminated whiplash-associated facet joint pain demonstrated abnormal psychological profiles secondary to pain which normalized with successful pain elimination. The impact of compensation on recovery remains controversial, while the concept that mild traumatic brain injury occurs in the absence of loss of consciousness has been largely refuted. The Quebec Task Force on Whiplash-Associated Disorders recently published a report in which the scientific literature was exhaustively reviewed and has made recommendations regarding the prevention and treatment of whiplash and its associated disorders. The Quebec Task Force highlighted the paucity of good scientific evidence; however, they still provided consensus treatment guidelines, which have not been validated. There continues to be a need for further research.

diagnostic imaging of acute head trauma

International Nuclear Information System (INIS)

Prayer, D.; Rametsteiner, C.

2001-01-01

Computed tomography (CT) is the primary modality of choice for imaging patients with acute head trauma. Lesions of the soft tissues and of the bones can be assessed more precisely than with other imaging modalities. With magnetic resonance imaging (MRI) additional information may be gained especially in subacute and chronic posttraumatic conditions. Urgent indication to perform a CT examination depends on the patient's history and on the mechanism of trauma. Imaging interpretation has been performed in the context of typical pathologic effects of trauma and with respect to potential therapy. (author)

Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial

DEFF Research Database (Denmark)

Kongsted, Alice; Montvilas, Erisela Qerama; Kasch, Helge

2007-01-01

practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to "act-as-usual," or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12......-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. Methods. Participants were recruited from emergency units and general......Study Design. Randomized, parallel-group trial. Objective. To compare the effect of 3 early intervention strategies following whiplash injury. Summary of Background Data. Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion...

Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial

DEFF Research Database (Denmark)

Kongsted, Alice; Montvilas, Erisela Qerama; Kasch, Helge

2007-01-01

Study Design. Randomized, parallel-group trial. Objective. To compare the effect of 3 early intervention strategies following whiplash injury. Summary of Background Data. Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion......-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. Methods. Participants were recruited from emergency units and general...... practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to "act-as-usual," or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12...

Alterations of the transverse ligament: an MRI study comparing patients with acute whiplash and matched control subjects.

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Ulbrich, Erika Jasmin; Eigenheer, Sandra; Boesch, Chris; Hodler, Juerg; Busato, André; Schraner, Christian; Anderson, Suzanne E; Bonel, Harald; Zimmermann, Heinz; Sturzenegger, Matthias

2011-10-01

The objective of our study was to evaluate whether there is injury to the transverse ligament of the atlas in patients with acute whiplash. Ninety patients with an acute (transverse ligament was measured on midsagittal T1 volumetric interpolated breath-hold examination (VIBE) images and transverse reformatted VIBE images. The signal intensity of the transverse ligament was measured on transverse STIR images and on transverse reformatted T1 VIBE images before and after IV administration of gadoterate. Contrast between the transverse ligament and CSF and alterations of contrast after gadoterate injection were calculated. Patients had a minimally thicker transverse ligament (posttraumatic swelling) than control subjects, and the difference in thickness was significant in men only (p = 0.03). In patients, a significant signal alteration of the transverse ligament (p = 0.03) was seen on STIR (posttraumatic edema) and native VIBE sequences. The contrast between the transverse ligament and the CSF on VIBE images was significantly (p = 0.005) lower in patients than in control subjects. With the application of a contrast agent, the contrast difference between the transverse ligament and CSF in patients and control subjects was less pronounced (p = 0.038). There was no abnormal uptake of contrast agent by the transverse ligament or CSF. The results of our study indicate possible involvement of the transverse ligament in whiplash injury. Although MRI may be helpful to study injury-related changes of anatomic structures in cohorts, it is not suited for individual diagnosis because the alterations are too small.

Whiplash Continues Its Challenge.

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Jull, Gwendolen

2016-10-01

There have been many advances in the management of neck pain disorders, but a personal frustration as a clinician and researcher in the field is that the incidence of full recovery following a whiplash injury as a result of a motor vehicle crash has not increased and, subsequently, the rate of transition to chronic neck pain has not lessened. The commentaries in this special issue reflect the multifaceted nature of whiplash-associated disorders and the wide-ranging research in the field. While management of whiplash, especially the challenge of lessening the rate of transition to chronicity, has yet to be achieved, the picture is becoming clearer. This should give great confidence and some hope to individuals with whiplash-associated disorders who have long-term pain and functional disability that after the next decade of research and clinical development, the outcomes following whiplash are likely to be vastly improved. J Orthop Sports Phys Ther 2016;46(10):815-817. doi:10.2519/jospt.2016.0112.

Information needs of patients with whiplash associated disorders: A Delphi study of patient beliefs.

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Sterling, Joanna; Maujean, Annick; Sterling, Michele

2018-02-01

Whiplash associated disorders (WAD) result in significant personal and economic costs. Patient education and reassurance are recommended treatments for acute WAD but the information needs of patients have not been investigated. To determine what information whiplash-injured patients believe is important to help recovery in the acute stage of injury. A Delphi design survey series with three rounds. Thirty-three participants who had sustained a whiplash injury within the last three years were invited to participate. Participants were asked to provide five statements, in response to an open-ended question, regarding what they believed was the most important information to provide to patients following a whiplash injury. Nineteen patients responded and 85 statements were collected and reviewed independently by two of the authors to remove duplicates. The importance of the remaining items was rated by the participants in the second survey round. Items rated by >50% of participants as important were included in the third survey round. To be deemed key information, >80% of participants had to rate an item as important in this final round. Eighteen items met the criteria for key information. These points addressed four areas: assessment and treatment, recovery and symptoms, patient attitudes during treatment and relationships with health practitioners. The key information points endorsed by patients in this study may provide useful information to constitute a basis for reassurance and education provided to patients with WAD. The results also suggest that improved relationships between patients with whiplash and health practitioners is required. Copyright © 2017 Elsevier Ltd. All rights reserved.

Whiplash – en usynlig lidelse

DEFF Research Database (Denmark)

Lauritzen, Jette

2005-01-01

A disease such as whiplash presents a large number of complex social problems. With the help of medical anthropology it is possible to look at whiplash as a multifaceted concept influenced by the social and cultural norms in Western society. In this way whiplash can be considered to be a socially...

The relationship between chronic whiplash-associated disorder and post-traumatic stress: attachment-anxiety may be a vulnerability factor

Directory of Open Access Journals (Sweden)

Tonny Elmose Andersen

2011-01-01

Full Text Available Background: In more than 90% of whiplash accidents a good explanation regarding the association between trauma mechanism, organic pathology, and persistent symptoms has failed to be provided. Objective: We predicted that the severity of chronic whiplash-associated disorder (WAD, measured as number of whiplash symptoms, pain duration, pain-related disability, and degree of somatisation would be associated with the number of post-traumatic stress disorder symptoms (PTSD. Secondly, we expected attachment-anxiety to be a vulnerability factor in relation to both PTSD and WAD. Design: Data were collected from 1,349 women and 360 men suffering from WAD from the Danish Society for Polio, Traffic, and Accident Victims. The PTSD symptoms were measured by the Harvard Trauma Questionnaire. All three core PTSD clusters were included: re-experiencing, avoidance, and hyperarousal. Attachment security was measured along the two dimensions, attachment-anxiety and attachment-avoidance, by the Revised Adult Attachment Scale. Results: PTSD symptoms were significantly related to the severity of WAD. In particular, the PTSD clusters of avoidance and hyperarousal were associated with the number of whiplash symptoms, disability, and somatisation. Attachment-anxiety was significantly related to PTSD symptoms and somatisation but not to pain and disability. A co-morbidity of 38.8% was found between the PTSD diagnosis and WAD, and about 20% of the sample could be characterised as securely attached. Conclusions: The PTSD clusters of avoidance and hyperarousal were significantly associated with severity of WAD. The study emphasises the importance of assessing PTSD symptomatology after whiplash injury. Furthermore, it highlights that attachment theory may facilitate the understanding of why some people are more prone to develop PTSD and WAD than others.For abstract or full text in other languages, please see Supplementary files under Reading Tools online

Novel insights into the interplay between ventral neck muscles in individuals with whiplash-associated disorders

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Peterson, Gunnel; Nilsson, David; Trygg, Johan; Falla, Deborah; Dedering, Åsa; Wallman, Thorne; Peolsson, Anneli

2015-01-01

Chronic whiplash-associated disorder (WAD) is common after whiplash injury, with considerable personal, social, and economic burden. Despite decades of research, factors responsible for continuing pain and disability are largely unknown, and diagnostic tools are lacking. Here, we report a novel model of mechanical ventral neck muscle function recorded from non-invasive, real-time, ultrasound measurements. We calculated the deformation area and deformation rate in 23 individuals with persistent WAD and compared them to 23 sex- and age-matched controls. Multivariate statistics were used to analyse interactions between ventral neck muscles, revealing different interplay between muscles in individuals with WAD and healthy controls. Although the cause and effect relation cannot be established from this data, for the first time, we reveal a novel method capable of detecting different neck muscle interplay in people with WAD. This non-invasive method stands to make a major breakthrough in the assessment and diagnosis of people following a whiplash trauma. PMID:26472599

Epidemiology of acute wrist trauma

DEFF Research Database (Denmark)

Larsen, C F; Lauritsen, Jens

1993-01-01

Epidemiological data on wrist injuries in a population can be used for planning by applying them to criteria for care and thus deriving estimates of provisions for care according to currently desirable standards. In a 1-year study all patients > or = 15 years with acute wrist trauma and treated...... in the emergency room were examined according to an algorithm until a diagnosis was established. The overall incidence of wrist trauma was 69 per 10,000 inhabitants per year. Incidence of wrist trauma requiring x-ray examination was 58 per 10,000 per year. The incidence of distal radius fractures was 27 per 10...... using data from a population-based study. A completeness rate of 0.56 (95% confidence interval: 0.31-0.78) was found. An x-ray had been taken for all patients reporting a fracture thus justifying the use of fractures as an incidence measure when comparing groups of patients with wrist trauma....

Acute trauma-induced Budd-Chiari syndrome

International Nuclear Information System (INIS)

Izard, G.; Houri, R.; Randrianasolo, S.; Gailleton, R.

1995-01-01

The diagnosis of Budd-Chiari syndrome is based on clinical signs including liver enlargement and ascites and findings of complementary examinations: echography, echo-Doppler, cat scanning (CT-scan), magnetic resonance imaging, angiography, pressure readings, laparoscopy and biopsy. Trauma is rarely reported as a cause of acute Budd-Chiari syndrome. In some cases, the trauma is so violent the supra-hepatic veins are ruptured and the dramatic outcome leaves no time for the syndrome to develop. In others, the resulting haematomas form a compression block of the supra hepatic vessels. The mechanism of the trauma in our case appears to have been unreported to date. Four days after a violent motorcycle accident, a 33-year-old man developed an acute Budd-Chiari syndrome probably due to partial and temporary thrombosis of the left and middle supra hepatic veins. A side-to-side porto-cava anastomosis with a calibrated venous graft was performed in an emergency procedure. Outcome was quite favourable and after a 4 year follow-up, the patient is in good health. (authors). 13 refs

Changes in Pain Modulation Occur Soon After Whiplash Trauma but are not Related to Altered Perception of Distorted Visual Feedback.

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Daenen, Liesbeth; Nijs, Jo; Cras, Patrick; Wouters, Kristien; Roussel, Nathalie

2014-09-01

Widespread sensory hypersensitivity has been observed in acute whiplash associated disorders (WAD). Changes in descending pain modulation take part in central sensitization. However, endogenous pain modulation has never been investigated in acute WAD. Altered perception of distorted visual feedback has been observed in WAD. Both mechanisms (ie, pain modulation and perception of distorted visual feedback) may be different components of one integrated system orchestrated by the brain. This study evaluated conditioned pain modulation (CPM) in acute WAD. Secondly, we investigated whether changes in CPM are associated with altered perception of distorted visual feedback. Thirty patients with acute WAD, 35 patients with chronic WAD and 31 controls were subjected to an experiment evaluating CPM and a coordination task inducing visual mediated changes between sensory feedback and motor output. A significant CPM effect was observed in acute WAD (P = 0.012 and P = 0.006), which was significantly lower compared to controls (P = 0.004 and P = 0.020). No obvious differences in CPM were found between acute and chronic WAD (P = 0.098 and P = 0.041). Changes in CPM were unrelated to altered perception of distorted visual feedback (P > 0.01). Changes in CPM were observed in acute WAD, suggesting less efficient pain modulation. The results suggest that central pain and sensorimotor processing underlie distinctive mechanisms. © 2013 World Institute of Pain.

A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study

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Kasch, Helge; Kongsted, Alice; Qerama, Erisela; Bach, Flemming W; Bendix, Tom; Jensen, Troels Staehelin

2013-01-01

Objectives An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented. Design The design was an observational prospective study of risk factors embedded in a randomised controlled study. Setting Acute whiplash patients from units, general practitioners in four Danish counties were referred to two research centres. Participants During a 2-year inclusion period, acute consecutive whiplash-injured (age 18–70 years, rear-end or frontal-end car accident and WAD (whiplash-associated disorders) grades I–III, symptoms within 72 h, examination prior to 10 days postinjury, capable of written/spoken Danish, without other injuries/fractures, pre-existing significant somatic/psychiatric disorder, drug/alcohol abuse and previous significant pain/headache). 688 (438 women and 250 men) participants were interviewed and examined by a study nurse after 5 days; 605 were completed after 1 year. A risk score which included items of initial neck pain/headache intensity, a number of non-painful complaints and active neck mobility was applied. The primary outcome parameter was 1-year work disability. Results The risk score and number of sick-listing days were related (Kruskal-Wallis, pwhiplash. Neck-mobility was a strong predictor in this study; however, it was a more inconsistent predictor in other studies. Conclusions Application of the risk assessment score and use of the risk strata system may be beneficial in future studies and may be considered as a valuable tool to assess return-to-work following injuries; however, further studies are needed. PMID:23370009

Laypersons' expectation of the sequelae of whiplash injury: a cross-cultural comparative study between Canada and Greece.

Science.gov (United States)

Ferrari, Robert; Constantoyannis, Constantine; Papadakis, Nikolas

2003-03-01

The objective of the present study is to compare the frequency and nature of expected 'whiplash' symptoms in Greece [a country where the chronic whiplash syndrome is rare or unknown] with that in Canada. A symptom checklist was administered to 2 subject groups selected from local companies in Patras Greece, and Edmonton, Canada, respectively. Subjects were asked to imagine having suffered a neck sprain [whiplash injury] with no loss of consciousness in a motor vehicle collision, and to check which, of a variety of symptoms, they would expect might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist. In both the Greek and Edmontonian groups, the pattern of symptoms anticipated closely resembled the acute symptoms commonly reported by accident victims with acute neck sprain, but while up to 50% of Edmontonians also anticipated symptoms to last months or years, very few Greek subjects selected any symptoms as likely to persist. In Greece, despite the documented occurrence of neck sprain symptoms in individuals following motor vehicle collisions, there is a very low rate of expectation of any sequelae from this injury. What current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Greece may, in part, determine the low prevalence of the chronic whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the chronic whiplash syndrome are needed.

Laypersons' expectation of the sequelae of whiplash injury. A cross-cultural comparative study between Canada and Lithuania.

Science.gov (United States)

Ferrari, Robert; Obelieniene, Diana; Russell, Anthony; Darlington, Paul; Gervais, Roger; Green, Paul

2002-11-01

The objective of the present study is to compare the frequency and nature of expected 'whiplash' symptoms in Lithuania (a country where the late whiplash syndrome is rare or unknown) with that in Canada. A symptom checklist was administered to 2 subject groups selected from local companies in Kaunas, Lithuania, and Edmonton, Canada, respectively. Subjects were asked to imagine having suffered a neck sprain (whiplash injury) with no loss of consciousness in a motor vehicle accident, and to check which, of a variety of symptoms, they would expect might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist. In both the Lithuanian and Edmontonian groups, the pattern of symptoms anticipated closely resembled the acute symptoms commonly reported by accident victims with acute neck sprain, but while up to 50% of Edmontonians also anticipated symptoms to last months or years, very few Lithuanian subjects selected any symptoms as likely to persist. In Lithuania, despite the documented occurrence of neck sprain symptoms in some 50% of individuals following motor vehicle accidents, there is a very low rate of expectation of any sequelae from this injury. What current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Lithuania may, in part, determine the low prevalence of the late whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the late whiplash syndrome are needed.

Can kinesiophobia predict the duration of neck symptoms in acute whiplash?

NARCIS (Netherlands)

Buitenhuis, J; Jaspers, JPC; Fidler, [No Value

2006-01-01

Objectives: In low back pain, clinical studies suggest that kinesiophobia (fear of movement/(re)injury) is important in the etiology of chronic symptoms. In this prospective cohort study, the predictive role of kinesiophobia in the development of late whiplash syndrome was examined. Methods: Victims

The reliability of measuring pain distribution and location using body pain diagrams in patients with acute whiplash-associated disorders.

Science.gov (United States)

Southerst, Danielle; Stupar, Maja; Côté, Pierre; Mior, Silvano; Stern, Paula

2013-09-01

The objective of this study was to measure the interexaminer reliability of scoring pain distribution using paper and electronic body pain diagrams in patients with acute whiplash-associated disorder and to assess the intermethod reliability of measuring pain distribution and location using paper and electronic diagrams. We conducted an interexaminer reliability study on 80 participants recruited from a randomized controlled trial on the conservative management of acute grade I/II whiplash-associated disorder. Participants were assessed for inclusion/exclusion criteria by an experienced clinician. As part of the baseline assessment, participants independently completed paper and electronic pain diagrams. Diagrams were scored independently by 2 examiners using the body region method. Interexaminer and intermethod reliability was computed using intraclass correlation coefficients (ICCs) for pain distribution and κ coefficient for pain location. We used Bland-Altman plots to compute limits of agreement. The interexaminer reliability was ICC = 0.925 for paper and ICC = 0.997 for the electronic body pain diagram. The intermethod reliability for measuring pain distribution ranged from ICC = 0.63 to ICC = 0.93. For pain location, the intermethod reliability varied from κ = 0.23 (posterior neck) to κ = 0.90 (right side of the face). We found good to excellent interexaminer reliability for scoring 2 versions of the body pain diagram. Pain distribution and pain location were reliably and consistently measured on body pain diagrams using paper and electronic methods; therefore, clinicians and researchers may choose either medium when using body pain diagrams. Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Chronic neck pain and whiplash: a case-control study of the relationship between acute whiplash injuries and chronic neck pain.

Science.gov (United States)

Freeman, M D; Croft, Arthur C; Rossignol, Annette M; Centeno, Christopher J; Elkins, Whitney L

2006-01-01

The authors undertook a case-control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain. Four hundred nineteen patients and 246 controls were randomly enrolled. Patients were defined as individuals with chronic neck pain, and controls as those with chronic back pain. The two groups were surveyed for cause of chronic pain as well as demographic information. The two groups were compared using an exposure-odds ratio. Forty-five per cent of the patients attributed their pain to a motor vehicle accident. An OR of 4.0 and 2.1 was calculated for men and women, respectively. Based on the results of the present study, it reasonable to infer that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident.

Chronic neck pain and whiplash: A case-control study of the relationship between acute whiplash injuries and chronic neck pain

Science.gov (United States)

Freeman, Michael D; Croft, Arthur C; Rossignol, Annette M; Centeno, Christopher J; Elkins, Whitney L

2006-01-01

The authors undertook a case-control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain. Four hundred nineteen patients and 246 controls were randomly enrolled. Patients were defined as individuals with chronic neck pain, and controls as those with chronic back pain. The two groups were surveyed for cause of chronic pain as well as demographic information. The two groups were compared using an exposure-odds ratio. Forty-five per cent of the patients attributed their pain to a motor vehicle accident. An OR of 4.0 and 2.1 was calculated for men and women, respectively. Based on the results of the present study, it reasonable to infer that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident. PMID:16770448

What factors have influence on persistence of neck pain after a whiplash?

Science.gov (United States)

Cobo, Eulogio Pleguezuelos; Mesquida, M Engracia Pérez; Fanegas, Elisabet Palomera; Atanasio, Eva Moreno; Pastor, M Beatriz Samitier; Pont, Cristina Perucho; Prieto, Carlos Matarrubia; Gómez, Genoveva Reverón; Cano, Lluis Guirao

2010-04-20

Prospective longitudinal study. To identify prognosis factors that allow us to identify patients with risk of developing chronic symptoms and disabilities after a whiplash injury. The prognosis factors for poor recovery in acute whiplash are not conclusive. We included 557 patients who suffered whiplash injury after road traffic accident and visited the Department of Physical Medicine and Rehabilitation of Mataró Hospital (Spain) for medical evaluation and rehabilitation treatment. The variables were collected following a protocol designed for the study, and all patients were assessed through the Visual Analogue Scale (VAS) for the intensity of neck pain, the Goldberg Depression and Anxiety Scale and the Northwick Park Neck Pain Questionnaire (NPH) for cervical column functionality at initial evaluation and 6 months later. Factors related with VAS 6 months after the whiplash injury were women, age, number of days of cervical column immobilization, previous neck pain, self-employed workers, housewives, pensioners, students, presence of headache or dizziness, and VAS, Goldberg Depression and Anxiety scale, and NPH scores at initial evaluation. In multivaried analysis, it had been found that the variables that had influence on VAS 6 months after the whiplash injury were statistically significant for age, presence of dizziness, self-employed workers, and VAS and NPH scores at initial evaluation. Our findings indicate that factors that allow us to identify patients at risk for poor recovery are age, dizziness, and initial evaluation of neck pain with VAS and cervical column functionality with NPH.

[Whiplash. Epidemiology, diagnosis and treatment].

Science.gov (United States)

Lønnberg, F

2001-04-16

Recent years have seen an increasing number of car occupants with neck complaints following a car collision and a declining number of persons involved in car crashes--a relationship that is not well understood. Presumably less than 5% will suffer from persistent, (long-lasting), disabling neck pain. Although mostly men are involved in motor vehicle accidents, an equal number of men and women seek emergency care, but it is mostly women, who have persistent (long-lasting) neck complaints after a car collision. In general, there is no documentation of specific injury to the brain or spinal cord from a simple whiplash (WAD 1-3). Whiplash-related neck pain is caused by a distortion of the cervical spine, and, as such, should be interpreted as a benign condition with a good prognosis. Whiplash should be considered a risk factor rather than a medical diagnosis. The association between cause (whiplash mechanism) and effect (symptoms) is poor. Persistent (long-lasting) health problems from a whiplash should be treated like other post-traumatic conditions, and need a bio-psycho-social approach.

Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study

DEFF Research Database (Denmark)

Kasch, H; Qerama, E; Kongsted, Alice

2008-01-01

BACKGROUND AND PURPOSE: Physical mechanisms are the possible factors involved in the development and maintenance of long-term handicaps after acute whiplash injury. This study prospectively examined the role of active neck mobility, cervical and extra-cervical pains, as well as non-painful...... of non-painful complaints and active neck mobility [active cervical range of motion (CROM)]. All 458 high-risk patients and 230 low-risk patients received mailed questionnaires after 3, 6 and 12 months. Two examiners examined all high-risk patients (n = 458) and 41 consecutive low-risk patients at median...... complaints after a whiplash injury as predictors for subsequent handicap. METHODS: Consecutive acute whiplash patients (n = 688) were interviewed and examined by a study nurse after the median of 5 days after injury, and divided into a high- or a low-risk group by an algorithm based on pain intensity, number...

Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? A prospective observational study

DEFF Research Database (Denmark)

Johansson, Per Ingemar; Sorensen, Anne Marie; Perner, Anders

2011-01-01

ABSTRACT: INTRODUCTION: It is debated whether the early trauma induced coagulopathy (TIC) in severely injured patients reflects disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype, acute coagulopathy of trauma shock (ACoTS) or yet other entities. This study investigated the...

A Clinical Study on the Effects of Sweet Bee Venom Herbal Acupuncture for Patients with Whiplash Injury

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Beom-Yong Song

2007-12-01

Full Text Available Objectives : The aim of this study is to investigate the effect of Sweet Bee Venom herbal acupuncture for patients with acute whiplash injury by Traffic Accident. Methods : This clinical study was carried out 25 cases of acute whiplash injury patients which had been treatment in Woosuk oriental hospital from March, 2007 to September, 2007. Sweet bee venom herbal acupuncture(N=15 and normal saline(N=10 injected on the acupoints that were cervical area. I checked the VAS for the pain and ROM(range of motion of the cervical. these were checked 3 times. one was before treatments, another was after 3 times treatments with sweet bee venom herbal acupuncture and normal saline injection, and the other was after 5 times treatments with sweet bee venom herbal acupuncture and normal saline injection. Results : VAS score was significantly improved after 5 times treatments with the sweet bee venom herbal acupuncture compared to normal saline I.M. on the acupoints that was cervical area. There were significant changes in the sweet bee venom herbal acupuncture group with VAS and ROM check. Conclusions : This study suggests that sweet bee venom herbal acupuncture can improve symptoms in patients with acute whiplash injury by traffic accident.

Protocol for an economic evaluation alongside University Health Network Whiplash Intervention Trial: Cost-effectiveness of education and activation, a rehabilitation program, and the legislated standard of care for acute whiplash injury in Ontario

NARCIS (Netherlands)

van de Velde, G.; Cote, P.; Bayoumi, A.M.; Cassidy, J.D.; Boyle, E.; Shearer, H.M.; Stupar, M.; Jacobs, C.; Ammendolia, C.; Carette, S.; van Tulder, M.W.

2011-01-01

Background: Whiplash injury affects 83% of persons in a traffic collision and leads to whiplash-associated disorders (WAD). A major challenge facing health care decision makers is identifying cost-effective interventions due to lack of economic evidence. Our objective is to compare the

MRI of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1-2: high-signal changes by age, gender, event and time since trauma

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Vetti, Nils; Kraakenes, Jostein; Roervik, Jarle; Espeland, Ansgar [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Section for Radiology, Department of Surgical Sciences, Bergen (Norway); Eide, Geir Egil [Haukeland University Hospital, Centre for Clinical Research, Bergen (Norway); University of Bergen, Department of Public Health and Primary Health Care, Bergen (Norway); Gilhus, Nils Erik [Haukeland University Hospital, Department of Neurology, Bergen (Norway); University of Bergen, Section for Neurology, Department of Clinical Medicine, Bergen (Norway)

2009-04-15

This study describes the prevalence of high-signal changes at magnetic resonance imaging (MRI) of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1-2 in relation to age, gender, spinal degeneration, type of trauma event and time since trauma. In 1,266 consecutive WAD1-2 patients (779 women, 487 men; mean age 42 years) referred from clinicians, high-signal changes in the alar and transverse ligaments at high-resolution proton-weighted MRI were prospectively graded 0-3 based on a previously reported, reliable grading system. Type of event according to The International Statistical Classification of Diseases and Related Health Problems and time of trauma were obtained from referral letters. MRI showed grades 2-3 alar ligament changes in 449 (35.5%; 95% confidence interval (CI), 32.8 to 38.1%) and grades 2-3 transverse ligament changes in 311 (24.6%; 95% CI, 22.2% to 26.9%) of the 1,266 patients. Grades 2-3 changes were more common in men than women, odds ratio 1.9 (95% CI, 1.5 to 2.5) for alar and 1.5 (95% CI, 1.1 to 2.0) for transverse ligament changes. High-signal changes were not related to age, spinal degeneration, type of trauma event or time since trauma (median 5 years). Unilateral changes were more often left- than right-sided. High-signal changes of the alar and transverse ligaments are common in WAD1-2 and unlikely to represent age-dependent degeneration. Their male and left-side preponderance cannot be explained by variation in ligament stretching or image artefacts. Further studies are needed to clarify whether such changes are caused by trauma. (orig.)

MRI of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1-2: high-signal changes by age, gender, event and time since trauma

International Nuclear Information System (INIS)

Vetti, Nils; Kraakenes, Jostein; Roervik, Jarle; Espeland, Ansgar; Eide, Geir Egil; Gilhus, Nils Erik

2009-01-01

This study describes the prevalence of high-signal changes at magnetic resonance imaging (MRI) of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1-2 in relation to age, gender, spinal degeneration, type of trauma event and time since trauma. In 1,266 consecutive WAD1-2 patients (779 women, 487 men; mean age 42 years) referred from clinicians, high-signal changes in the alar and transverse ligaments at high-resolution proton-weighted MRI were prospectively graded 0-3 based on a previously reported, reliable grading system. Type of event according to The International Statistical Classification of Diseases and Related Health Problems and time of trauma were obtained from referral letters. MRI showed grades 2-3 alar ligament changes in 449 (35.5%; 95% confidence interval (CI), 32.8 to 38.1%) and grades 2-3 transverse ligament changes in 311 (24.6%; 95% CI, 22.2% to 26.9%) of the 1,266 patients. Grades 2-3 changes were more common in men than women, odds ratio 1.9 (95% CI, 1.5 to 2.5) for alar and 1.5 (95% CI, 1.1 to 2.0) for transverse ligament changes. High-signal changes were not related to age, spinal degeneration, type of trauma event or time since trauma (median 5 years). Unilateral changes were more often left- than right-sided. High-signal changes of the alar and transverse ligaments are common in WAD1-2 and unlikely to represent age-dependent degeneration. Their male and left-side preponderance cannot be explained by variation in ligament stretching or image artefacts. Further studies are needed to clarify whether such changes are caused by trauma. (orig.)

Redegørelse om whiplash

DEFF Research Database (Denmark)

Lønnberg, Frank

Begrebet whiplash anvendes ofte som om, der er tale om en velafgrænset sygdomsenhed, hvilket ikke er tilfældet. Whiplash er medicinsk set ikke en lidelse eller en diagnose, men en potentiel skadesmekanisme/risikofaktor uden et specifikt symptombillede. Der er ingen sikker sammenhæng imellem...... påvirkning, vævslæsion og symptombillede. Psykologiske faktorer påvirker symptomer og sygdomsoplevelse efter whiplash, ligesom sociokulturelle faktorer har indflydelse på forekomsten af længerevarende symptomer. Relevant klinisk undersøgelse tidligt i forløbet anbefales, aktivering synes at have fordele frem...

The variation of acute treatment costs of trauma in high-income countries.

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Willenberg, Lynsey; Curtis, Kate; Taylor, Colman; Jan, Stephen; Glass, Parisa; Myburgh, John

2012-08-21

In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries. A systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS), per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities. A total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1%) or charge estimate (25.9%) for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701). However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS), surgical intervention, hospital and intensive care, length of stay, polytrauma and age. The acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied and the cost methods employed are the primary drivers for the

The variation of acute treatment costs of trauma in high-income countries

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Willenberg Lynsey

2012-08-01

Full Text Available Abstract Background In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries. Methods A systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS, per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities. Results A total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1% or charge estimate (25.9% for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701. However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS, surgical intervention, hospital and intensive care, length of stay, polytrauma and age. Conclusion The acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied

Whiplash Injuries Can be Visible by Functional Magnetic Resonance Imaging

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Bengt H Johansson

2006-01-01

Full Text Available Whiplash trauma can result in injuries that are difficult to diagnose. Diagnosis is particularly difficult in injuries to the upper segments of the cervical spine (craniocervical joint [CCJ] complex. Studies indicate that injuries in that region may be responsible for the cervicoencephalic syndrome, as evidenced by headache, balance problems, vertigo, dizziness, eye problems, tinnitus, poor concentration, sensitivity to light and pronounced fatigue. Consequently, diagnosis of lesions in the CCJ region is important. Functional magnetic resonance imaging is a radiological technique that can visualize injuries of the ligaments and the joint capsules, and accompanying pathological movement patterns.

Acute appendicitis following blunt abdominal trauma. Coincidence or causality?

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Sergio Iván Latorre

2017-01-01

Full Text Available Acute appendicitis is a common disease in clinical practice; some well-defined causes include luminal obstruction by fecoliths, lymphoid hyperplasia, foreign bodies and intestinal parasites. Closed abdominal trauma has been associated as an etiological factor, although, their causal relationship is still unclear. This paper presents the case of a patient with appendicitis after a closed abdominal trauma.

Cervical vertigo and dizziness after whiplash injury.

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Endo, Kenji; Ichimaru, Katsuji; Komagata, Mashashi; Yamamoto, Kengo

2006-06-01

Whiplash injury is not only limited to neck injury but also brainstem injury that does not involve direct damage to the neck or head. The symptoms of whiplash injury are polymorphous, with the most common complaints being cervical pain, headache and scapulodynia. Vertigo and dizziness are also reported in 25-50% of the cases. In otoneurologic studies, magnetic resonance angiography (MRA) is used for the evaluation of vertebrobasilar hemodynamics in patients who complain of dizziness and vertigo. It is reported that vertebrobasilar artery insufficiency (VBI) leads to brainstem and cerebellar ischemia and infarction following cervical manipulation. Here we examined the correlation between vertigo or dizziness and the right and left side difference in vertebral arteries after whiplash injury using MRA. We studied 20 patients who complained of neck pain with vertigo or dizziness after whiplash injury and 13 healthy volunteers as a control. In the control group, abnormal MRA findings in the vertebral arteries such as occlusion, stenosis or slow blood flow were seen in 77% of the cases. In the patient group, abnormal MRA findings were seen in 60%. The side difference in blood flow was 3.5+/-2.5 cm/s in the control group and 6.1+/-3.0 cm/s in the patient group. Our findings suggest that some subjects with persistent vertigo or dizziness after whiplash injury are more likely to have VBI on MRA. VBI might be an important background factor to evoke cervical vertigo or dizziness after whiplash injury. The side difference between the two vertebral arteries could cause a circulation disorder in the vertebrobasilar system after whiplash injury. However, the VBI on MRA itself was also seen in the control group, and thus it is not clear whether it is due to whiplash injury in the patient group.

Use of botulinum toxin-A for musculoskeletal pain in patients with whiplash associated disorders [ISRCTN68653575

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Juan Francisco J

2004-02-01

Full Text Available Abstract Background Whiplash associated disorder is commonly linked to motor vehicle accidents and sports injuries. Cervical injury is attributed to rapid extension followed by neck flexion. The exact pathophysiology of whiplash is uncertain but probably involves some degree of aberrant muscle spasms and may produce a wide range of symptoms. The most commonly prescribed pharmacological agents for initial treatment of whiplash-associated pain are oral muscle relaxants and nonsteroidal anti-inflammatory drugs. However, potential systemic adverse effects limit these agents. Physical interventions such as mobilization, manipulation, and exercises have proved beneficial for pain and dysfunction but only on a time-limited basis. Little evidence suggests that physical therapy specifically aimed at the musculature (e.g., transcutaneous electrical nerve stimulation, ultrasonography, heat, ice, and acupuncture improves prognosis in acute whiplash associated disorder. A new approach to treatment is the use of botulinum toxin, which acts to reduce muscle spasms. Methods/design This is a prospective, randomized, controlled clinical trial and botulinum toxin-A (Botox® injections will be compared with placebo injections. The primary objective is to determine the efficacy of Botox® in the management of musculoskeletal pain in whiplash associated disorders. Discussion Botulinum toxin type-A toxin has been studied in small trials on whiplash associated disorder patients and has generally been found to relieve pain and improve range of motion. Specifically, we seek to assess the efficacy of Botox® in reducing pain and to improve the cervical spine range of movement, during the 6-month trial period.

Video-assisted thoracoscopic surgery for acute thoracic trauma

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Michael Goodman

2013-01-01

Full Text Available Background: Operative intervention for thoracic trauma typically requires thoracotomy. We hypothesized that thoracoscopy may be safely and effectively utilized for the acute management of thoracic injuries. Materials and Methods: The Trauma Registry of a Level I trauma center was queried from 1999 through 2010 for all video-assisted thoracic procedures within 24 h of admission. Data collected included initial vital signs, operative indication, intraoperative course, and postoperative outcome. Results: Twenty-three patients met inclusion criteria: 3 (13% following blunt injury and 20 (87% after penetrating trauma. Indications for urgent thoracoscopy included diaphragmatic/esophageal injury, retained hemothorax, ongoing hemorrhage, and open/persistent pneumothorax. No conversions to thoracotomy were required and no patient required re-operation. Mean postoperative chest tube duration was 2.9 days and mean length of stay was 5.6 days. Conclusion: Video-assisted thoracoscopic surgery is safe and effective for managing thoracic trauma in hemodynamically stable patients within the first 24 h post-injury.

Examination of the diagnostic validity of 'headache attributed to whiplash injury': a controlled, prospective study.

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Schrader, H; Stovner, L J; Obelieniene, D; Surkiene, D; Mickeviciene, D; Bovim, G; Sand, T

2006-11-01

Acute and chronic headache attributed to whiplash injury are new diagnostic entities in the International Classification of Headache Disorders, second edition. A main objective of the present study was to assess the validity of these nosologic entities by studying the headache pattern in an inception cohort of 210 rear-end car collision victims and in 210 matched controls. Consecutive drivers involved in rear-end collisions were identified from the daily records of the Traffic Police Department of Kaunas, Lithuania. A standard self-report questionnaire was sent to the drivers between 2 and 7 days after the collision, and their passengers were recruited as well. Headache and neck pain were evaluated within 7 days of the collision, at 2 months and 1 year after the collision. A control group of non-traumatized subjects received questionnaires at the time of the selection and 1 year later. Of the 75 collision victims who developed headache within the first 7 days of the collision, 37 had a clinical picture in accordance with the criteria for acute whiplash headache (i.e., concomitant neck pain) and 38 did not. For acute headache after collision, concomitant neck pain was of no relevance to the headache type or its course. In both these subgroups, migraine and tension-type headache could be diagnosed in similar proportions and the prognosis after 2 months and 1 year was also similar. Preexisting headache was a strong prognostic factor in both groups for both acute and chronic pain. Compared with the non-traumatized control group, the 1-year incidence of new or worsened headache, or of headache improvement, was the same. A likely interpretation of the data is that acute headaches after rear-end car collisions mainly represent episodes of a primary headache precipitated by the stress of the situation. We conclude that the nosologic validity of both acute and chronic whiplash headache is poor as the headaches, in accordance with the criteria lack distinguishing clinical

Psychologic processes in daily life with chronic whiplash: relations of posttraumatic stress symptoms and fear-of-pain to hourly pain and uptime.

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Sterling, Michele; Chadwick, Benjamin J

2010-09-01

Recent models of the relationship between posttraumatic stress and whiplash pain suggest that psychological stress relating to a motor vehicle crash may influence pain perception. The mechanisms of this relationship may be through more direct, psychological pathways, or through factors proposed by the fear-avoidance models of chronic pain. This study sought to investigate the relative contribution of fear-of-pain and trauma symptomatology to daily pain and time spent in an upright posture (uptime) in chronic whiplash-associated disorder (WAD). Hourly electronic-diary reports were used to explore the within-day relationship of psychological trauma symptoms and fear-of-pain to same-hour and next-hour pain reports and next-hour uptime (measured by accelerometers) in 32 individuals with a chronic WAD. Within-person effects were analyzed for 329 diary entries using multilevel modeling with fixed slopes and random intercepts. Reports of trauma-related hyperarousal were associated with greater same-hour pain, and this relationship was mediated by fear-of-pain. Fear-of-pain and uptime were independently associated with reports of increased next-hour pain (controlling for first-order serial autocorrelation). Fear-of-pain was unrelated to next-hour uptime, but trauma-related avoidance symptoms were associated with reduced uptime. This study supports the relationship between psychological trauma responses and pain, suggesting behavioral (avoidance) pathways and effects on pain perception through fear-of-pain. These findings reinforce the need to evaluate traumatic stress as a factor in recovery from WAD.

Validity and internal consistency of a whiplash-specific disability measure.

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Pinfold, Melanie; Niere, Ken R; O'Leary, Elizabeth F; Hoving, Jan Lucas; Green, Sally; Buchbinder, Rachelle

2004-02-01

Cross-sectional study of patients with whiplash-associated disorders investigating the internal consistency, factor structure, response rates, and presence of floor and ceiling effects of the Whiplash Disability Questionnaire (WDQ). The aim of this study was to confirm the appropriateness of the proposed WDQ items. Whiplash injuries are a common cause of pain and disability after motor vehicle accidents. Neck disability questionnaires are often used in whiplash studies to assess neck pain but lack content validity for patients with whiplash-associated disorders. The newly developed WDQ measures functional limitations associated with whiplash injury and was designed after interviews with 83 patients with whiplash in a previous study. Researchers sought expert opinion on items of the WDQ, and items were then tested on a clinical whiplash population. Data were inspected to determine floor and ceiling effects, response rates, factor structure, and internal consistency. Packages of questionnaires were distributed to 55 clinicians, whose patients with whiplash completed and returned 101 questionnaires to researchers. No substantial floor or ceiling effects were identified on inspection of data. The overall floor effect was 12%, and the overall ceiling effect was 4%. Principal component analysis identified one broad factor that accounted for 65% of the variance in responses. Internal consistency was high; Cronbach's alpha = 0.96. Results of the study supported the retention of the 13 proposed items in a whiplash-specific disability questionnaire. Dependent on the results of further psychometric testing, the WDQ is likely to be an appropriate outcome measure for patients with whiplash.

Clinical practice guidelines for the management of acute limb compartment syndrome following trauma.

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Wall, Christopher J; Lynch, Joan; Harris, Ian A; Richardson, Martin D; Brand, Caroline; Lowe, Adrian J; Sugrue, Michael

2010-03-01

Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes.

Acute pain from the perspective of minor trauma patients treated at the emergency unit

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Andrea Regina Martin

Full Text Available OBJECTIVE: To study the factors that influence the perception of acute pain and the consequences of this experience in patients suffering from mild trauma. METHOD: Descriptive qualitative study conducted in an emergency service in southern Brazil. Data was collected in October 2013, through semi-structured interviews with 29 individuals who reported pain after physical trauma, regardless of the triggering factor. To process the data, we used a Content Analysis technique, subject modality. RESULTS: Two categories emerged: Factors that influence the perception of pain resulting from trauma and, Consequences of acute pain due to trauma. The acute pain sensation was influenced by biological, emotional, spiritual and socio-cultural factors and induced biological and emotional consequences for individuals. CONCLUSION: The health professionals need to consider the factors that influence soreness and its consequences for the proper assessment and management of pain resulting from trauma.

The Evidence for Brain Injury in Whiplash Injuries

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Michael P. Alexander

2003-01-01

Full Text Available The evidence that brain damage can occur in injuries that produce whiplash is reviewed. The clinical phenomena for the two injuries are the same. Pure whiplash injury implies no, or minimal head contact, but many patients also have head contact against a head rest or the steering wheel or windshield. The relative severity of the neck injury and the head injury distinguishes whiplash from mild closed head injury. If there is brain injury is some patients with whiplash, it, by definition, falls at the mildest end of the concussion spectrum. The relationship between these two injuries is examined.

What occupant kinematics and neuromuscular responses tell us about whiplash injury.

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Siegmund, Gunter P

2011-12-01

Literature-based review. To review the published data on occupant kinematic and neuromuscular responses during low-speed impacts and analyze how these data inform our understanding of whiplash injury. A stereotypical kinematic and neuromuscular response has been observed in human subjects exposed to rear-end impacts. Combined with various models of injury, these response data have been used to develop anti-whiplash seats that prevent whiplash injury in many, but not all, individuals exposed to a rear-end crash. Synthesis of the literature. Understanding of the occupant kinematics and neuromuscular responses, combined with data from various seat-related interventions, have shown that differential motion between the superior and inferior ends of the cervical spine is responsible for many whiplash injuries. The number of whiplash injuries not prevented by current anti-whiplash seats suggests than further work remains, possibly related to designing seats that respond dynamically to the occupant and collision properties. Neck muscles alter the head and neck kinematics during the interval in which injury likely occurs, even in initially relaxed occupants. It remains unclear whether muscle activation mitigates or exacerbates whiplash injury. If muscle activation mitigates injury, then advance warning could be used to help occupant tense their muscles before impact. Alternatively, if muscle activation exacerbates whiplash injury, then a loud preimpact sound that uncouples the startle and postural components of the muscle response could reduce peak muscle activation during a whiplash exposure. Our improved understanding of whiplash injury has led to anti-whiplash seats that have prevented many whiplash injuries. Further work remains to optimize these and possibly other systems to further reduce the number of whiplash injuries.

Correlations between coping styles and symptom expectation for whiplash injury.

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Ferrari, Robert; Russell, Anthony S

2010-11-01

In pain conditions, active coping has been found to be associated with less severe depression, increased activity level, and less functional impairment. Studies indicate that Canadians have a high expectation for chronic pain following whiplash injury. Expectation of recovery has been shown to predict recovery in whiplash victims. The objective of this study was to compare both the expectations and the coping style for whiplash injury in injury-naive subjects. The Vanderbilt Pain Management Inventory was administered to university students. Subjects who had not yet experienced whiplash injury were given a vignette concerning a neck sprain (whiplash injury) in a motor vehicle collision and were asked to indicate how likely they were to have thoughts or behaviors indicated in the coping style questionnaire. Subjects also completed expectation questionnaires regarding whiplash injury. Subjects (57%) held an expectation of chronic pain after whiplash injury. The mean active coping style score was 28.5±6.6 (40 is the maximum score for active coping). The mean passive coping style score was 28.5±6.6 (50 is the maximum score for passive coping). Those with high passive coping styles had a higher mean expectation score. The correlation between passive coping style score and expectation score was 0.62, while the correlation between active coping style score and expectation was -0.48. Both expectations and coping styles may interact or be co-modifiers in the outcomes of whiplash injury in whiplash victims. Further studies of coping style as an etiologic factor in the chronic whiplash syndrome are needed.

Whiplash causes increased laxity of cervical capsular ligament

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Ivancic, Paul C.; Ito, Shigeki; Tominaga, Yasuhiro; Rubin, Wolfgang; Coe, Marcus P.; Ndu, Anthony B.; Carlson, Erik J.; Panjabi, Manohar M.

2009-01-01

Background Previous clinical studies have identified the cervical facet joint, including the capsular ligaments, as sources of pain in whiplash patients. The goal of this study was to determine whether whiplash caused increased capsular ligament laxity by applying quasi-static loading to whiplash-exposed and control capsular ligaments. Methods A total of 66 capsular ligament specimens (C2/3 to C7/T1) were prepared from 12 cervical spines (6 whiplash-exposed and 6 control). The whiplash-exposed spines had been previously rear impacted at a maximum peak T1 horizontal acceleration of 8 g. Capsular ligaments were elongated at 1 mm/s in increments of 0.05 mm until a tensile force of 5 N was achieved and subsequently returned to neutral position. Four pre-conditioning cycles were performed and data from the load phase of the fifth cycle were used for subsequent analyses. Ligament elongation was computed at tensile forces of 0, 0.25, 0.5, 0.75, 1.0, 2.5, and 5.0 N. Two factor, non-repeated measures ANOVA (Pwhiplash-exposed and control groups and between spinal levels. Findings Average elongation of the whiplash-exposed capsular ligaments was significantly greater than that of the control ligaments at tensile forces of 0 and 5 N. No significant differences between spinal levels were observed. Interpretation Capsular ligament injuries, in the form of increased laxity, may be one component perpetuating chronic pain and clinical instability in whiplash patients. PMID:17959284

Whiplash causes increased laxity of cervical capsular ligament.

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Ivancic, Paul C; Ito, Shigeki; Tominaga, Yasuhiro; Rubin, Wolfgang; Coe, Marcus P; Ndu, Anthony B; Carlson, Erik J; Panjabi, Manohar M

2008-02-01

Previous clinical studies have identified the cervical facet joint, including the capsular ligaments, as sources of pain in whiplash patients. The goal of this study was to determine whether whiplash caused increased capsular ligament laxity by applying quasi-static loading to whiplash-exposed and control capsular ligaments. A total of 66 capsular ligament specimens (C2/3 to C7/T1) were prepared from 12 cervical spines (6 whiplash-exposed and 6 control). The whiplash-exposed spines had been previously rear impacted at a maximum peak T1 horizontal acceleration of 8 g. Capsular ligaments were elongated at 1mm/s in increments of 0.05 mm until a tensile force of 5 N was achieved and subsequently returned to neutral position. Four pre-conditioning cycles were performed and data from the load phase of the fifth cycle were used for subsequent analyses. Ligament elongation was computed at tensile forces of 0, 0.25, 0.5, 0.75, 1.0, 2.5, and 5.0 N. Two factor, non-repeated measures ANOVA (Pwhiplash-exposed and control groups and between spinal levels. Average elongation of the whiplash-exposed capsular ligaments was significantly greater than that of the control ligaments at tensile forces of 0 and 5 N. No significant differences between spinal levels were observed. Capsular ligament injuries, in the form of increased laxity, may be one component perpetuating chronic pain and clinical instability in whiplash patients.

The Role of Exercise and Patient Education in the Noninvasive Management of Whiplash.

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Rebbeck, Trudy

2017-07-01

Synopsis The majority of people with whiplash-associated disorder do not have neurological deficit or fracture and are therefore largely managed with nonsurgical interventions such as exercise, patient education, and behavioral-based interventions. To date, clinical guidelines, systematic reviews, and the results of high-quality randomized controlled trials recommend exercise and patient education as the primary interventions for people in both acute and chronic stages after injury. However, the relatively weak evidence and small effect sizes in individual trials have led authors of some systematic reviews to reach equivocal recommendations for either exercise or patient education, and led policy makers and funders to question whether the more expensive intervention (exercise) should be funded at all. Physical therapists, one of the most commonly consulted professionals treating individuals with whiplash-associated disorder, need to look beyond the evidence for insights as to what role patient education and exercise should play in the future management of whiplash. This clinical commentary therefore will review the evidence for exercise, patient education, and behavioral-based interventions for whiplash and provide clinical insight as to the future role that exercise and patient education should play in the management of this complex condition. Possible subgroups of patients who may best respond to exercise will be explored using stratification based on impairments, treatment response, and risk/prognostic factors. J Orthop Sports Phys Ther 2017;47(7):481-491. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7138.

Surgical fasciectomy of the trapezius muscle combined with neurolysis of the Spinal accessory nerve; results and long-term follow-up in 30 consecutive cases of refractory chronic whiplash syndrome

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Freeman Michael

2010-04-01

Full Text Available Abstract Background Chronic problems from whiplash trauma generally include headache, pain and neck stiffness that may prove refractory to conservative treatment modalities. As has previously been reported, such afflicted patients may experience significant temporary relief with injections of local anesthetic to painful trigger points in muscles of the shoulder and neck, or lasting symptomatic improvement through surgical excision of myofascial trigger points. In a subset of patients who present with chronic whiplash syndrome, the clinical findings suggest an affliction of the spinal accessory nerve (CN XI, SAN by entrapment under the fascia of the trapezius muscle. The present study was undertaken to assess the effectiveness of SAN neurolysis in chronic whiplash syndrome. Methods A standardized questionnaire and a linear visual-analogue scale graded 0-10 was used to assess disability related to five symptoms (pain, headache, insomnia, weakness, and stiffness before, and one year after surgery in a series of thirty consecutive patients. Results The preoperative duration of symptoms ranged from seven months to 13 years. The following changes in disability scores were documented one year after surgery: Overall pain decreased from 9.5 +/- 0.9 to 3.2 +/- 2.6 (p Conclusions Entrapment of the spinal accessory nerve and/or chronic compartment syndrome of the trapezius muscle may cause chronic debilitating pain after whiplash trauma, without radiological or electrodiagnostic evidence of injury. In such cases, surgical treatment may provide lasting relief.

The notion of a “whiplash culture”: a review of the evidence

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Haneline, Michael T.

2009-01-01

Objective Most whiplash patients eventually recover, although some are left with ongoing pain and impairment. Why some develop long-term symptoms after whiplash, whereas others do not, is largely unknown. One explanation blames the cultural expectations of the population wherein the injury occurred, engendering the moniker whiplash culture. The purpose of this review was to locate and discuss studies that were used as a basis for developing the whiplash culture concept and to evaluate its plausibility. Methods The PubMed database was searched using combinations of the terms whiplash culture, whiplash OR WAD, and chronic OR late OR long term. Search dates spanned from 1950 to June 2008. Filters were set to only retrieve English-language citations. Articles that dealt with the whiplash culture were selected and examined to determine which studies had been used to create the concept. Results Nineteen articles discussed the cultural aspects of whiplash and were explored to determine which were used as a basis for the whiplash culture. Eight studies were found that met this final criterion. Conclusion There are many unanswered questions about the basis of chronic whiplash, and the notion of a whiplash culture is controversial. Chronic whiplash symptoms are surely not caused entirely by cultural issues, yet they are probably not entirely physical. Presumably, a tissue injury component exists in most chronic whiplash-associated disorder victims that becomes aggravated in those who are susceptible to biopsychosocial factors. As with many other controversial health care topics, the answer to the debate probably lies somewhere in the middle. PMID:19703667

Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK)

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2012-01-01

Background Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study. Methods Data from the Norwegian population-based “Hordaland Health Study” (HUSK, 1997–99); N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45). Results Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (pwhiplash was more commonly reported than whiplash-injury a long time ago, and the association of interest weakly increased with time since whiplash

Re-estimation of acute subdural hematoma in children caused by trivial household head trauma

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Nishimoto, Hiroshi; Kurihara, Jun

2006-01-01

The objective of this study was to identify characteristics of acute subdural hematoma in children caused by a trivial household head trauma from a modem neurosurgical and medicolegal standpoint. We performed a retrospective study of 25 children younger than 48 months hospitalized for acute subdural hematoma from December 1, 1993, through February 28, 2003. Inclusion criteria were as follows: acute subdural hematoma caused by trivial household trauma and a history of trauma corroborated by a caretaker, absence of physical injuries consistent with child abuse, fundoscopic examinations performed by a pediatric ophthalmologist, absence of fractures on general bone survey, and child abuse ruled out by long-term follow-up (more than 5 years). Twenty-one of the patients were boys, and 4 were girls. The patients ranged in age from 6 to 17 months, with an average age of 8.5 months. In 17 of 25 patients trauma had been caused by falls to the floor while standing with support or while sitting. Most of the patients were admitted to the hospital because of generalized convulsions or seizures that had developed soon after a trivial household trauma. Fifteen of the 25 (60%) patients had retinal or preretinal hemorrhage and 9 patients had bilateral retinal hemorrhage. Computed tomography showed fluid-type acute subdural hematomas at the frontal convexity or in the interhemispheric fissure in 18 of 25 (72%) patients. Fourteen of 25 (56%) patients had pre-existing external hydrocephalus (enlargements of the subarachnoid space). The long-term outcomes included normal mental development (IQ≥80) in 18 cases, mild mental retardation (IQ<80) in 7 cases, and epilepsy in 3 cases. Acute subdural hematoma in children caused by trivial household trauma is a clinical entity distinct from acute subdural hematoma caused by child abuse or shaken-baby syndrome. (author)

MR Analysis of the Transverse Ligament in the Late Stage of Whiplash Injury

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Krakenes, J.; Nordli, H.; Moen, G. [Haukeland Univ. Hospital, Bergen (Norway). Section of Neuroradiology; Kaale, B.R. [Firda Medical Center, Sandane (Norway); Rorvik, J. [Haukeland Univ. Hospital, Bergen (Norway). Dept. of Radiology; Gilhus, N.E. [Haukeland Univ. Hospital, Bergen (Norway). Dept. of Neurology

2003-11-01

Purpose: To analyse and classify structural changes in the transverse ligament in the late stage of whiplash injury by use of high-resolution MRI, and to evaluate the reliability of our classification. Material and Methods: Ninety-two whiplash-injured (2-9 years previously, mean 6 years) and 30 non-injured individuals underwent proton-weighted MR imaging of the craniovertebral junction in three orthogonal planes. Structural changes in the transverse ligaments were graded twice (grades 1-3) based on increased signal, independently by 3 radiologists with a 4-month interval. Inter- and intraobserver statistics were calculated by ordinary and weighted kappa (K). Results: Image quality was excellent in 109 cases and slightly reduced in 13. Twenty-two out of 30 ligaments in the control group were classified as normal (73%) compared with only 32 out of 92 in the injured group (36%). Two or all 3 observers agreed in their grading in 101 out of 122 ligaments (83%). Intraobserver agreement (weighted K) was fair to good (0.33-0.73). Pair-wise interobserver agreement was fair (0.24-0.39). Reasons for divergent grading were insufficient knowledge of normal variations, low signal intensity in the peridental soft tissue obscuring the ligament and interpretation flaw. Conclusion: Whiplash trauma can damage the transverse ligament. By use of high-resolution proton-weighted MR images such lesions can be detected and classified. The reliability of this classification still needs improvement.

MR Analysis of the Transverse Ligament in the Late Stage of Whiplash Injury

International Nuclear Information System (INIS)

Krakenes, J.; Nordli, H.; Moen, G.; Rorvik, J.; Gilhus, N.E.

2003-01-01

Purpose: To analyse and classify structural changes in the transverse ligament in the late stage of whiplash injury by use of high-resolution MRI, and to evaluate the reliability of our classification. Material and Methods: Ninety-two whiplash-injured (2-9 years previously, mean 6 years) and 30 non-injured individuals underwent proton-weighted MR imaging of the craniovertebral junction in three orthogonal planes. Structural changes in the transverse ligaments were graded twice (grades 1-3) based on increased signal, independently by 3 radiologists with a 4-month interval. Inter- and intraobserver statistics were calculated by ordinary and weighted kappa (K). Results: Image quality was excellent in 109 cases and slightly reduced in 13. Twenty-two out of 30 ligaments in the control group were classified as normal (73%) compared with only 32 out of 92 in the injured group (36%). Two or all 3 observers agreed in their grading in 101 out of 122 ligaments (83%). Intraobserver agreement (weighted K) was fair to good (0.33-0.73). Pair-wise interobserver agreement was fair (0.24-0.39). Reasons for divergent grading were insufficient knowledge of normal variations, low signal intensity in the peridental soft tissue obscuring the ligament and interpretation flaw. Conclusion: Whiplash trauma can damage the transverse ligament. By use of high-resolution proton-weighted MR images such lesions can be detected and classified. The reliability of this classification still needs improvement

Persistent myalgia following whiplash.

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Dommerholt, Jan

2005-10-01

Persistent myalgia following whiplash is commonly considered the result of poor psychosocial status, illness behavior, or failing coping skills. However, there is much evidence that persistent myalgia may be due to neurophysiologic mechanisms involving peripheral and central sensitization. Myofascial trigger points may play a crucial role in maintaining sensitization. Recent research suggests that the chemical environment of myofascial trigger points is an important factor. Several consequences are reviewed when central pain mechanisms and myofascial trigger points are included in the differential diagnosis and in the management of patients with persistent pain following whiplash.

Analysis the findings of chest radiograph and CT scan in 217 acute thoracic trauma

International Nuclear Information System (INIS)

Huang Shaoying

2005-01-01

Objective: To evaluate chest radiograph and CT scan in assessing acute thoracic trauma. Methods: Retrospectively analyzed the findings of chest radiograph and CT scan in 217 cases of acute thoracic trauma and positive rate of each modality was compared. Results: The positive rate of rib and clavicle fracture was higher in chest radiograph than these in CT scan. But the positive rate of chest wall hematoma, mediastinum and subcutaneous emphysema, pneumothorax, hydropneumothorax, damage of lung parenchyma and traumatic pulmonary atelectasis was higher in CT scan than those in chest radiograph. Conclusion: The application of the combined imaging modalities improves assessing of acute thoracic trauma, because the imaging manifestation of the lesion is various. (authors)

Measuring acute rehabilitation needs in trauma: preliminary evaluation of the Rehabilitation Complexity Scale.

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Hoffman, Karen; West, Anita; Nott, Philippa; Cole, Elaine; Playford, Diane; Liu, Clarence; Brohi, Karim

2013-01-01

Injury severity, disability and care dependency are frequently used as surrogate measures for rehabilitation requirements following trauma. The true rehabilitation needs of patients may be different but there are no validated tools for the measurement of rehabilitation complexity in acute trauma care. The aim of the study was to evaluate the potential utility of the Rehabilitation Complexity Scale (RCS) version 2 in measuring acute rehabilitation needs in trauma patients. A prospective observation study of 103 patients with traumatic injuries in a Major Trauma Centre. Rehabilitation complexity was measured using the RCS and disability was measured using the Barthel Index. Demographic information and injury characteristics were obtained from the trauma database. The RCS was closely correlated with injury severity (r=0.69, p<0.001) and the Barthel Index (r=0.91, p<0.001). However the Barthel was poor at discriminating between patients rehabilitation needs, especially for patients with higher injury severities. Of 58 patients classified as 'very dependent' by the Barthel, 21 (36%) had low or moderate rehabilitation complexity. The RCS correlated with acute hospital length of stay (r=0.64, p=<0.001) and patients with a low RCS were more likely to be discharged home. The Barthel which had a flooring effect (56% of patients classified as very dependent were discharged home) and lacked discrimination despite close statistical correlation. The RCS outperformed the ISS and the Barthel in its ability to identify rehabilitation requirements in relation to injury severity, rehabilitation complexity, length of stay and discharge destination. The RCS is potentially a feasible and useful tool for the assessment of rehabilitation complexity in acute trauma care by providing specific measurement of patients' rehabilitation requirements. A larger longitudinal study is needed to evaluate the RCS in the assessment of patient need, service provision and trauma system performance

The Nature of Trauma Memories in Acute Stress Disorder in Children and Adolescents

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Salmond, C. H.; Meiser-Stedman, R.; Glucksman, E.; Thompson, P.; Dalgleish, T.; Smith, P.

2011-01-01

Background: There is increasing theoretical, clinical and research evidence for the role of trauma memory in the aetiology of acute pathological stress responses in adults. However, research into the phenomenology of trauma memories in young people is currently scarce. Methods: This study compared the nature of trauma narratives to narratives of…

Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK

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Myrtveit Solbjørg

2012-08-01

Full Text Available Abstract Background Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study. Methods Data from the Norwegian population-based “Hordaland Health Study” (HUSK, 1997–99; N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45. Results Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p Conclusions The increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model

Whiplash Syndrome Reloaded: Digital Echoes of Whiplash Syndrome in the European Internet Search Engine Context.

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Noll-Hussong, Michael

2017-03-27

In many Western countries, after a motor vehicle collision, those involved seek health care for the assessment of injuries and for insurance documentation purposes. In contrast, in many less wealthy countries, there may be limited access to care and no insurance or compensation system. The purpose of this infodemiology study was to investigate the global pattern of evolving Internet usage in countries with and without insurance and the corresponding compensation systems for whiplash injury. We used the Internet search engine analytics via Google Trends to study the health information-seeking behavior concerning whiplash injury at national population levels in Europe. We found that the search for "whiplash" is strikingly and consistently often associated with the search for "compensation" in countries or cultures with a tort system. Frequent or traumatic painful injuries; diseases or disorders such as arthritis, headache, radius, and hip fracture; depressive disorders; and fibromyalgia were not associated similarly with searches on "compensation." In this study, we present evidence from the evolving viewpoint of naturalistic Internet search engine analytics that the expectations for receiving compensation may influence Internet search behavior in relation to whiplash injury. ©Michael Noll-Hussong. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 27.03.2017.

A Systematic Review of Early Prognostic Factors for Persistent Pain Following Acute Orthopedic Trauma

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Fiona J Clay

2012-01-01

Full Text Available Persistent or chronic pain is prevalent in many developed countries, with estimates ranging from 10% to higher than 50%, and is a major economic burden to individuals and societies. However, the variation in pain outcomes after acute orthopedic trauma and treatment confronts treating physicians with uncertainty in providing prognostic advice regarding long-term recovery. Although several previous reviews have addressed the determinants of chronic pain outcomes secondary to acute trauma, they have primarily focused on specific injury samples and, furthermore, lack consistency with respect to the important prognostic factors, which limits the generalizability of findings. This review, however, aimed specifically to identify the early prognostic factors associated with variation in persistent pain outcomes following acute orthopedic trauma presenting with a spectrum of pathologies.

Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial.

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Rosenfeld, Mark; Seferiadis, Aris; Carlsson, Jane; Gunnarsson, Ronny

2003-11-15

Three-year follow-up of a prospective randomized trial in 97 patients exposed to whiplash trauma in motor vehicle collisions. To compare the long-term efficacy of active intervention with that of standard intervention and the effect of early versus delayed initiation of intervention. There is no strong evidence for many treatments for whiplash-associated disorders. Some studies provide weak evidence supporting active intervention. Patients were randomized to an intervention using frequent active cervical rotation complemented by assessment and treatment according to McKenzie's principles or to a standard intervention of initial rest, recommended soft collar, and gradual self-mobilization. To test the time factor, interventions were either made within 96 hours or delayed 14 days from collision. The effects of the two interventions and the time factor on pain intensity, cervical range of motion, and sick leave were analyzed at 6 months and 3 years. Cervical range of motion at 3 years was also compared with that in matched, unexposed individuals. Pain intensity and sick leave were significantly (P whiplash-associated disorders, active intervention is more effective in reducing pain intensity and sick leave, and in retaining/regaining total range of motion than a standard intervention. Active intervention can be carried out as home exercises initiated and supported by appropriately trained health professionals.

Protocol for an economic evaluation alongside the University Health Network Whiplash Intervention Trial: cost-effectiveness of education and activation, a rehabilitation program, and the legislated standard of care for acute whiplash injury in Ontario

OpenAIRE

van der Velde Gabrielle; Côté Pierre; Bayoumi Ahmed M; Cassidy J David; Boyle Eleanor; Shearer Heather M; Stupar Maja; Jacobs Craig; Ammendolia Carlo; Carette Simon; van Tulder Maurits

2011-01-01

Abstract Background Whiplash injury affects 83% of persons in a traffic collision and leads to whiplash-associated disorders (WAD). A major challenge facing health care decision makers is identifying cost-effective interventions due to lack of economic evidence. Our objective is to compare the cost-effectiveness of: 1) physician-based education and activation, 2) a rehabilitation program developed by Aviva Canada (a group of property and casualty insurance providers), and 3) the legislated st...

Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash?

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Elliott, James M; Dayanidhi, Sudarshan; Hazle, Charles; Hoggarth, Mark A; McPherson, Jacob; Sparks, Cheryl L; Weber, Kenneth A

2016-10-01

Synopsis It is generally accepted that up to 50% of those with a whiplash injury following a motor vehicle collision will fail to fully recover. Twenty-five percent of these patients will demonstrate a markedly complex clinical picture that includes severe pain-related disability, sensory and motor disturbances, and psychological distress. A number of psychosocial factors have shown prognostic value for recovery following whiplash from a motor vehicle collision. To date, no management approach (eg, physical therapies, education, psychological interventions, or interdisciplinary strategies) for acute whiplash has positively influenced recovery rates. For many of the probable pathoanatomical lesions (eg, fracture, ligamentous rupture, disc injury), there remains a lack of available clinical tests for identifying their presence. Fractures, particularly at the craniovertebral and cervicothoracic junctions, may be radiographically occult. While high-resolution computed tomography scans can detect fractures, there remains a lack of prevalence data for fractures in this population. Conventional magnetic resonance imaging has not consistently revealed lesions in patients with acute or chronic whiplash, a "failure" that may be due to limitations in the resolution of available devices and the use of standard sequences. The technological evolution of imaging techniques and sequences eventually might provide greater resolution to reveal currently elusive anatomical lesions (or, perhaps more importantly, temporal changes in physiological responses to assumed lesions) in those patients at risk of poor recovery. Preliminary findings from 2 prospective cohort studies in 2 different countries suggest that this is so, as evidenced by changes to the structure of skeletal muscles in those who do not fully recover. In this clinical commentary, we will briefly introduce the available imaging decision rules and the current knowledge underlying the pathomechanics and pathophysiology of

Cumulative exposure to prior collective trauma and acute stress responses to the Boston marathon bombings.

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Garfin, Dana Rose; Holman, E Alison; Silver, Roxane Cohen

2015-06-01

The role of repeated exposure to collective trauma in explaining response to subsequent community-wide trauma is poorly understood. We examined the relationship between acute stress response to the 2013 Boston Marathon bombings and prior direct and indirect media-based exposure to three collective traumatic events: the September 11, 2001 (9/11) terrorist attacks, Superstorm Sandy, and the Sandy Hook Elementary School shooting. Representative samples of residents of metropolitan Boston (n = 846) and New York City (n = 941) completed Internet-based surveys shortly after the Boston Marathon bombings. Cumulative direct exposure and indirect exposure to prior community trauma and acute stress symptoms were assessed. Acute stress levels did not differ between Boston and New York metropolitan residents. Cumulative direct and indirect, live-media-based exposure to 9/11, Superstorm Sandy, and the Sandy Hook shooting were positively associated with acute stress responses in the covariate-adjusted model. People who experience multiple community-based traumas may be sensitized to the negative impact of subsequent events, especially in communities previously exposed to similar disasters. © The Author(s) 2015.

Therapy Recommendation “Act as Usual” in Patients with Whiplash Injuries QTF I°

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Dehner, Christoph; Kraus, Michael; Schöll, Hendrik; Schneider, Florian; Richter, Peter; Kramer, Michael

2012-01-01

Up to now no therapy study has used the classification system of the Quebec Task Force (QTF) to differentiate between patients with (QTF II°) and without functional disorders (QTF I°). This differentiation seems meaningful, as this difference may be relevant for the correct treatment planning. In this context the effect of the therapy recommendation “act as usual” has been evaluated in a homogeneous patient collective with whiplash injuries QTF I°. 470 patients with acute whiplash injuries had been catched in this study and classified according to the QTF. 359 patients (76.4%) with QTF I° injuries could be identified. Out of that 162 patients were enrolled to the study and received the therapy recommendation “act as usual” and the adapted pain treatment with non-steroidal anti-inflammatory drugs (NSAID). After six months the outcome was evaluated by phone. After injury the median pain score assessed by a visual analogue scale (VAS) was 5.4 (min = 3.3; max = 8.5). After six months 5 of the 162 patients complained intermittent pain symptoms (VAS values whiplash injuries QTF I° do not need physical therapy. An escalation of therapy measures should be reserved to patients with complicated healing processes. PMID:23121740

Physiotherapy in a whiplash injury: a case report

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C. Van Eck

2008-01-01

Full Text Available Study Design: Case ReportObjectives: To describe physiotherapy intervention in an individual with asuspected whiplash injury.Background: The patient was a 29-year old male with complaints of neckpain and tightness following a motor vehicle accident. Methods and Measures: The focus of the case study is physiotherapyassessment and intervention in a stage II whiplash injury. Results: Following intervention, positive changes occurred in outcome measures such as pain, work status and activities of daily living. Conclusion: Physiotherapy intervention is successful in addressing whiplash associated disorders.

The relation of appraisal, coping efforts, and acuteness of trauma to PTS symptoms among former political prisoners.

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Kanninen, Katri; Punamäki, Raija-Leena; Qouta, Samir

2002-06-01

We examined how trauma-specific appraisals and coping efforts mediate between traumatic experiences, acuteness of trauma, and length of imprisonment and posttraumatic stress symptoms (PTS) among 103 Palestinian former political prisoners. The findings provide support for both direct and mediated models of trauma. The acuteness of trauma (time since release), appraisal of prison experience as harmful and involving loss, and use of both emotion- and problem-focused coping efforts were associated with high levels of PTS symptoms. Torture and ill-treatment had a direct association with intrusion, and recent release from prison with avoidance symptoms. Acuteness of trauma turned out to be important in the coping and symptom association: emotion-focused coping was associated with a low level of PTS symptoms in the long run, whereas problem-focused coping was associated with a low level of PTS symptoms in the short run.

Isometric muscle fatigue of the paravertebral and upper extremity muscles after whiplash injury.

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Rastovic, Pejana; Gojanovic, Marija Definis; Berberovic, Marina; Pavlovic, Marko; Lesko, Josip; Galic, Gordan; Pandza, Maja

2017-01-01

Whiplash-associated disorders (WAD) result from injury of neck structures that most often occur during traffic accidents as a result of rapid acceleration-deceleration. The dominant symptoms manifest in the musculoskeletal system and include increased fatigue. Because of the frequency of whiplash injuries, a simple, cheap and useful diagnostic tool is needed to differentiate whiplash injury from healthy patients or those faking symptoms. To determine muscle fatigue in patients with whiplash injury in six body positions. Analytical cross-sectional study. Emergency center, university hospital. We studied patients with whiplash injury from vehicular traffic accidents who presented to the emergency center within 6 hours of sustaining the injury. We determined whiplash injury grade according to the Quebec Task Force (QTF) classification and measured isometric muscle endurance in six different body positions. Control subjects for each patient were matched by age, gender and anthropomorphic characteristics. Cut-off values were determined to distinguish patients with whiplash injury from controls and for determination of injury grade . QTF grade, time to muscle fatigue in seconds. From September 2013 to September 2016, we enrolled 75 patients with whiplash injury and 75 matching control subjects. In all six positions, the patients with whiplash injury felt muscle fatigue faster than equivalent controls (P whiplash injury grade in all six positions (P whiplash injury and grade. The size of the sample was small. An objective parameter such as electromyography is needed to confirm isometric muscle fatigue.

Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up

DEFF Research Database (Denmark)

Kongsted, Alice; Sorensen, Joan; Andersen, Hans

2008-01-01

. Clinical follow-ups were performed after 3 and 12 months. Outcome parameters were neck pain, headache, neck disability and working ability. A total of 178 participants had a cervical MRI scan on average 13 days after the injury. Traumatic findings were observed in seven participants. Signs of disc......Neck pain is the cardinal symptom following whiplash injuries. The trauma mechanism could theoretically lead to both soft tissue and bone injury that could be visualised by means of MRI. From previous quite small trials it seems that MRI does not demonstrate significant tissue damage. Large...... prospectively followed cohorts are needed to identify possible clinically relevant MRI findings. The objective of this trial was to evaluate (1) the predictive value of cervical MRI after whiplash injuries and (2) the value of repeating MRI examinations after 3 months including sequences with flexion...

Managing Injuries of the Neck Trial (MINT): a randomised controlled trial of treatments for whiplash injuries.

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Lamb, S E; Williams, M A; Williamson, E M; Gates, S; Withers, E J; Mt-Isa, S; Ashby, D; Castelnuovo, E; Underwood, M; Cooke, M W

2012-01-01

To examine the clinical effectiveness of a stepped care approach over a 12-month period after an acute whiplash injury; to estimate the costs and cost-effectiveness of each strategy including treatments and subsequent health-care costs; and to gain participants' perspective on experiencing whiplash injury, NHS treatment, and recovery within the context of the Managing Injuries of the Neck Trial (MINT). Two linked, pragmatic, randomised controlled trials. In Step 1, emergency departments (EDs) were cluster randomised to usual care advice (UCA) or The Whiplash Book advice (WBA)/active management advice. In Step 2, participants were individually randomised to either a single session of advice from a physiotherapist or a physiotherapy package of up to six sessions. An economic evaluation and qualitative study were run in parallel with the trial. Twelve NHS trusts in England comprising 15 EDs. People who attended EDs with an acute whiplash injury of whiplash-associated disorder grades I-III were eligible for Step 1. People who had attended EDs with whiplash injuries and had persistent symptoms 3 weeks after ED attendance were eligible for Step 2. In Step 1, the control intervention was UCA and the experimental intervention was a psycho-educational intervention (WBA/active management advice). In Step 2 the control treatment was reinforcement of the advice provided in Step 1 and the experimental intervention was a package of up to six physiotherapy treatments. The primary outcome was the Neck Disability Index (NDI), which measures severity and frequency of pain and symptoms, and a range of activities including self-care, driving, reading, sleeping and recreation. Secondary outcomes included the mental and physical health-related quality-of-life (HRQoL) subscales of the Short Form questionnaire-12 items (SF-12) and the number of work days lost. A total of 3851 patients were recruited to Step 1 of the trial. 1598 patients attending EDs were randomised to UCA, and 2253 were

Comparing 2 Whiplash Grading Systems to Predict Clinical Outcomes.

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Croft, Arthur C; Bagherian, Alireza; Mickelsen, Patrick K; Wagner, Stephen

2016-06-01

Two whiplash severity grading systems have been developed: Quebec Task Force on Whiplash-Associated Disorders (QTF-WAD) and the Croft grading system. The majority of clinical studies to date have used the modified grading system published by the QTF-WAD in 1995 and have demonstrated some ability to predict outcome. But most studies include only injuries of lower severity (grades 1 and 2), preventing a broader interpretation. The purpose of this study was assess the ability of these grading systems to predict clinical outcome within the context of a broader injury spectrum. This study evaluated both grading systems for their ability to predict the bivalent outcome, recovery, within a sample of 118 whiplash patients who were part of a previous case-control designed study. Of these, 36% (controls) had recovered, and 64% (cases) had not recovered. The discrete bivariate distribution between recovery status and whiplash grade was analyzed using the 2-tailed cross-tabulation statistics. Applying the criteria of the original 1993 Croft grading system, the subset comprised 1 grade 1 injury, 32 grade 2 injuries, 53 grade 3 injuries, and 32 grade 4 injuries. Applying the criteria of the modified (QTF-WAD) grading system, there were 1 grade 1 injury, 89 grade 2 injuries, and 28 grade 3 injuries. Both whiplash grading systems correlated negatively with recovery; that is, higher severity grades predicted a lower probability of recovery, and statistically significant correlations were observed in both, but the Croft grading system substantially outperformed the QTF-WAD system on this measure. The Croft grading system for whiplash injury severity showed a better predictive measure for recovery status from whiplash injuries as compared with the QTF-WAD grading system.

Chronic resuscitation after trauma-hemorrhage and acute fluid replacement improves hepatocellular function and cardiac output.

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Remmers, D E; Wang, P; Cioffi, W G; Bland, K I; Chaudry, I H

1998-01-01

To determine whether prolonged (chronic) resuscitation has any beneficial effects on cardiac output and hepatocellular function after trauma-hemorrhage and acute fluid replacement. Acute fluid resuscitation after trauma-hemorrhage restores but does not maintain the depressed hepatocellular function and cardiac output. Male Sprague-Dawley rats underwent a 5-cm laparotomy (i.e., trauma was induced) and were bled to and maintained at a mean arterial pressure of 40 mmHg until 40% of maximal bleed-out volume was returned in the form of Ringer's lactate (RL). The animals were acutely resuscitated with RL using 4 times the volume of maximum bleed-out over 60 minutes, followed by chronic resuscitation of 0, 5, or 10 mL/kg/hr RL for 20 hours. Hepatocellular function was determined by an in vivo indocyanine green clearance technique. Hepatic microvascular blood flow was assessed by laser Doppler flowmetry. Plasma levels of interleukin-6 (IL-6) were determined by bioassay. Chronic resuscitation with 5 mL/kg/hr RL, but not with 0 or 10 mL/kg/hr RL, restored cardiac output, hepatocellular function, and hepatic microvascular blood flow at 20 hours after hemorrhage. The regimen above also reduced plasma IL-6 levels. Because chronic resuscitation with 5 mL/kg/hr RL after trauma-hemorrhage and acute fluid replacement restored hepatocellular function and hepatic microvascular blood flow and decreased plasma levels of IL-6, we propose that chronic fluid resuscitation in addition to acute fluid replacement should be routinely used in experimental studies of trauma-hemorrhage.

Driving skills after whiplash.

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Gimse, R; Bjørgen, I A; Straume, A

1997-09-01

Previous studies have shown that some persons with longlasting problems after whiplash have changed eye movements. These changes have been related to disturbance of the posture control system. The question raised in the present study is whether such disturbances can influence daily life functions connected with balance, position and external movements, such as car driving. A group of 23 persons with disturbed eye movements due to whiplash injury, was tested in a driving simulator, together with a closely matched control group. The results revealed significant differences between the two groups with respect to response times to the traffic signs presented, identification of type of sign, as well as steering precision while the subjects' attention was directed to the process of identifying the signs. Alternative explanations such as driving experience, pain, medication or malingering are at least partly controlled for, but cannot completely be ruled out. A distorted posture control system leading to disturbance of eye movements seems to be the most likely primary causative factor, but these disturbances are most certainly complexly determined. Reduced attention capacity is considered to be a mediating secondary factor. Registration of eye movements may be a useful diagnostic tool to evaluate driving skill after whiplash.

Whiplash-Associated Disorders

DEFF Research Database (Denmark)

Ferrara, S. D.; Ananian, V.; Baccino, E.

2016-01-01

The manuscript presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD). The document...

Geriatric resources in acute care hospitals and trauma centers: a scarce commodity.

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Maxwell, Cathy A; Mion, Lorraine C; Minnick, Ann

2013-12-01

The number of older adults admitted to acute care hospitals with traumatic injury is rising. The purpose of this study was to examine the location of five prominent geriatric resource programs in U.S. acute care hospitals and trauma centers (N = 4,865). As of 2010, 5.8% of all U.S. hospitals had at least one of these programs. Only 8.8% of trauma centers were served by at least one program; the majorities were in level I trauma centers. Slow adoption of geriatric resource programs in hospitals may be due to lack of champions who will advocate for these programs, lack of evidence of their impact on outcomes, or lack of a business plan to support adoption. Future studies should focus on the benefits of geriatric resource programs from patients' perspectives, as well as from business case and outcomes perspectives. Copyright 2013, SLACK Incorporated.

Acute Stress Symptoms in Seriously Injured Patients: Precipitating Versus Cumulative Trauma and the Contribution of Peritraumatic Distress.

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Briere, John; Dias, Colin P; Semple, Randye J; Scott, Catherine; Bigras, Noémie; Godbout, Natacha

2017-08-01

The relationship between type of trauma exposure, cumulative trauma, peritraumatic distress, and subsequent acute stress disorder (ASD) symptoms was examined prospectively in 96 individuals presenting with acute medical injuries to a Level 1 emergency/trauma department. Common precipitating traumas included motor vehicle-related events, stabbings, shootings, and physical assaults. At 2 to 3 weeks follow-up, 22.9% of participants had developed ASD. Univariate analysis revealed no relationship between type of precipitating trauma and ASD symptoms, whereas robust path analysis indicated direct effects of gender, lifetime cumulative trauma exposure, and peritraumatic distress. Peritraumatic distress did not mediate the association between cumulative trauma and symptoms, but did mediate the association between gender and symptomatology. These results, which account for 23.1% of the variance in ASD symptoms, suggest that ASD may be more due to cumulative trauma exposure than the nature of the precipitating trauma, but that cumulative trauma does not exert its primary effect by increasing peritraumatic distress to the most recent trauma. Copyright © 2017 International Society for Traumatic Stress Studies.

A Prospective, Randomized Investigation of Plasma First Resuscitation for Traumatic Hemorrhage and Attenuation of Acute Coagulopathy of Trauma

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2016-05-01

COMBAT study staff was made aware of a code 10 trauma return of a male patient who sustained an anterior left- chest stab wound. Paramedics enrolled the...Attenuation of Acute Coagulopathy of Trauma . PRINCIPAL INVESTIGATOR: Ernest E. Moore, MD CONTRACTING ORGANIZATION: University of Colorado Denver...Randomized Investigation of “Plasma First Resuscitation” for Traumatic Hemorrhage and Attenuation of Acute Coagulopathy of Trauma . 5b. GRANT NUMBER

Late sequelae of whiplash injury with dissection of cervical arteries.

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Hauser, Vital; Zangger, Peter; Winter, Yaroslav; Oertel, Wolfgang; Kesselring, Jürg

2010-01-01

The objective of our study was to estimate the incidence of posttraumatic dissections of cervical arteries in patients with whiplash injury acquired in a car accident. We performed a retrospective analysis of medical records of 500 patients with whiplash injury acquired in car accidents between 1996 and 2005 and searched for dissections of cervical arteries occurring within 12 months after injury. Eight cases of cervical arterial dissection occurred within 12 months following whiplash injury. In 7 cases (87.5%), the dissection was complicated by brain infarction. The incidence of posttraumatic dissections after whiplash injuries was much higher than the overall incidence of cervical arterial dissections in the general population (1.6 vs. 0.0041%). The risk of cerebrovascular events was still increased 4-12 months after whiplash injury (0.6 vs. 0.003075% in the general population). There is an increased risk of posttraumatic dissection and cerebrovascular events within 12 months after whiplash injury. Car accident is an important risk factor for arterial dissections. The victims of car accidents should be screened for arterial dissections. The results of this study should be more thoroughly investigated in a prospective trial of car accident victims as a risk factor for arterial dissections. Copyright © 2010 S. Karger AG, Basel.

Psychiatric morbidity in patients with chronic whiplash-associated disorder.

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Kivioja, Jouko; Själin, Mikael; Lindgren, Urban

2004-06-01

Prospective cohort with age- and gender-matched controls. To compare psychiatric morbidity between two groups: patients having chronic symptoms after a whiplash injury and patients who recovered completely. Psychiatric morbidity may influence the outcome of somatic diseases, and it has been suggested that psychological factors are often involved in the development of chronic symptoms after whiplash injuries, but there is no study assessing psychiatric morbidity in whiplash-associated disorder (WAD) using the Structured Clinical Interview for DSM-IV. We studied a consecutive sample of 278 patients with a whiplash injury. Eighty-five had persisting neck pain after 1 year, and 38 of these participated in this study. For each patient with chronic neck pain at the 1 year follow-up, a gender- and age-matched recovered patient was selected from the study cohort of 278 cases. Psychiatric morbidity was determined using the Structured Clinical Interview for DSM-IV (SCID). The interview was conducted at 1 year after the accident (360 days, SD 2 days). The chronic WAD group had a significantly (P factor for chronic symptoms after a whiplash injury. The development of chronic symptoms after awhiplash injury seems to be associated with psychiatric vulnerability.

Does knowledge of seat design and whiplash injury mechanisms translate to understanding outcomes?

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Ivancic, Paul C

2011-12-01

Review of whiplash injury mechanisms and effects of anti-whiplash systems including active head restraint (AHR) and Whiplash Protection System (WHIPS). This article provides an overview of previous biomechanical and epidemiological studies of AHR and WHIPS and investigates whether seat design and biomechanical knowledge of proposed whiplash injury mechanisms translates to understanding outcomes of rear crash occupants. In attempt to reduce whiplash injuries, some newer automobiles incorporate anti-whiplash systems such as AHR or WHIPS. During a rear crash, mechanically based systems activate by occupant momentum pressing into the seatback whereas electronically based systems activate using crash sensors and an electronic control unit linked to the head restraint. To investigate the effects of AHR and WHIPS on occupant responses including head and neck loads and motions, biomechanical studies of simulated rear crashes have been performed using human volunteers, mathematical models, crash dummies, whole cadavers, and hybrid cadaveric/surrogate models. Epidemiological studies have evaluated the effects of AHR and WHIPS on reducing whiplash injury claims and lessening subjective complaints of neck pain after rear crashes. RESULTS.: Biomechanical studies indicate that AHR and WHIPS reduced the potential for some whiplash injuries but did not completely eliminate the injury risk. Epidemiological outcomes indicate reduced whiplash injury claims or subjective complaints of crash-related neck pain between 43 and 75% due to AHR and between 21% and 49% due to WHIPS as compared to conventional seats and head restraints. Yielding energy-absorbing seats aim to reduce occupant loads and accelerations whereas AHRs aim to provide early head support to minimize head and neck motions. Continued objective biomechanical and epidemiological studies of anti-whiplash systems together with industry, governmental, and clinical initiatives will ultimately lead to reduced whiplash injuries

Acute care nurse practitioners in trauma care: results of a role survey and implications for the future of health care delivery.

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Noffsinger, Dana L

2014-01-01

The role of acute care nurse practitioners (ACNPs) in trauma care has evolved over time. A survey was performed with the aim of describing the role across the United States. There were 68 respondents who depicted the typical trauma ACNP as being a 42-year-old woman who works full-time at a level I American College of Surgeons verified trauma center. Trauma ACNPs typically practice with 80% of their time for clinical care and are based on a trauma and acute care surgery service. They are acute care certified and hold several advanced certifications to supplement their nursing license.

Value-based cognitive-behavioural therapy for the prevention of chronic whiplash associated disorders: protocol of a randomized controlled trial.

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Andersen, Tonny Elmose; Ravn, Sophie Lykkegaard; Roessler, Kirsten Kaya

2015-09-01

Whiplash injury is the most common traffic-related injury affecting thousands of people every year. Conservative treatments have not proven effective in preventing persistent symptoms and disability after whiplash injury. Early established maladaptive pain behaviours within the first weeks after the injury may explain part of the transition from acute to chronic whiplash associated disorder (WAD). Hence, early targeting of psychological risk factors such as pain catastrophizing, fear-avoidance-beliefs, depression, and symptoms of posttraumatic stress disorder (PTSD) may be important in preventing the development of chronic WAD. Some evidence exists that targeting fear-avoidance beliefs and PTSD with exposure strategies and value-based actions may prevent development of persistent disability after whiplash injury. Yet, the results have to be tested in a randomized controlled trial (RCT). The primary objective of the present study is to test whether a specifically tailored value-based cognitive-behavioural therapy program (V-CBT) is able to prevent the development of persistent disability, pain, and psychological distress if delivered within the first three months after a whiplash injury. The current study is a two-armed randomized controlled study with a crossover design. Group A is scheduled for V-CBT within one week of randomization and group B with a delayed onset 3 months after randomization. If the study detects significant effects of V-CBT as a preventive intervention, the study will provide new insights of preventive treatment for patients with WAD and thereby serve as an important step towards preventing the chronic condition. Current Controlled Trials Registration September 19, 2014: NCT02251028.

What is the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered either on the Internet or face-to-face for people with acute whiplash associated disorder? A randomized controlled trial.

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Bring, Annika; Åsenlöf, Pernilla; Söderlund, Anne

2016-05-01

To investigate the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered via the Internet or face-to-face for people with acute whiplash associated disorders. A multicentre, randomized, three-group design, with concealed allocation. A total of 55 participants (37 female), age 18-65, with acute Whiplash Associated Disorder (Grade I-II), recruited at two emergency clinics in Sweden. Before randomization all participants received standard self-care instructions. The Internet and face-to-face groups followed a seven-week behavioural programme involving individual tailoring, via email (Internet group), or in sessions at a physical therapy unit (face-to-face group). The control group only received the self-care instructions. Pain-related disability, pain intensity, self-efficacy in daily activities, catastrophizing and fear of movement/(re)injury. Assessments were performed at baseline (2-4 weeks postinjury) and at three, six and 12 months postintervention. Both the Internet (n = 16) and face-to-face (n = 14) group showed a larger decrease in pain-related disability than the control group (n = 16); -12 and -11, respectively, compared with -5 in the control group at 12-months follow-up. Significant differences between the groups in overall treatment effect were shown in all outcomes except pain intensity. All groups improved significantly over time in all outcomes, except for fear of movement/(re)injury and catastrophizing in the control group. An individually tailored behavioural programme improved biopsychosocial factors in patients with whiplash associated disorders up to 12 months after treatment. Internet-delivered intervention was as effective as clinic-based face-to-face therapy sessions. © The Author(s) 2015.

Whiplash and the compensation hypothesis.

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Spearing, Natalie M; Connelly, Luke B

2011-12-01

Review article. To explain why the evidence that compensation-related factors lead to worse health outcomes is not compelling, either in general, or in the specific case of whiplash. There is a common view that compensation-related factors lead to worse health outcomes ("the compensation hypothesis"), despite the presence of important, and unresolved sources of bias. The empirical evidence on this question has ramifications for the design of compensation schemes. Using studies on whiplash, this article outlines the methodological problems that impede attempts to confirm or refute the compensation hypothesis. Compensation studies are prone to measurement bias, reverse causation bias, and selection bias. Errors in measurement are largely due to the latent nature of whiplash injuries and health itself, a lack of clarity over the unit of measurement (specific factors, or "compensation"), and a lack of appreciation for the heterogeneous qualities of compensation-related factors and schemes. There has been a failure to acknowledge and empirically address reverse causation bias, or the likelihood that poor health influences the decision to pursue compensation: it is unclear if compensation is a cause or a consequence of poor health, or both. Finally, unresolved selection bias (and hence, confounding) is evident in longitudinal studies and natural experiments. In both cases, between-group differences have not been addressed convincingly. The nature of the relationship between compensation-related factors and health is unclear. Current approaches to testing the compensation hypothesis are prone to several important sources of bias, which compromise the validity of their results. Methods that explicitly test the hypothesis and establish whether or not a causal relationship exists between compensation factors and prolonged whiplash symptoms are needed in future studies.

Role of spinal inhibitory mechanisms in whiplash injuries.

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Lo, Yew-Long; Tan, Yam-Eng; Fook-Chong, Stephanie; Boolsambatra, Pensie; Yue, Wai-Mun; Chan, Ling-Ling; Tan, Seang-Beng

2007-06-01

Whiplash injury, commonly encountered in road traffic accidents, is a major cause of morbidity. Its pathophysiology is not well understood, and diagnosis remains clinical. Imaging and electrophysiological methods have not provided objective diagnostic evidence. Availability of a sensitive and specific diagnostic method would be of high clinical interest. We studied 20 consecutive patients with chronic whiplash injury. Despite persistent symptoms, most had minimal neurological findings. Cutaneous silent period (CSP), a nociceptive spinal inhibitory electromyographic reflex, showed 90% sensitivity and 90% specificity for its diagnosis. In contrast, only two patients (10%) had abnormal transcranial magnetic stimulation findings, and another two (10%) showed abnormal electromyography. Magnetic resonance imaging (MRI) showed cervical cord abnormalities in only two of 20 (10%) patients. None of the patients had abnormal somatosensory evoked potential studies. Our findings suggest that neurological dysfunction of whiplash may occur at several possible spinal cord localities in the CSP functional pathway. The use of this simple, quick, and sensitive method is advocated in the diagnostic work up of whiplash injury.

Trauma indices for prediction of acute respiratory distress syndrome.

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Afshar, Majid; Smith, Gordon S; Cooper, Richard S; Murthi, Sarah; Netzer, Giora

2016-04-01

A myriad of trauma indices has been validated to predict probability of trauma survival. We aimed to compare the performance of commonly used indices for the development of the acute respiratory distress syndrome (ARDS). Historic, observational cohort study of 27,385 consecutive patients admitted to a statewide referral trauma center between July 11, 2003 and October 31, 2011. A validated algorithm was adapted to identify patients with ARDS. Each trauma index was evaluated in logistic regression using the area under the receiver operating characteristic curve. The case rate for ARDS development was 5.8% (1594). The receiver operating characteristics for injury severity score (ISS) had the best discrimination and had an area under the curve of 0.88 (95% confidence interval [CI] = 0.87-0.89). Glasgow coma score (0.71, 95% CI = 0.70-0.73), A Severity Characterization of Trauma (0.86, 95% CI = 0.85-0.87), Revised Trauma Score (0.71, 95% CI = 0.70-0.72) and thorax Abbreviated Injury Score (0.73, 95% CI = 0.72-0.74) performed worse (P < 0.001) and Trauma and Injury Severity Score (0.88, 95% CI = 0.87-0.88) performed equivocally (P = 0.51) in comparison to ISS. Using a cutoff point ISS ≥16, sensitivity and specificity were 84.9% (95% CI = 83.0%-86.6%) and 75.6% (95% CI = 75.1%-76.2%), respectively. Among commonly used trauma indices, ISS has superior or equivocal discriminative ability for development of ARDS. A cutoff point of ISS ≥16 provided good sensitivity and specificity. The use of ISS ≥16 is a simple method to evaluate ARDS in trauma epidemiology and outcomes research. Copyright © 2016 Elsevier Inc. All rights reserved.

Do head-restraints protect the neck from whiplash injuries?

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Morris, F

1989-01-01

Over an 11-month period a study was made of all patients presenting to an accident and emergency department who had sustained whiplash as a result of rear-bumper impacts. The patients were analysed with respect to the presence of head-restraints in their vehicles. A significant increase in the incidence of whiplash was found in patients whose vehicles did not have head-restraints fitted. Legislation requiring all passenger cars to have head-restraints fitted as standard would have a major impact in reducing the number of whiplash injuries sustained in rear bumper impacts. PMID:2712983

Whiplash Syndrome Reloaded: Digital Echoes of Whiplash Syndrome in the European Internet Search Engine Context

Science.gov (United States)

2017-01-01

Background In many Western countries, after a motor vehicle collision, those involved seek health care for the assessment of injuries and for insurance documentation purposes. In contrast, in many less wealthy countries, there may be limited access to care and no insurance or compensation system. Objective The purpose of this infodemiology study was to investigate the global pattern of evolving Internet usage in countries with and without insurance and the corresponding compensation systems for whiplash injury. Methods We used the Internet search engine analytics via Google Trends to study the health information-seeking behavior concerning whiplash injury at national population levels in Europe. Results We found that the search for “whiplash” is strikingly and consistently often associated with the search for “compensation” in countries or cultures with a tort system. Frequent or traumatic painful injuries; diseases or disorders such as arthritis, headache, radius, and hip fracture; depressive disorders; and fibromyalgia were not associated similarly with searches on “compensation.” Conclusions In this study, we present evidence from the evolving viewpoint of naturalistic Internet search engine analytics that the expectations for receiving compensation may influence Internet search behavior in relation to whiplash injury. PMID:28347974

Are altered smooth pursuit eye movements related to chronic pain and disability following whiplash injuries? A prospective trial with one-year follow-up.

Science.gov (United States)

Kongsted, Alice; Jørgensen, Lars Vincents; Leboeuf-Yde, Charlotte; Qerama, Erisela; Korsholm, Lars; Bendix, Tom

2008-05-01

To evaluate the ability of early smooth pursuit testing to predict chronic whiplash-associated disorders, and to study whether the presence of abnormal smooth pursuit eye movements at one-year follow-up is associated with symptoms at that time. Prospective cohort study with one-year follow-up. The study was carried out at a university research centre and participants were recruited from emergency units and general practitioners. In all, 262 participants were recruited within 10 days from a whiplash injury. Smooth pursuit eye movements were tested with electrooculography (EOG) an average of 12 days after a whiplash trauma and again after one year. Analyses of EOG recordings were computerized. Associations between test results both from baseline and one-year tests and self-reported neck pain, headache, neck disability and working ability one year after the car collision were determined. Results of early eye movement tests were not associated with the prognosis. Reduced smooth pursuit performance when tested in static cervical rotation at the one-year follow-up was significantly associated with higher neck pain intensity at that time (regression coefficient 0.8, 95% confidence interval (CI) 0.04-1.5), but the association was too weak for the test to discriminate between recovered participants and those with lasting symptoms. Although reduced smooth pursuit performance at one-year follow-up was associated with persistent neck pain, smooth pursuit eye movement tests are not useful as predictive or diagnostic tests in whiplash-associated disorders.

Risk Factors of Poor Prognosis after Whiplash Injury

Directory of Open Access Journals (Sweden)

Samy Suissa

2003-01-01

Full Text Available Whiplash, a common injury following motor vehicle crashes, is associated with high costs and a prognosis that is variable and difficult to predict. In this paper, we review findings from the Quebec cohort epidemiological study on predictive factors of recovery from whiplash injury after a motor vehicle crash. We formed a population-based incident cohort of all 4,759 individuals who sustained a whiplash injury resulting from a motor vehicle crash in the province of Québec, Canada, in 1987, and followed these patients for up to seven years. The data were obtained from the universal automobile insurance plan (SAAQ that covers all seven million residents of the Province for all vehicular-related injuries. From this cohort, we formed the cohort of 3,014 for whom a police report was completed. For this cohort, we obtained data on crash-related factors directly from the police report. We also formed the cohort of 2,627 subjects who had strictly a whiplash injury, without associated injuries. For this cohort, the data on signs and symptoms were obtained from the medical charts kept by the SAAQ. For both cohorts, data on the outcome, the recovery time from whiplash, was obtained from the SAAQ databases. The crash-related cohort study found that socio-demographic factors associated with a longer recovery from whiplash include older age, female sex, having dependents and not being employed full time and that each decreases the rate of recovery by 14 to 16 per cent. Factors related to the crash conditions indicate that being in a truck or bus, with a decrease of 52% in the rate of recovery, being a passenger in the vehicle (15%, colliding with a moving vehicle (16%, and a side or frontal collision (15% all decrease the rate of recovery. We introduce a combined risk score that predicts longer recovery. In the cohort of subjects with signs and symptoms, the median recovery time was 32 days and 12% of subjects had still not recovered after 6 months. The signs

Incidence, clinical predictors and outcome of acute renal failure among North Indian trauma patients

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Medha; Subramanian, Arulselvi; Pandey, Ravindra Mohan; Sawhney, Chhavi; Upadhayay, Ashish Dutt; Albert, Venencia

2013-01-01

Context: There is a need for identifying risk factors aggravating development of acute renal failure after attaining trauma and defining new parameters for better assessment and management. Aim of the study was to determine the incidence of acute renal failure among trauma patients, and its correlation with various laboratory and clinical parameters recorded at the time of admission and in-hospital mortality. Subjects and Methods: The retrospective cohort study included admitted 208 trauma patients over a period of one year. 135 trauma patients at the serum creatinine level >2.0 mg/dL were enrolled in under the group of acute renal failure. 73 patients who had normal creatinine level made the control group. They were further assessed with clinical details and laboratory investigations. Results: Incidence of acute renal failure was 3.1%. There were 118 (87.4%) males and average length of stay was 9 (1, 83) days. Severity of injury (ISS, GCS) was relatively more among the renal failure group. Renal failure was transient in 35 (25.9%) patients. They had higher incidence of bone fracture (54.0%) (P= 0.04). Statistically significant association was observed between patients with head trauma and mortality 72 (59.0%) (P= 0.001). Prevalence of septic 24 (59.7%) and hemorrhagic 9 (7.4%) shock affected the renal failure group. Conclusion: Trauma patients at the urea level >50 mg/dL, ISS >24 on the first day of admission had 23 times and 7 times the risk of developing renal failure. Similarly, patients with hepatic dysfunction and pulmonary dysfunction were 12 times and 6 times. Patients who developed cardiovascular dysfunction, hematological dysfunction and post-trauma renal failure during the hospital stay had risk for mortality 29, 7 and 8 times, respectively. The final prognostic score obtained was: 14*hepatic dysfunction + 11*cISS + 18*cUrea + 12*cGlucose + 10*pulmonary dysfunction. Optimal score cut-off for prediction of renal failure was found to be ≥25 with

Incidence, clinical predictors and outcome of acute renal failure among North Indian trauma patients

Directory of Open Access Journals (Sweden)

Medha

2013-01-01

Full Text Available Context: There is a need for identifying risk factors aggravating development of acute renal failure after attaining trauma and defining new parameters for better assessment and management. Aim of the study was to determine the incidence of acute renal failure among trauma patients, and its correlation with various laboratory and clinical parameters recorded at the time of admission and in-hospital mortality. Subjects and Methods: The retrospective cohort study included admitted 208 trauma patients over a period of one year. 135 trauma patients at the serum creatinine level >2.0 mg/dL were enrolled in under the group of acute renal failure. 73 patients who had normal creatinine level made the control group. They were further assessed with clinical details and laboratory investigations. Results: Incidence of acute renal failure was 3.1%. There were 118 (87.4% males and average length of stay was 9 (1, 83 days. Severity of injury (ISS, GCS was relatively more among the renal failure group. Renal failure was transient in 35 (25.9% patients. They had higher incidence of bone fracture (54.0% (P = 0.04. Statistically significant association was observed between patients with head trauma and mortality 72 (59.0% (P = 0.001. Prevalence of septic 24 (59.7% and hemorrhagic 9 (7.4% shock affected the renal failure group. Conclusion: Trauma patients at the urea level >50 mg/dL, ISS >24 on the first day of admission had 23 times and 7 times the risk of developing renal failure. Similarly, patients with hepatic dysfunction and pulmonary dysfunction were 12 times and 6 times. Patients who developed cardiovascular dysfunction, hematological dysfunction and post-trauma renal failure during the hospital stay had risk for mortality 29, 7 and 8 times, respectively. The final prognostic score obtained was: 14FNx01hepatic dysfunction + 11FNx01cISS + 18FNx01cUrea + 12FNx01cGlucose + 10FNx01pulmonary dysfunction. Optimal score cut-off for prediction of renal failure was

The pharmacokinetics of meperidine in acute trauma patients.

Science.gov (United States)

Kirkwood, C F; Edwards, D J; Lalka, D; Lasezkay, G; Hassett, J M; Slaughter, R L

1986-12-01

Traumatic injury has the potential to alter the hepatic clearance and hence the efficacy and toxicity of drugs by a variety of mechanisms. These include changes in hepatic microsomal enzyme activity, hepatic blood flow rate, and plasma protein binding. Unfortunately, there have been few pharmacokinetic studies in trauma patients. Thus, few data are available to provide guidance in drug regimen design for these individuals. Meperidine clearance was therefore evaluated in patients with traumatic injury and an effort was made to identify physiologic and/or clinical predictors of clearance which could facilitate initial dosage selection. Meperidine total body clearance (TBC) was determined on 12 occasions at steady state following IM administration of meperidine to nine severely injured nonseptic trauma patients with normal renal and hepatic function. TBC of this drug averaged 684 +/- 206 ml/min (mean +/- SD) and was highly correlated with ideal body weight (IBW) (r2 = 0.735; F = 27.75; n = 12; p less than 0.01). The serum concentration of the acute phase reactant protein, alpha 1 acid glycoprotein (AGP), which binds meperidine and many other basic drugs increased strikingly in an apparent linear manner at a rate of 27 mg/dl/day up to 9 days after the traumatic event (r2 = 0.828; F = 42.30; n = 12; p less than 0.01). However, this increase in binding protein concentration was not associated with an alteration in meperidine TBC as has been reported for other drugs. It is concluded that IBW may be a useful guide initial dosage selection of meperidine in acute trauma patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Kinematics of a Head-Neck Model Simulating Whiplash

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Colicchia, Giuseppe; Zollman, Dean; Wiesner, Hartmut; Sen, Ahmet Ilhan

2008-01-01

A whiplash event is a relative motion between the head and torso that occurs in rear-end automobile collisions. In particular, the large inertia of the head results in a horizontal translation relative to the thorax. This paper describes a simulation of the motion of the head and neck during a rear-end (whiplash) collision. A head-neck model that…

Pregabalin versus placebo in targeting pro-nociceptive mechanisms to prevent chronic pain after whiplash injury in at-risk individuals - a feasibility study for a randomised controlled trial.

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Nikles, J; Keijzers, G; Mitchell, G; Schug, S; Ware, R; McLean, S A; Connelly, L; Gibson, S; Farrell, S F; Sterling, M

2018-01-17

Whiplash-associated disorders (WAD) are an enormous and costly burden to Australian society. Up to 50% of people who experience a whiplash injury will never fully recover. Whiplash is resistant to treatment and no early management approach has yet been shown to prevent chronic pain. The early presence of central sensitization is associated with poor recovery. Pregabalin's effects on central sensitization indicate the potential to prevent or modulate these processes after whiplash injury and to improve health outcomes, but this has not been investigated. This paper describes the protocol for a feasibility study for a randomised controlled trial of pregabalin plus evidence-based advice compared to placebo plus evidence-based advice for individuals with acute whiplash injury who are at risk of poor recovery. This double blind, placebo-controlled randomised feasibility study will examine the feasibility and potential effectiveness of pregabalin and evidence-based advice (intervention) compared to placebo and evidence-based advice (control) for individuals with acute whiplash injury at risk of poor recovery. Thirty participants (15 per group) aged 18-65 years with Grade II WAD, within 48 hours of injury and currently experiencing at least moderate pain (NRS: ≥ 5/10) will be recruited from Emergency Departments of public hospitals in Queensland, Australia. Pregabalin will be commenced at 75 mg bd and titrated up to 300 mg bd as tolerated for 4 weeks followed by 1 week of weaning. The feasibility of trial procedures will be tested, as well as the potential effect of the intervention on the outcomes. The primary outcome of neck pain intensity at 3 months from randomisation will be compared between the treatment groups using standard analysis of variance techniques. Feasibility and potential effectiveness data will inform an appropriately powered full trial, which if successful, will provide an effective and cost-effective intervention for a costly and treatment

Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis.

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Walton, David M; Macdermid, Joy C; Giorgianni, Anthony A; Mascarenhas, Joanna C; West, Stephen C; Zammit, Caroline A

2013-02-01

Systematic review and meta-analysis. To update a previous review and meta-analysis on risk factors for persistent problems following whiplash secondary to a motor vehicle accident. Prognosis in whiplash-associated disorder (WAD) has become an active area of research, perhaps owing to the difficulty of treating chronic problems. A previously published review and meta-analysis of prognostic factors included primary sources up to May 2007. Since that time, more research has become available, and an update to that original review is warranted. A systematic search of international databases was conducted, with rigorous inclusion criteria focusing on studies published between May 2007 and May 2012. Articles were scored, and data were extracted and pooled to estimate the odds ratio for any factor that had at least 3 independent data points in the literature. Four new cohorts (n = 1121) were identified. In combination with findings of a previous review, 12 variables were found to be significant predictors of poor outcome following whiplash, 9 of which were new (n = 2) or revised (n = 7) as a result of additional data. The significant variables included high baseline pain intensity (greater than 5.5/10), report of headache at inception, less than postsecondary education, no seatbelt in use during the accident, report of low back pain at inception, high Neck Disability Index score (greater than 14.5/50), preinjury neck pain, report of neck pain at inception (regardless of intensity), high catastrophizing, female sex, WAD grade 2 or 3, and WAD grade 3 alone. Those variables robust to publication bias included high pain intensity, female sex, report of headache at inception, less than postsecondary education, high Neck Disability Index score, and WAD grade 2 or 3. Three existing variables (preaccident history of headache, rear-end collision, older age) and 1 additional novel variable (collision severity) were refined or added in this updated review but showed no significant

Cervical vertigo and dizziness after whiplash injury

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Endo, Kenji; Ichimaru, Katsuji; Komagata, Mashashi; Yamamoto, Kengo

2006-01-01

Whiplash injury is not only limited to neck injury but also brainstem injury that does not involve direct damage to the neck or head. The symptoms of whiplash injury are polymorphous, with the most common complaints being cervical pain, headache and scapulodynia. Vertigo and dizziness are also reported in 25–50% of the cases. In otoneurologic studies, magnetic resonance angiography (MRA) is used for the evaluation of vertebrobasilar hemodynamics in patients who complain of dizziness and verti...

What characterizes individuals developing chronic whiplash?: The Nord-Trøndelag Health Study (HUNT).

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Myrtveit, Solbjørg Makalani; Wilhelmsen, Ingvard; Petrie, Keith J; Skogen, Jens Christoffer; Sivertsen, Børge

2013-05-01

Most individuals experiencing whiplash accidents recover rapidly. A considerable proportion, however, develop chronic symptoms. Psychological factors may slow recovery, possibly by increasing the likelihood of other symptoms being misattributed to, and amplified by the whiplash injury. We aimed to investigate how pre-injury mental and somatic symptoms, self-rated health, use of health-services and medications, health-behavior and socio-demographics predict the development of chronic whiplash. Data from two waves of a large, population based study (HUNT2 (baseline) and HUNT3) were used. Individuals reporting no whiplash at baseline were identified in HUNT3. Characteristics reported at baseline were compared between those who had developed chronic whiplash in HUNT3 (n=199) and those who had not (n=20,600), using Pearson's chi-squared tests, independent sample t-tests and logistic regression analyses. Individuals developing chronic whiplash reported worse baseline health than those reporting no chronic whiplash. Poor self-rated health was a strong risk factor for subsequent chronic whiplash (OR=2.26, 95%CI: 1.68-3.04). Musculoskeletal pain also increased the risk (OR=1.21, 95%CI: 1.15-1.26), as did diffuse somatic symptoms (OR=2.09, 95%CI: 1.47-2.96), use of different health services (OR=1.31, 95%CI: 1.19-1.45), high use of medications (OR=1.28, 95%CI: 1.14-1.43) and symptoms of anxiety (OR=1.93, 95%CI: 1.39-2.68). Physical activity was protective (OR=0.67, 95%CI: 0.49-0.91). Most socio-demographic variables were not significantly associated with chronic whiplash. Poor somatic and mental pre-injury health increased the risk of subsequent chronic whiplash. This suggests that chronic whiplash is not merely an organic disorder, and highlights the importance of individual expectations, symptom reattribution and amplification in development of chronic whiplash. Copyright © 2013 Elsevier Inc. All rights reserved.

How can animal models inform on the transition to chronic symptoms in whiplash?

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Winkelstein, Beth A.

2011-01-01

Study Design A non-systematic review of the literature. Objective The objective was to present general schema for mechanisms of whiplash pain and review the role of animal models in understanding the development of chronic pain from whiplash injury. Summary of Background Data Extensive biomechanical and clinical studies of whiplash have been performed to understand the injury mechanisms and symptoms of whiplash injury. However, only recently have animal models of this painful disorder been developed based on other pain models in the literature. Methods A non-systematic review was performed and findings were integrated to formulate a generalized picture of mechanisms by chronic whiplash pain develops from mechanical tissue injuries. Results The development of chronic pain from tissue injuries in the neck due to whiplash involves complex interactions between the injured tissue and spinal neuroimmune circuits. A variety of animal models are beginning to define these mechanisms. Conclusion Continued work is needed in developing appropriate animal models to investigate chronic pain from whiplash injuries and care must be taken to determine whether such models aim to model the injury event or the pain symptom. PMID:22020616

ECONOMIC ASPECTS OF "WHIPLASH" INJURY.

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SNOW, G H

1964-10-01

The term "whiplash," used to describe a neck injury received in an automobile accident, has no foundation in medical science to support the complaints of persons suing for damages. The term is gaining unwarranted popularity as a term describing an injury, even though there are no clinical or pathological findings to support it."Whiplash" cases today account for an estimated 30 per cent of all injuries in automobile accidents. Direct compensation for damages paid to persons injured in automobile accidents in the United States in 1961 amounted to approximately one billion, seven hundred million dollars. It has been estimated that five hundred and eighty million dollars of that amount was paid in compensation on allegation of neck injuries.

Grade II whiplash injuries to the neck: what is the benefit for patients treated by different physical therapy modalities?

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Dehner, Christoph; Elbel, Martin; Strobel, Philipp; Scheich, Matthias; Schneider, Florian; Krischak, Gert; Kramer, Michael

2009-01-01

Background In a majority of cases, whiplash injuries are a domain of conservative therapy. Nevertheless it remains unclear whether physical therapy is of medical or economic benefit in patients with whiplash injuries. Methods Seventy patients with acute Quebec Task Force (QTF) grade II whiplash injuries were randomized to two therapy groups and received either active (APT) or passive (PPT) physical therapy. Patients were compared with regard to pain and range of motion with data obtained in an earlier study from a group with grade II whiplash injuries in which the therapy recommendation had been "act as usual" (AAU; n = 20). The above-mentioned parameters were assessed at 24 hours and two months after the injury. Furthermore patients' period of disability was documented after two months. Results After two months, patients in both the APT and PPT groups showed significant improvement in the median period of disability (active: 14 days; passive: 14 days) compared to the AAU group (49 days). No group difference was observed with regard to median improvement in range of motion (active: 120°; passive: 108°; activity as usual: 70°). The median pain reduction was significantly greater in the APT group (50.5) than in the PPT (39.2) or AAU group (28.8). Conclusion Our data show that active physical therapy results in enhanced pain reduction and shortening of post-injury disability. Therefore, active physical therapy should be considered the treatment of choice in patients with QTF grade II whiplash injuries. Trial registration The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission. PMID:19149880

Grade II whiplash injuries to the neck: what is the benefit for patients treated by different physical therapy modalities?

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Krischak Gert

2009-01-01

Full Text Available Abstract Background In a majority of cases, whiplash injuries are a domain of conservative therapy. Nevertheless it remains unclear whether physical therapy is of medical or economic benefit in patients with whiplash injuries. Methods Seventy patients with acute Quebec Task Force (QTF grade II whiplash injuries were randomized to two therapy groups and received either active (APT or passive (PPT physical therapy. Patients were compared with regard to pain and range of motion with data obtained in an earlier study from a group with grade II whiplash injuries in which the therapy recommendation had been "act as usual" (AAU; n = 20. The above-mentioned parameters were assessed at 24 hours and two months after the injury. Furthermore patients' period of disability was documented after two months. Results After two months, patients in both the APT and PPT groups showed significant improvement in the median period of disability (active: 14 days; passive: 14 days compared to the AAU group (49 days. No group difference was observed with regard to median improvement in range of motion (active: 120°; passive: 108°; activity as usual: 70°. The median pain reduction was significantly greater in the APT group (50.5 than in the PPT (39.2 or AAU group (28.8. Conclusion Our data show that active physical therapy results in enhanced pain reduction and shortening of post-injury disability. Therefore, active physical therapy should be considered the treatment of choice in patients with QTF grade II whiplash injuries. Trial registration The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission.

Therapy recommendation "act as usual" in patients with whiplash injuries QTF I°.

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Dehner, Christoph; Kraus, Michael; Schöll, Hendrik; Schneider, Florian; Richter, Peter; Kramer, Michael

2012-08-20

Up to now no therapy study has used the classification system of the Quebec Task Force (QTF) to differentiate between patients with (QTF II°) and without functional disorders (QTF I°). This differentiation seems meaningful, as this difference may be relevant for the correct treatment planning. In this context the effect of the therapy recommendation "act as usual" has been evaluated in a homogeneous patient collective with whiplash injuries QTF I°. 470 patients with acute whiplash injuries had been catched in this study and classified according to the QTF. 359 patients (76.4%) with QTF I° injuries could be identified. Out of that 162 patients were enrolled to the study and received the therapy recommendation "act as usual" and the adapted pain treatment with non-steroidal anti-inflammatory drugs (NSAID). After six months the outcome was evaluated by phone. After injury the median pain score assessed by a visual analogue scale (VAS) was 5.4 (min = 3.3; max = 8.5). After six months 5 of the 162 patients complained intermittent pain symptoms (VAS values < 2). This is consistent with a chronification rate of 3.1%. After injury, the median pain disability index (PDI) was 3.9 (min = 1.9; max = 7.7). After six months 3 of the 162 patients stated persisting disability during sporting and physical activities (VAS values < 1). The therapy recommendation "act as usual" in combination with an adapted pain treatment is sufficient. Usually patients with whiplash injuries QTF I° do not need physical therapy. An escalation of therapy measures should be reserved to patients with complicated healing processes.

Perceived Cognitive Deficits, Emotional Distress and Disability following Whiplash Injury

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Michael JL Sullivan

2002-01-01

Full Text Available OBJECTIVES: To describe the pattern of perceived cognitive deficits in patients with whiplash injury, to examine the relation between perceived cognitive deficits and disability, and to examine the determinants of perceived cognitive deficits in patients with whiplash injury.

Dual-energy computed tomography of cruciate ligament injuries in acute knee trauma

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Peltola, Erno K. [Helsinki University Hospital, Toeoeloe Trauma Center, Department of Radiology, Helsinki Medical Imaging Center, Helsinki (Finland); Koskinen, Seppo K. [Karolinska Universitetssjukhuset, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden)

2015-09-15

To examine dual-energy computed tomography (DECT) in evaluating cruciate ligament injuries. More specifically, the purpose was to assess the optimal keV level in DECT gemstone spectral imaging (GSI) images and to examine the usefulness of collagen-specific color mapping and dual-energy bone removal in the evaluation of cruciate ligaments and the popliteus tendon. At a level 1 trauma center, a 29-month period of emergency department DECT examinations for acute knee trauma was reviewed by two radiologists for presence of cruciate ligament injuries, visualization of the popliteus tendon and the optimal keV level in GSI images. Three different evaluating protocols (GSI, bone removal and collagen-specific color mapping) were rated. Subsequent MRI served as a reference standard for intraarticular injuries. A total of 18 patients who had an acute knee trauma, DECT and MRI were found. On MRI, six patients had an ACL rupture. DECT's sensitivity and specificity to detect ACL rupture were 79 % and 100 %, respectively. The DECT vs. MRI intra- and interobserver proportions of agreement for ACL rupture were excellent or good (kappa values 0.72-0.87). Only one patient had a PCL rupture. In GSI images, the optimal keV level was 63 keV. GSI of 40-140 keV was considered to be the best evaluation protocol in the majority of cases. DECT is a usable method to evaluate ACL in acute knee trauma patients with rather good sensitivity and high specificity. GSI is generally a better evaluation protocol than bone removal or collagen-specific color mapping in the evaluation of cruciate ligaments and popliteus tendon. (orig.)

Catastrophizing and perceived injustice: risk factors for the transition to chronicity after whiplash injury.

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Sullivan, Michael J L; Adams, Heather; Martel, Marc-Olivier; Scott, Whitney; Wideman, Timothy

2011-12-01

The article will summarize research that has supported the role of pain catastrophizing and perceived injustice as risk factors for problematic recovery after whiplash injury. This article focuses on two psychological variables that have been shown to impact on recovery trajectories after whiplash injury; namely pain catastrophizing and perceived injustice. Research has shown that psychological variables play a role in determining the trajectory of recovery after whiplash injury. This article will focus on two psychological variables that have been shown to impact on recovery trajectories after whiplash injury; namely pain catastrophizing and perceived injustice. The article will summarize research that has supported the role of pain catastrophizing and perceived injustice as risk factors for problematic recovery after whiplash injury. Several investigations have shown that measures of catastrophizing and perceived injustice prospectively predict problematic trajectories of recovery after whiplash injury. Basic research points to the potential roles of expectancies, attention, coping and endogenous opioid dysregulation as possible avenues through which catastrophizing might heighten the probability of the persistence of pain after whiplash injury. Although research has yet to systematically address the mechanisms by which perceived injustice might contribute to prolonged disability in individuals with whiplash injuries, there are grounds for suggesting the potential contributions of catastrophizing, pain behavior and anger. A challenge for future research will be the development and evaluation of risk factor-targeted interventions aimed at reducing catastrophizing and perceived injustice to improve recovery trajectories after whiplash injury.

Validity and internal consistency of a whiplash-specific disability measure

NARCIS (Netherlands)

Pinfold, Melanie; Niere, Ken R.; O'Leary, Elizabeth F.; Hoving, Jan Lucas; Green, Sally; Buchbinder, Rachelle

2004-01-01

STUDY DESIGN: Cross-sectional study of patients with whiplash-associated disorders investigating the internal consistency, factor structure, response rates, and presence of floor and ceiling effects of the Whiplash Disability Questionnaire (WDQ). OBJECTIVES: The aim of this study was to confirm the

Calculation and analysis of whiplash effect in multi-DOF system

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Chen, Gong; Qi, Qunfu; Yang, Hongmei; Li, Ling

2017-04-01

The response of structural vibration depends on the degree of freedomss, mass, stiffness, external effect of the structure. Natural frequency of structure is its inherent property, also it is related to its own factors, but not related to the external factors. Firstly the nature and characteristics of resonance effect and whiplash effect are analyzed. Secondly whiplash effect of multi-degree freedomss system is analyzed, then orthogonality in main models is used to verify the results of calculation. Then the improvements of whiplash effect are proposed, also the improved models are analyzed. Finally the conclusions are made.

Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability

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Annick Maujean

2017-12-01

Conclusion:. Given that only the hyperarousal/numbing symptom cluster predicted long-term neck pain-related disability, this finding may have implications in terms of diagnosis, assessment, and management of the psychological impact of whiplash-injured individuals following a MVC.

Acute and overuse elbow trauma: radio-orthopaedics overview.

Science.gov (United States)

Nocerino, Elisabetta Antonia; Cucchi, Davide; Arrigoni, Paolo; Brioschi, Marco; Fusi, Cristiano; Genovese, Eugenio A; Messina, Carmelo; Randelli, Pietro; Masciocchi, Carlo; Aliprandi, Alberto

2018-01-19

The correct management of acute, subacute and overuse-related elbow pathologies represents a challenging diagnostic and therapeutic problem. While major trauma frequently requires a rapid surgical intervention, subluxation and minor trauma allow taking more time for diagnostics and planning the correct elective treatment after careful clinical and radiological investigation. In these conditions, communication between orthopaedic surgeon and radiologist allow to create a detailed radiology report, tailored to the patient's and surgeon's needs and optimal to plan proper management. Imaging technique as X-Ray, CT, US, MRI, CTA and MRA all belong to the radiologist's portfolio in elbow diagnostics. Detailed knowledge of elbow pathology and its classification and of the possibilities and limits of each imaging technique is of crucial importance to reach the correct diagnosis efficiently. The aim of this review is to present the most frequent elbow pathologies and suggest a suitable diagnostic approach for each of them.

Functional health status in subjects after a motor vehicle accident, with emphasis on whiplash associated disorders: design of a descriptive, prospective inception cohort study

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Helders Paul JM

2008-12-01

Full Text Available Abstract Background The clinical consequences of whiplash injuries resulting from a motor vehicle accident (MVA are poorly understood. Thereby, there is general lack of research on the development of disability in patients with acute and chronic Whiplash Associated Disorders. Methods/Design The objective is to describe the design of an inception cohort study with a 1-year follow-up to determine risk factors for the development of symptoms after a low-impact motor vehicle accident, the prognosis of chronic disability, and costs. Victims of a low-impact motor vehicle accident will be eligible for participation. Participants with a Neck Disability Index (NDI score of 7 or more will be classified as experiencing post-traumatic neck pain and will enter the experimental group. Participants without complaints (a NDI score less than 7 will enter the reference group. The cohort will be followed up by means of postal questionnaires and physical examinations at baseline, 3 months, 6 months, and 12 months. Recovery from whiplash-associated disorders will be measured in terms of perceived functional health, and employment status (return to work. Life tables will be generated to determine the 1-year prognosis of whiplash-associated disorders, and risk factors and prognostic factors will be assessed using multiple logistic regression analysis. Discussion Little is known about the development of symptoms and chronic disability after a whiplash injury. In the clinical setting, it is important to identify those people who are at risk of developing chronic symptoms. This inception prospective cohort study will provide insight in the influence of risk factors, of the development of functional health problems, and costs in people with whiplash-associated disorders.

Functional health status in subjects after a motor vehicle accident, with emphasis on whiplash associated disorders: design of a descriptive, prospective inception cohort study

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Schmitt, Maarten A; van Meeteren, Nico LU; de Wijer, Anton; Helders, Paul JM; Graaf, Yolanda van der

2008-01-01

Background The clinical consequences of whiplash injuries resulting from a motor vehicle accident (MVA) are poorly understood. Thereby, there is general lack of research on the development of disability in patients with acute and chronic Whiplash Associated Disorders. Methods/Design The objective is to describe the design of an inception cohort study with a 1-year follow-up to determine risk factors for the development of symptoms after a low-impact motor vehicle accident, the prognosis of chronic disability, and costs. Victims of a low-impact motor vehicle accident will be eligible for participation. Participants with a Neck Disability Index (NDI) score of 7 or more will be classified as experiencing post-traumatic neck pain and will enter the experimental group. Participants without complaints (a NDI score less than 7) will enter the reference group. The cohort will be followed up by means of postal questionnaires and physical examinations at baseline, 3 months, 6 months, and 12 months. Recovery from whiplash-associated disorders will be measured in terms of perceived functional health, and employment status (return to work). Life tables will be generated to determine the 1-year prognosis of whiplash-associated disorders, and risk factors and prognostic factors will be assessed using multiple logistic regression analysis. Discussion Little is known about the development of symptoms and chronic disability after a whiplash injury. In the clinical setting, it is important to identify those people who are at risk of developing chronic symptoms. This inception prospective cohort study will provide insight in the influence of risk factors, of the development of functional health problems, and costs in people with whiplash-associated disorders. PMID:19099574

Use of cervical collar after whiplash injuries.

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Józefiak-Wójtowicz, Anna; Stolarczyk, Artur; Deszczyński, Jarosław Michał; Materek, Magdalena; Pietras, Marta; Bażant, Katarzyna

2014-08-08

Whiplash injuries, also known as neck sprains and strains, are currently some of the most common injuries of the cervical spine. Mechanism of injury is still controversial and current treatment methods do not provide satisfactory results. In this article we present QTF classification of related disorders, epidemiological data and treatment methods. We described basic principles of using a soft collar, goals and effects of collar use and potential complications ensuing from immobilization. Authors reviewed publications comparing the effects of collar use with other methods of treatment and physiotherapy following whiplash injury.

Dry needling and exercise for chronic whiplash - a randomised controlled trial

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Souvlis Tina

2009-12-01

Full Text Available Abstract Background Chronic whiplash is a common and costly problem. Sensory hypersensitivity is a feature of chronic whiplash that is associated with poor responsiveness to physical treatments such as exercise. Modalities such as dry-needling have shown some capacity to modulate sensory hypersensitivity, suggesting that when combined with advice and exercise, such an approach may be more effective in the management of chronic whiplash. The primary aim of this project is to investigate the effectiveness of dry-needling, advice and exercise for chronic whiplash. Method/Design A double-blind randomised controlled trial will be conducted. 120 participants with chronic whiplash, grade II will be randomised to receive either 1 dry-needling, advice and exercise or 2 sham dry-needling, advice and exercise. All participants will receive an educational booklet on whiplash. Participants who are randomised to Group 1 will receive 6 treatments of combined dry-needling and exercise delivered in the first 3 weeks of the 6 week program, and 4 treatments of exercise only in the last 3 weeks of the program. Participants randomised to Group 2 will receive an identical protocol, except that a sham dry-needling technique will be used instead of dry-needling. The primary outcome measures are the Neck Disability Index (NDI and participants' perceived recovery. Outcomes will be measured at 6, 12, 24 and 52 weeks after randomization by an assessor who is blind to the group allocation of the participants. In parallel, an economic analysis will be conducted. Discussion This trial will utilise high quality trial methodologies in accordance with CONSORT guidelines. The successful completion of this trial will provide evidence of the effectiveness and cost-effectiveness of a combined treatment approach for the management of chronic whiplash. Trial registration ACTRN12609000470291

Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies.

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Scholten-Peeters, Gwendolijne G M; Verhagen, Arianne P; Bekkering, Geertruida E; van der Windt, Daniëlle A W M; Barnsley, Les; Oostendorp, Rob A B; Hendriks, Erik J M

2003-07-01

We present a systematic review of prospective cohort studies. Our aim was to assess prognostic factors associated with functional recovery of patients with whiplash injuries. The failure of some patients to recover following whiplash injury has been linked to a number of prognostic factors. However, there is some inconsistency in the literature and there have been no systematic attempts to analyze the level of evidence for prognostic factors in whiplash recovery. Studies were selected for inclusion following a comprehensive search of MEDLINE, EMBASE, CINAHL, the database of the Dutch Institute of Allied Health Professions up until April 2002 and hand searches of the reference lists of retrieved articles. Studies were selected if the objective was to assess prognostic factors associated with recovery; the design was a prospective cohort study; the study population included at least an identifiable subgroup of patients suffering from a whiplash injury; and the paper was a full report published in English, German, French or Dutch. The methodological quality was independently assessed by two reviewers. A study was considered to be of 'high quality' if it satisfied at least 50% of the maximum available quality score. Two independent reviewers extracted data and the association between prognostic factors and functional recovery was calculated in terms of risk estimates. Fifty papers reporting on twenty-nine cohorts were included in the review. Twelve cohorts were considered to be of 'high quality'. Because of the heterogeneity of patient selection, type of prognostic factors and outcome measures, no statistical pooling was able to be performed. Strong evidence was found for high initial pain intensity being an adverse prognostic factor. There was strong evidence that for older age, female gender, high acute psychological response, angular deformity of the neck, rear-end collision, and compensation not being associated with an adverse prognosis. Several physical (e

Health resource utilisation costs in acute patients with persistent midline cervical tenderness following road trauma.

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Ackland, Helen M; Wolfe, Rory; Cameron, Peter A; Cooper, D James; Malham, Gregory M; Varma, Dinesh K; Fitt, Gregory J; Rosenfeld, Jeffrey V; Liew, Susan M

2012-11-01

The costs associated with patients discharged with isolated clinician-elicited persistent midline tenderness and negative computed tomography (CT) findings have not been reported. Our aim was to determine the association of acute and post-acute patient and injury characteristics with health resource costs in such patients following road trauma. In a prospective cohort study, road trauma patients presenting with isolated persistent midline cervical tenderness and negative CT, who underwent additional acute imaging with MRI, were recruited. Patients were reviewed in the outpatient spine clinic following discharge, and were followed up at 6 and 12 months post-trauma. Multivariate linear regression was used to assess the association of injury mechanism, clinical assessment, socioeconomic factors and outcome findings with health resource costs generated in the acute hospital and post-acute periods. There were 64 patients recruited, of whom 24 (38%) had cervical spine injury detected on MRI. Of these, 2 patients were managed operatively, 6 were treated in cervical collars and 16 had the cervical spine cleared and were discharged. At 12 months, there were 25 patients (44%) with residual neck pain, and 22 (39%) with neck-related disability. The mean total cost was AUD $10,153 (SD=10,791) and the median was $4015 (IQR: 3044-6709). Transient neurologic deficit, which fully resolved early in the emergency department, was independently associated with higher marginal mean acute costs (represented in the analysis by the β coefficient) by $3521 (95% CI: 50-6880). Low education standard (β coefficient: $5988, 95% CI: 822-13,317), neck pain at 6 months (β coefficient: $4017, 95% CI: 426-9254) and history of transient neurologic deficit (β coefficient: $8471, 95% CI: 1766-18,334) were associated with increased post-acute costs. In a homogeneous group of road trauma patients with non fracture-related persistent midline cervical tenderness, health resource costs varied

SCINTIGRAPHY IN URGENT CONDITIONS AND COMPLICATIONS OF ACUTE DISEASES AND TRAUMAS

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N. Ye. Kudryashova

2014-01-01

Full Text Available ABSTRACT. The data generalized in the review characterize radionuclide method as a high informative technique in diagnosis of the row of acute diseases and traumas and complications of them. It was shown that each radionuclide technique decides the concrete clinical tests and has a strictly definite place in the diagnostic algorithm. Urgent radionuclide techniques give the important information for the choice of the treatment’s policy or operation’s volume in such acute diseases as tromboembolism, arterial occlusions, small bowel obstruction, acute cholecystitis and cholelithiasis, acute myocardial infarct, rhabdomyolysis, differentiation of acute urological and acute abdominal surgical diseases and so on. The main aim of the work of our radionuclide department is to perfect, modificate of urgent radionuclide techniques and to correct the place of them in urgent conditions’s diagnostic algorithm for increasing of the quality and the rapidity in diagnosis. 

On associations between different factors and whiplash injury

OpenAIRE

Berglund, Anita

2002-01-01

The overall aim of this thesis was to evaluate associations between different factors and whiplash injury (defined as a soft tissue injury to the neck without fracture or dislocation), focusing on risk of initial and future complaints. The objectives in Paper 1 and II was to determine whether exposure to a rear-end collision, with or without whiplash injury, is associated with future neck or shoulder pain (Paper 1) and other health complaints, besides neck pain (Paper II). T...

Disc pathology after whiplash injury. A prospective magnetic resonance imaging and clinical investigation

International Nuclear Information System (INIS)

Pettersson, K.; Hildingsson, C.; Toolanen, G.; Fagerlund, M.; Bjornebrink, J.

1997-01-01

Although disc pathology seems to be one contributing factor in the development of chronic symptoms after whiplash injury, it may be unnecessary to examine these patients in the acute phase with magnetic resonance imaging ; correlating initial symptoms and signs to magnetic resonance imaging findings is difficult because of the relatively high proportion of false-positive results. Magnetic resonance imaging is indicated later in the course of treatment in patients with persistent arm pain, neurologic deficits, or clinical signs of nerve root compression to diagnose disc herniations requiring surgery. (authors)

Population-based estimates of whiplash injury using nass cds data - biomed 2009.

Science.gov (United States)

Storvik, Steven G; Stemper, Brian D; Yoganandan, Narayan; Pintar, Frank A

2009-01-01

Clinical investigations identified occupant-related factors that may predispose specific populations to increased whiplash injury susceptibility. However, clinical studies represent a specific patient population and are not representative of the population at large. The present objective was to analyze nationally-representative data to assess the association between gender and whiplash in motor vehicle rear-end impacts. A cohort of front-seat occupants in rear impacts (5-7 o'clock) from 1998-2007 were acquired using the National Automotive Sampling System (NASS) Crashworthiness Data System database. Outcome measure was "cervical spine strain" without fracture or dislocation, coded as 640278.1. Differences between injured population proportions were analyzed using Chi-Square test of independence. 1,973 rear impacts were selected, representing 936,439 weighted crashes from across the United States. Females accounted for 69% of the weighted whiplash injuries, and the proportion of females sustaining whiplash was 10% higher than males. Furthermore, gender was associated with acquiring whiplash in rear impacts (odds ratio for females: 2.16; 95% confidence interval: 1.5-3.1). Although NASS data is inherently weighted toward more severe impacts (i.e., tow-away collisions), this population-based study has demonstrated increased female susceptibility to whiplash injury. The importance of gender suggests that specific safety measures for female front-seat occupants should be addressed separately from males.

An examination of coping styles and expectations for whiplash injury in Germany: comparison with Canadian data.

Science.gov (United States)

Ferrari, Robert; Pieschl, Stephanie

2011-09-01

Cross-sectional cohort study: to examine concurrent expectations and coping style for whiplash injury in injury-naive subjects in Germany. Studies suggest the recovery rate from whiplash injury may be faster in Germany than in Canada. Canadians have a high expectation for chronic pain following whiplash injury and Germans do not. Expectation of recovery not only predicts recovery in whiplash victims but is also known to correlate with coping style. The Vanderbilt Pain Management Inventory was administered to university students and staff in Germany. Subjects who had not yet experienced whiplash injury were given a vignette concerning a neck sprain (whiplash injury) in a motor vehicle collision and were asked to indicate how likely they were to have thoughts or behaviours indicated in the coping style questionnaire. Subjects also completed expectation questionnaires regarding whiplash injury. Sixteen percent of subjects held an expectation of chronic neck or back pain after whiplash injury. The mean active coping style score was 27.4±3.6 (40 is the maximum score for active coping). The mean passive coping style score was 27.0±6.3 (50 is the maximum score for passive coping). Coping style scores and patterns were not different from those previously observed in Canadian studies, but there was no correlation between expectations and coping style among German subjects, a finding that differs from Canadian studies. Although expectations and coping styles may interact or be co-modifiers in the outcomes of whiplash injury in Canadian whiplash victims, in Germany, despite having similar coping styles to Canadians, the lack of expectation for chronic pain may be protective from the effect of passive coping styles. Further studies of coping style as an aetiologic factor in the chronic whiplash syndrome are needed.

Acute longitudinal ligament rupture following acute spinal trauma

Directory of Open Access Journals (Sweden)

Donald Hansom

2014-06-01

Full Text Available The authors present a rare case of anterior longitudinal ligament (ALL rupture in a 47- year-old gentleman following a bicycle accident. The ALL is a continuous band of a variable thickness that acts as a primary spinal stabiliser. Stress, strain or rupture of the ALL usually occurs as a result of hyperextension, with the primary perpetrator being whiplash injuries. Such injuries have been shown to result in cervical spine instability during extension, axial rotation, and lateral bending modes. Spine radiographs of such patients may be routinely assessed as normal, therefore this specific type of injury does not lend itself to identification by traditional imaging methods. This account demonstrates the importance of having a high index of suspicion of a ligamentous neck injury in the setting of normal plain radiographs but abnormal clinical examination.

Laypersons' expectations of recovery and beliefs about whiplash injury: a cross-cultural comparison between Australians and Singaporeans.

Science.gov (United States)

Ng, T S; Bostick, G; Pedler, A; Buchbinder, R; Vicenzino, B; Sterling, M

2013-09-01

Beliefs and expectations are thought to influence outcome following whiplash injury. Studies have proposed a link between rates of chronic whiplash and laypersons' expectations about outcome following a motor vehicle accident. The prevalence of chronic whiplash is relatively high in Australia and apparently low in Singapore. This study's objectives were to compare laypersons' beliefs and expectations of recovery of whiplash injury in Brisbane and Singapore and to assess the effect of demographic factors on whiplash beliefs. A cross-sectional study using online surveys was conducted on adult Internet users in Brisbane (Australia) and Singapore. The 14-item whiplash beliefs questionnaire (WBQ) was used to evaluate whiplash beliefs. Two additional items assessed expectations of recovery. Individual items of WBQ, WBQ score and expectations of recovery were analysed. Stratified analysis was performed to adjust for sampling bias due to quota sampling. A total of 402 participants from Singapore and 411 participants from Brisbane, Australia, completed the survey. While participants from Singapore demonstrated slightly more negative whiplash beliefs than participants from Brisbane [t(811)  = -5.72; p expectations of quick recovery and return to normal activities following whiplash injury. Only gender had a significant effect on whiplash beliefs [estimated marginal means of WBQ score for men = 21.5; standard error (SE) = 0.20; women = 22.5; SE = 0.20; F(1,810)  = 11.2; p = 0.001]. Laypersons' expectations of recovery and beliefs about whiplash injury in Brisbane and Singapore were generally similar and mostly positive. Our results demonstrate that cultural differences reflected by laypersons' beliefs may not reflect the differences in prevalence of chronic whiplash between countries. © 2012 European Federation of International Association for the Study of Pain Chapters.

An unusual presentation of whiplash injury: long thoracic and spinal accessory nerve injury

Science.gov (United States)

Omar, N.; Srinivasan, M. S.

2007-01-01

Whiplash injuries from motor vehicle accidents are very common. The usual presentation and course of this condition normally results in resolution of symptoms within a few weeks. Brachial plexus traction injuries without any bone or joint lesion of the cervical spine have been reported before. We report a case where a gentleman was involved in a rear end vehicle collision, sustained a whiplash injury and was later found to have a long thoracic nerve palsy and spinal accessory nerve palsy. Although isolated injuries of both nerves following a whiplash injury have been reported, combined injury of the two nerves following a whiplash injury is very uncommon and is being reported for the first time. PMID:17587067

Whiplash evokes descending muscle recruitment and sympathetic responses characteristic of startle

Science.gov (United States)

Mang, Daniel WH; Siegmund, Gunter P; Blouin, Jean-Sébastien

2014-01-01

Whiplash injuries are the most common injuries following rear-end collisions. During a rear-end collision, the human muscle response consists of both a postural and a startle response that may exacerbate injury. However, most previous studies only assessed the presence of startle using data collected from the neck muscles and head/neck kinematics. The startle response also evokes a descending pattern of muscle recruitment and changes in autonomic activity. Here we examined the recruitment of axial and appendicular muscles along with autonomic responses to confirm whether these other features of a startle response were present during the first exposure to a whiplash perturbation. Ten subjects experienced a single whiplash perturbation while recording electromyography, electrocardiogram, and electrodermal responses. All subjects exhibited a descending pattern of muscle recruitment, and increasing heart rate and electrodermal responses following the collision. Our results provide further support that the startle response is a component of the response to whiplash collisions. PMID:24932015

Mechanisms underlying chronic whiplash: contributions from an incomplete spinal cord injury?

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Elliott, James M; Dewald, Julius P A; Hornby, T George; Walton, David M; Parrish, Todd B

2014-11-01

To explore the association between findings on advanced, but available, magnetic resonance imaging (MRI) sequences of the cervical spinal cord and muscular system, in tandem with biomechanical measures of maximum volitional plantar flexion torques as a proxy for a mild incomplete spinal cord injury. Observational case series. University research laboratory. Three patients with chronic whiplash and one patient with history of whiplash injury but no current symptoms. We measured lower extremity muscle fat, morphological changes in descending spinal cord pathways with advanced MRI applications and maximal activation of the plantar flexors. Larger magnitudes of lower extremity muscle fat corresponded to altered spinal cord anatomy and reductions in the ability to maximally activate plantar flexor torques in the three subjects with chronic whiplash. Such findings were not present in the recovered participant. The potential value of MRI to quantify neuromuscular degeneration in chronic whiplash is recognized. Larger scaled prospective studies are warranted before stronger conclusions can be drawn. Wiley Periodicals, Inc.

Multishot diffusion-weighted MR imaging features in acute trauma of spinal cord

International Nuclear Information System (INIS)

Zhang, Jin Song; Huan, Yi

2014-01-01

To analyse diffusion-weighted MRI of acute spinal cord trauma and evaluate its diagnostic value. Conventional MRI and multishot, navigator-corrected DWI were performed in 20 patients with acute spinal cord trauma using 1.5-T MR within 72 h after the onset of trauma. Twenty cases were classified into four categories according to the characteristics of DWI: (1) Oedema type: ten cases presented with variable hyperintense areas within the spinal cord. There were significant differences in the apparent diffusion coefficients (ADCs) between lesions and unaffected regions (t = -7.621, P < 0.01). ADC values of lesions were markedly lower than those of normal areas. (2) Mixed type: six cases showed heterogeneously hyperintense areas due to a mixture of haemorrhage and oedema. (3) Haemorrhage type: two cases showed lesions as marked hypointensity due to intramedullary haemorrhage. (4) Compressed type (by epidural haemorrhage): one of the two cases showed an area of mild hyperintensity in the markedly compressed cord due to epidural haematoma. Muti-shot DWI of the spinal cord can help visualise and evaluate the injured spinal cord in the early stage, especially in distinguishing the cytotoxic oedema from vasogenic oedema. It can assist in detecting intramedullary haemorrhage and may have a potential role in the evaluation of compressed spinal cord. (orig.)

MR diagnosis and clinical management of whiplash injury syndrome of spinal cord

International Nuclear Information System (INIS)

Lin Shixu; Lin Daiying; Wu Xianheng; Zeng Xianting

2003-01-01

Objective: To study the MR manifestations of whiplash injury syndrome of spinal cord. Methods: MR images of 21 cases diagnosed as whiplash injury syndrome were retrospectively studied. Those images included transverse and sagittal views and coronal scan had been performed in some cases. Results: MRI inspection safely and objectively reveals the extent of the spinal injury, and helps the anticipation of the prognosis. Conclusion: MRI is the first choice of the imaging modalities assessing the whiplash injury syndrome of the spinal cord. An early diagnosis is valuable to clinical management and rehabilitation

Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome?

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Eide Geir E

2010-11-01

Full Text Available Abstract Background Upper neck ligament high-signal changes on magnetic resonance imaging (MRI have been found in patients with whiplash-associated disorders (WAD but also in non-injured controls. The clinical relevance of such changes is controversial. Their prognostic role has never been evaluated. The purpose of this study was to examine if alar and transverse ligament high-signal changes on MRI immediately following the car accident are related to outcome after 12 months for patients with acute WAD grades 1-2. Methods Within 13 days after a car accident, 114 consecutive acute WAD1-2 patients without prior neck injury or prior neck problems underwent upper neck high-resolution proton-weighted MRI. High-signal changes of the alar and transverse ligaments were graded 0-3. A questionnaire including the impact of event scale for measuring posttraumatic stress response and questions on patients' expectations of recovery provided clinical data at injury. At 12 months follow-up, 111 (97.4% patients completed the Neck Disability Index (NDI and an 11-point numeric rating scale (NRS-11 on last week neck pain intensity. Factors potentially related to these outcomes were assessed using multiple logistic regression analyses. Results Among the 111 responders (median age 29.8 years; 63 women, 38 (34.2% had grades 2-3 alar ligament changes and 25 (22.5% had grades 2-3 transverse ligament changes at injury. At 12 months follow-up, 49 (44.1% reported disability (NDI > 8 and 23 (20.7% neck pain (NRS-11 > 4. Grades 2-3 ligament changes in the acute phase were not related to disability or neck pain at 12 months. More severe posttraumatic stress response increased the odds for disability (odds ratio 1.46 per 10 points on the impact of event scale, p = 0.007 and so did low expectations of recovery (odds ratio 4.66, p = 0.005. Conclusions High-signal changes of the alar and transverse ligaments close after injury did not affect outcome for acute WAD1-2 patients

A Systematic Review of the Usefulness of Glial Fibrillary Acidic Protein for Predicting Acute Intracranial Lesions following Head Trauma

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Teemu M. Luoto

2017-12-01

Full Text Available BackgroundThe extensive use of computed tomography (CT after acute head injury is costly and carries potential iatrogenic risk. This systematic review examined the usefulness of blood-based glial fibrillary acidic protein (GFAP for predicting acute trauma-related CT-positive intracranial lesions following head trauma. The main objective was to summarize the current evidence on blood-based GFAP as a potential screening test for acute CT-positive intracranial lesions following head trauma.MethodsWe screened MEDLINE, EMBASE, PsychInfo, CINAHL, Web of Science, the Cochrane Database, Scopus, Clinical Trials, OpenGrey, ResearchGate, and the reference lists of eligible publications for original contributions published between January 1980 and January 2017. Eligibility criteria included: (i population: human head and brain injuries of all severities and ages; (ii intervention: blood-based GFAP measurement ≤24 h post-injury; and (iii outcome: acute traumatic lesion on non-contrast head CT ≤24 h post-injury. Three authors completed the publication screening, data extraction, and quality assessment of eligible articles.ResultsThe initial search identified 4,706 articles, with 51 eligible for subsequent full-text assessment. Twenty-seven articles were ultimately included. Twenty-four (89% studies reported a positive association between GFAP level and acute trauma-related intracranial lesions on head CT. The area under the receiver operating characteristic curve for GFAP prediction of intracranial pathology ranged from 0.74 to 0.98 indicating good to excellent discrimination. GFAP seemed to discriminate mass lesions and diffuse injury, with mass lesions having significantly higher GFAP levels. There was considerable variability between the measured GFAP averages between studies and assays. No well-designed diagnostic studies with specific GFAP cutoff values predictive of acute traumatic intracranial lesions have been published

MRI of the tectorial and posterior atlanto-occipital membranes in the late stage of whiplash injury

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Krakenes, J.; Moen, G.; Nordli, H.; Rorvik, J. [Department of Radiology, University of Bergen and Haukeland University Hospital, 5021, Bergen (Norway); Kaale, B.R. [Firda Medical Centre, 6823, Sandane (Norway); Gilhus, N.E. [Department of Neurology, University of Bergen and Haukeland University Hospital, 5021, Bergen (Norway)

2003-09-01

Our aim was to characterise and classify permanent structural changes in the tectorial and posterior atlanto-occipital membranes several years after a whiplash injury, and to evaluate the reliability of our classification. We obtained sagittal proton density-weighted images of the craniovertebral junction of 92 whiplash-injured and 30 uninjured individuals. Structural abnormalities in the two membranes were classified as grades 1-3 independently by three radiologists blinded for clinical information. Grading criteria were based on reduced tectorial membrane thickness, and elongation or rupture of the posterior atlanto-occipital membrane/dura mater complex. The same images were reassessed 4 months later. Image quality was graded good in 104 cases, slightly reduced in 13 and unsatisfactory in five. Of 117 tectorial membranes 31 (26.5%) showed grade 2 or 3 lesions, in the uninjured group none were grade 3 and only three were grade 2. Pair-wise interobserver agreement (weighted kappa) was moderate (0.47-0.50), while the intraobserver agreement was moderate to good (0.51-0.70). Of 117 posterior atlanto-occipital membranes 20 (17.1%) had grade 2 or 3 lesions; there was no grade 3 and only one grade 2 lesion in the uninjured group. Inter- and intraobserver agreement was good (0.61-0.74 and 0.65-0.86, respectively). Reduced image quality was the main reason for disagreement, but partial thinning and lateral tapering, as normal tectorial membrane variations, created difficulties in some cases. This study strongly indicates that whiplash trauma can damage the tectorial and posterior atlanto-occipital membranes; this can be shown on high-resolution MRI. Better knowledge of normal anatomical variations and improved image quality should increase the reliability of lesion classification. (orig.)

MRI of the tectorial and posterior atlanto-occipital membranes in the late stage of whiplash injury

International Nuclear Information System (INIS)

Krakenes, J.; Moen, G.; Nordli, H.; Rorvik, J.; Kaale, B.R.; Gilhus, N.E.

2003-01-01

Our aim was to characterise and classify permanent structural changes in the tectorial and posterior atlanto-occipital membranes several years after a whiplash injury, and to evaluate the reliability of our classification. We obtained sagittal proton density-weighted images of the craniovertebral junction of 92 whiplash-injured and 30 uninjured individuals. Structural abnormalities in the two membranes were classified as grades 1-3 independently by three radiologists blinded for clinical information. Grading criteria were based on reduced tectorial membrane thickness, and elongation or rupture of the posterior atlanto-occipital membrane/dura mater complex. The same images were reassessed 4 months later. Image quality was graded good in 104 cases, slightly reduced in 13 and unsatisfactory in five. Of 117 tectorial membranes 31 (26.5%) showed grade 2 or 3 lesions, in the uninjured group none were grade 3 and only three were grade 2. Pair-wise interobserver agreement (weighted kappa) was moderate (0.47-0.50), while the intraobserver agreement was moderate to good (0.51-0.70). Of 117 posterior atlanto-occipital membranes 20 (17.1%) had grade 2 or 3 lesions; there was no grade 3 and only one grade 2 lesion in the uninjured group. Inter- and intraobserver agreement was good (0.61-0.74 and 0.65-0.86, respectively). Reduced image quality was the main reason for disagreement, but partial thinning and lateral tapering, as normal tectorial membrane variations, created difficulties in some cases. This study strongly indicates that whiplash trauma can damage the tectorial and posterior atlanto-occipital membranes; this can be shown on high-resolution MRI. Better knowledge of normal anatomical variations and improved image quality should increase the reliability of lesion classification. (orig.)

The profile of CT scan findings in acute head trauma in Orotta ...

African Journals Online (AJOL)

The use of investigation modalities are influenced by socioeconomic and cost effectiveness of the tests. Objective and methods: The purpose of the present five months observational study was to describe the profile of cranial computed tomography (CT) scan findings of 110 cases of acute head trauma in Orotta Hospital.

The Effects of Acute Stress-Induced Sleep Disturbance on Acoustic Trauma-Induced Tinnitus in Rats

Directory of Open Access Journals (Sweden)

Yiwen Zheng

2014-01-01

Full Text Available Chronic tinnitus is a debilitating condition and often accompanied by anxiety, depression, and sleep disturbance. It has been suggested that sleep disturbance, such as insomnia, may be a risk factor/predictor for tinnitus-related distress and the two conditions may share common neurobiological mechanisms. This study investigated whether acute stress-induced sleep disturbance could increase the susceptibility to acoustic trauma-induced tinnitus in rats. The animals were exposed to unilateral acoustic trauma 24 h before sleep disturbance being induced using the cage exchange method. Tinnitus perception was assessed behaviourally using a conditioned lick suppression paradigm 3 weeks after the acoustic trauma. Changes in the orexin system in the hypothalamus, which plays an important role in maintaining long-lasting arousal, were also examined using immunohistochemistry. Cage exchange resulted in a significant reduction in the number of sleep episodes and acoustic trauma-induced tinnitus with acoustic features similar to a 32 kHz tone at 100 dB. However, sleep disturbance did not exacerbate the perception of tinnitus in rats. Neither tinnitus alone nor tinnitus plus sleep disturbance altered the number of orexin-expressing neurons. The results suggest that acute sleep disturbance does not cause long-term changes in the number of orexin neurons and does not change the perception of tinnitus induced by acoustic trauma in rats.

Behandling af gener efter whiplash

DEFF Research Database (Denmark)

Rittig-Rasmussen, Bjarne; Kongsted, Alice; Carstensen, Tina

2010-01-01

Treatment of whiplash-associated disorders starts with a thorough clinical examination, which may be repeated after 1-3 weeks. For optimal results it is essential that the patient receives clear information about the condition and that any pain is treated effectively with analgesics. Risk factors...

Functional survival after acute care for severe head injury at a designated trauma center in Hong Kong.

Science.gov (United States)

Taw, Benedict B T; Lam, Alan C S; Ho, Faith L Y; Hung, K N; Lui, W M; Leung, Gilberto K K

2012-07-01

Severe head injury is known to be a major cause of early mortalities and morbidities. Patients' long-term outcome after acute care, however, has not been widely studied. We aim to review the outcome of severely head-injured patients after discharge from acute care at a designated trauma center in Hong Kong. This is a retrospective study of prospectively collected data of patients admitted with severe head injuries between 2004 and 2008. Patients' functional status post-discharge was assessed using the Extended Glasgow Outcome Score (GOSE). Of a total of 1565 trauma patients, 116 had severe head injuries and 41 of them survived acute hospital care. Upon the last follow-up, 23 (56.1%) of the acute-care survivors had improvements in their GOSE, six (11.8%) experienced deteriorations, and 12 (23.5%) did not exhibit any change. The greatest improvement was observed in patients with GOSE of 5 and 6 upon discharge, but two of the 16 patients with GOSE 2 or 3 also had a good recovery. On logistic regression analysis, old age and prolonged acute hospital stay were found to be independent predictors of poor functional outcome after a mean follow-up duration of 42 months. Multidisciplinary neurorehabilitation service is an important component of comprehensive trauma care. Despite significant early mortalities, a proportion of severely head-injured patients who survive acute care may achieve good long-term functional recovery. Copyright © 2012, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.

Predicting recovery from whiplash injury in the primary care setting.

Science.gov (United States)

Ferrari, Robert

2014-08-01

The effect of expectation of recovery on the recovery rate of whiplash patients in the primary care setting is not known. Whiplash patients were assessed in a primary care setting within 1 week of their collision for their expectations of recovery and were re-examined 3 months later for recovery. Initial expectations of recovery predicted recovery. According to adjusted odds ratios, subjects who expected 'to get better slowly' had a recovery rate that was nearly 1.9 times that of subjects with poor recovery expectations. Subjects who expected 'to get better soon' had a recovery rate that was 2.6 times greater than either of those with poor recovery expectations. In the primary care setting, asking patients with whiplash about their expectations of recovery is a useful predictor of their outcome.

PTSD Symptoms Mediate the Effect of Attachment on Pain and Somatisation after Whiplash Injury

OpenAIRE

Andersen, Tonny Elmose; Elklit, Ask; Brink, Ole

2013-01-01

Introduction: The development of persistent pain post-whiplash injury is still an unresolved mystery despite the fact that approximately 50% of individuals reporting whiplash develop persistent pain. There is agreement that high initial pain and PTSD symptoms are indicators of a poor prognosis after whiplash injury. Recently attachment insecurity has been proposed as a vulnerability factor for both pain and PTSD. In order to guide treatment it is important to examine possible mechanisms which...

The evaluation of fat saturation fast spin-echo T2WI for patients with acute spinal trauma

International Nuclear Information System (INIS)

Kim, Sung Gyu; Lee, Chang Jun; Lee, Myung Joon; Kang, Ik Won; Yoo, Jeong Hyun

2002-01-01

To determine the usefulness of fat saturation fast spin-echo T2WI for patients with mild acute trauma of the spine. Between July 1998 and June 2002, 36 patients with acute spinal trauma underwent MRI within four months of injury. One, whose clinal symptoms indicated neurological paralysis, was excluded form our study. A superconductive 1.0-T MRI scanner was used, and conventional T1W1, T2W1, and additional fat-saturation fast spin-echo T2W1 were performed. Two radiologists compared conventional T2-weighted sagittal imaging and fat-saturation T2-weighted sagittal imaging in terms of the extension of increased high signal intensities in soft tissue and vertebral bodies, bone marrow signal change, disk herniation, and signal change of the disk. The detection rate of focal high signal intensities in soft tissue and bone marrow was significantly higher at fat-saturation fast spin-echo T2W1 is useful the evaluation of patients with mild acute spinal trauma without neurological impairment

Disability in subacute whiplash patients: usefulness of the neck disability index.

Science.gov (United States)

Nieto, Rubén; Miró, Jordi; Huguet, Anna

2008-08-15

Cross-sectional study. To analyze the psychometric properties of the neck disability index (NDI), with a special emphasis in its factor structure, and its usefulness, in a sample of patients suffering from a subacute whiplash problem. A valid and reliable instrument to assess pain-related disability would be of great help to clinicians and researchers interested in whiplash associated disorders. First, to better understand the impact of whiplash on the patient's life, and his or her progress over time. Second, to formulate comprehensive treatment plans, and evaluate the results from therapeutic actions. Finally, to follow-up patients' changes and improvement. The NDI could be an appropriate instrument for these purposes. A convenience sample of 150 subacute whiplash patients participated. They were requested to complete the Catalan version of the NDI, and report about their pain intensity, pain interference and depression. RESULTS.: An exploratory factor analysis showed that the NDI can be viewed as a 2-factor instrument. The items and the instrument's total score were normally distributed. Internal consistency was also appropriate both for the total score (Cronbach's alpha: 0.87) and the 2 subscales (0.7 for the pain and interference with cognitive functioning scale, and 0.83 for the physical functioning scale). Total NDI and subscales scores significantly correlated with pain intensity, pain interference, and depression. The NDI showed excellent psychometric properties in a sample of subacute whiplash patients. Additional research is needed to replicate the NDIs factor structure.

Association between body mass index and recovery from whiplash injuries: a cohort study.

Science.gov (United States)

Yang, Xiaoqing; Côté, Pierre; Cassidy, J David; Carroll, Linda

2007-05-01

It is hypothesized that excess weight is a risk factor for delayed recovery from neck pain, such as from whiplash injuries. However, the association between obesity and recovery from whiplash injury has not been studied. The authors examined the association between body mass index and time to recovery from whiplash injuries in a population-based cohort study of traffic injuries in Saskatchewan, Canada. The cohort included 4,395 individuals who made an insurance claim to Saskatchewan Government Insurance and were treated for whiplash injury between July 1, 1994, and December 31, 1995. Of those, 87.7% had recovered by November 1, 1997. No association was found between baseline body mass index and time to recovery. Compared with individuals with normal weight, those who were underweight (hazard rate ratio = 0.88, 95% confidence interval: 0.73, 1.06), overweight (hazard rate ratio = 1.01, 95% confidence interval: 0.94, 1.09), and obese (hazard rate ratio = 0.99, 95% confidence interval: 0.90, 1.08) had similar rates of recovery, even after adjustment for other factors. The results do not support the hypothesis that individuals who are overweight or obese have a worse prognosis for whiplash.

Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care?

Directory of Open Access Journals (Sweden)

al-Ayoubi Fawzi

2012-09-01

Full Text Available Abstract Background Subspecialisation within general surgery has today reached further than ever. However, on-call time, an unchanged need for broad surgical skills are required to meet the demands of acute surgical disease and trauma. The introduction of a new subspecialty in North America that deals solely with acute care surgery and trauma is an attempt to offer properly trained surgeons also during on-call time. To find out whether such a subspecialty could be helpful in Sweden we analyzed our workload for emergency surgery and trauma. Methods Linköping University Hospital serves a population of 257 000. Data from 2010 for all patients, diagnoses, times and types of operations, surgeons involved, duration of stay, types of injury and deaths regarding emergency procedures were extracted from a prospectively-collected database and analyzed. Results There were 2362 admissions, 1559 emergency interventions; 835 were mainly abdominal operations, and 724 diagnostic or therapeutic endoscopies. Of the 1559 emergency interventions, 641 (41.1% were made outside office hours, and of 453 minor or intermediate procedures (including appendicectomy, cholecystectomy, or proctological procedures 276 (60.9% were done during the evenings or at night. Two hundred and fifty-four patients were admitted with trauma and 29 (11.4% required operation, of whom general surgeons operated on eight (3.1%. Thirteen consultants and 11 senior registrars were involved in 138 bowel resections and 164 cholecystectomies chosen as index operations for standard emergency surgery. The median (range number of such operations done by each consultant was 6 (3–17 and 6 (1–22. Corresponding figures for senior registrars were 7 (0–11 and 8 (1–39. Conclusion There was an uneven distribution of exposure to acute surgical problems and trauma among general surgeons. Some were exposed to only a few standard emergency interventions and most surgeons did not operate on a single patient

Cognitive activity limitations one year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury

DEFF Research Database (Denmark)

Sommer, Jens Bak; Norup, Anne; Poulsen, Ingrid

2013-01-01

Objective: To examine cognitive activity limitations and predictors of outcome 1 year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury. Subjects: The study included 119 patients with severe traumatic brain injury admitted to centralized sub-acute re......Objective: To examine cognitive activity limitations and predictors of outcome 1 year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury. Subjects: The study included 119 patients with severe traumatic brain injury admitted to centralized sub......-acute rehabilitation in the Eastern part of Denmark during a 5-year period from 2005 to 2009. Methods: Level of consciousness was assessed consecutively during rehabilitation and at 1 year post-trauma. Severity of traumatic brain injury was classified according to duration of post-traumatic amnesia. The cognitive...... subscale of Functional Independence MeasureTM (Cog-FIM) was used to assess cognitive activity limitations. Multivariate logistic regression analyses were performed to identify predictors of an independent level of functioning. Results: The majority of patients progressed to a post-confusional level...

The impact of subacute whiplash-associated disorders on functional self-efficacy: a cohort study.

Science.gov (United States)

Bunketorp-Käll, Lina Sofia; Andersson, Caroline; Asker, Barbita

2007-09-01

Self-efficacy is increasingly being recognized as an important factor to consider in medical research, especially in different pain conditions such as whiplash-associated disorders (WAD). When pain is not effectively treated or relieved, it may negatively affect patients' life situation and cause a decline in perceived self-efficacy. Knowledge of what level of self-efficacy can be considered an actual deficit in patients with WAD is, however, sparse. The purpose of this study is to analyze whether subacute WAD has an impact on self-efficacy beliefs. A cohort study was designed to identify the impact of WAD on self-efficacy beliefs. The exposed group consisted of 47 patients with subacute WAD following a whiplash trauma. The control group representing the general population consisted of 212 participants, and was randomly selected to match the distribution of age and sex in the exposed group. The Self-Efficacy Scale was used to assess the individuals' confidence in their ability to successfully carry out activities of daily living. In the exposed group, 47 responded (100%), and in the control group, 113 (53%) responded. The results show that the total scores on the Self-Efficacy Scale were significantly lower in the exposed group compared with the control group, concerning both the mean (P<0.001) and median (P<0.001) scores. In conclusion, patients with subacute WAD experience a decline in functional self-efficacy, which stresses the importance of incorporating these beliefs in clinical practice and research.

Thrombelastography and biomarker profiles in acute coagulopathy of trauma: a prospective study

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Larsen Claus F

2011-10-01

Full Text Available Abstract Background Severe injury induces an acute coagulopathy associated with increased mortality. This study compared the Thrombelastography (TEG and biomarker profiles upon admission in trauma patients. Methods Prospective observational study of 80 trauma patients admitted to a Level I Trauma Centre. Data on demography, biochemistry including standard coagulation tests, hematology, transfusions, Injury Severity Score (ISS and TEG were recorded. Retrospective analysis of thawed plasma/serum for biomarkers reflecting tissue injury (histone-complexed DNA fragments, sympathoadrenal activation (adrenaline, noradrenaline, coagulation activation/inhibition and fibrinolysis (sCD40L, protein C, activated Protein C, tissue-type plasminogen activator, plasminogen activator inhibitor-1, D-dimer, prothrombinfragment 1+2, plasmin/α2-antiplasmin complex, thrombin/antithrombin complex, tissue factor pathway inhibitor, antithrombin, von willebrand factor, factor XIII. Comparison of patients stratified according to ISS/TEG maximum clot strength. Linear regression analysis of variables associated with clot strength. Results Trauma patients had normal (86%, hypercoagulable (11% or hypocoagulable (1% TEG clot strength; one had primary hyperfibrinolysis. Hypercoagulable patients had higher age, fibrinogen and platelet count (all p 10 red blood cells the initial 24 h. Patients with normal or hypercoagulable TEG clot strength had comparable biomarker profiles, but the few patients with hypocoagulable TEG clot strength and/or hyperfibrinolysis had very different biomarker profiles. Increasing ISS was associated with higher levels of catecholamines, histone-complexed DNA fragments, sCD40L, activated protein C and D-dimer and reduced levels of non-activated protein C, antithrombin, fibrinogen and factor XIII (all p 26. In patients with ISS > 26, adrenaline and sCD40L were independently negatively associated with clot strength. Conclusions Trauma patients displayed

Cumulative Exposure to Prior Collective Trauma and Acute Stress Responses to the Boston Marathon Bombings

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Garfin, DR; Holman, EA; Silver, RC

2015-01-01

© The Author(s) 2015 The role of repeated exposure to collective trauma in explaining response to subsequent community-wide trauma is poorly understood. We examined the relationship between acute stress response to the 2013 Boston Marathon bombings and prior direct and indirect media-based exposure to three collective traumatic events: the September 11, 2001 (9/11) terrorist attacks, Superstorm Sandy, and the Sandy Hook Elementary School shooting. Representative samples of residents of metrop...

Factors related to non-recovery from whiplash. The Nord-Trøndelag Health Study (HUNT).

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Myrtveit, Solbjørg Makalani; Skogen, Jens Christoffer; Petrie, Keith J; Wilhelmsen, Ingvard; Wenzel, Hanne Gro; Sivertsen, Børge

2014-06-01

Whiplash injuries show a variable prognosis which is difficult to predict. Most individuals experiencing whiplash injuries rapidly recover but a significant proportion develop chronic symptoms and ongoing disability. By employing longitudinal data, we investigated how psychological and physical symptoms, self-rated health, use of health services and medications, health behavior and demographic factors predict recovery from whiplash. Data from two waves of a large, Norwegian, population-based study (The Nord-Trøndelag Health Study: HUNT2 and HUNT3) were used. Individuals reporting whiplash in HUNT2 (baseline) were identified in HUNT3 11 years later. The characteristics of individuals still suffering from whiplash in HUNT3 were compared with the characteristics of individuals who had recovered using Pearson's chi-squared test, independent sample t-tests and logistic regression. At follow-up, 31.6 % of those reporting whiplash at baseline had not recovered. These individuals (n = 199) reported worse health at baseline than recovered individuals (n = 431); they reported poorer self-rated health (odds ratio [OR] = 3.12; 95 % confidence interval [CI], 2.20-4.43), more symptoms of anxiety (OR = 1.70; 95 % CI, 1.15-2.50), more diffuse somatic symptoms (OR = 2.38; 95 % CI, 1.61-3.51) and more musculoskeletal symptoms (OR = 1.21; 95 % CI, 1.13-1.29). Individuals still suffering from whiplash also visited more health practitioners at baseline (OR = 1.18; 95 % CI, 1.06-1.32) and used more medications (OR = 1.24; 95 % CI, 1.09-1.40). Poor self-rated health seems to be a strong risk factor for whiplash injuries becoming chronic. Diffuse somatic symptoms, musculoskeletal symptoms and symptoms of anxiety at baseline are important prognostic risk factors. Knowledge of these maintaining risk factors enables identification of individuals at risk of non-recovery, facilitating adequate treatment for this vulnerable group.

Acute transfusion-related abdominal injury in trauma patients: a case report.

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Michel, P; Wähnert, D; Freistühler, M; Laukoetter, M G; Rehberg, S; Raschke, M J; Garcia, P

2016-10-19

Secondary abdominal compartment syndrome is well known as a life-threatening complication in critically ill patients in an intensive care unit. Massive crystalloid fluid resuscitation has been identified as the most important risk factor. The time interval from hospital admittance to the development of manifest abdominal compartment syndrome is usually greater than 24 hours. In the absence of any direct abdominal trauma, we observed a rapidly evolving secondary abdominal compartment syndrome shortly after hospital admittance associated with massive transfusion of blood products and only moderate crystalloid resuscitation. We report the case of an acute secondary abdominal compartment syndrome developing within 3 to 4 hours in a 74-year-old polytraumatized white woman. Although multiple fractures of her extremities and a B-type pelvic ring fracture were diagnosed by a full body computed tomography scan, no intra-abdominal injury could be detected. Hemorrhagic shock with a drop in her hemoglobin level to 5.7 g/dl was treated by massive transfusion of blood products and high doses of catecholamines. Shortly afterwards, her pulmonary gas exchange progressively deteriorated and mechanical ventilation became almost impossible with peak airway pressures of up to 60 cmH 2 O. Her abdomen appeared rigid and tense accompanied by a progressive hemodynamic decompensation necessitating mechanic cardiopulmonary resuscitation. Although preoperative computed tomography scans showed no signs of intra-abdominal fluid, a decompressive laparotomy under cardiopulmonary resuscitation conditions was performed and 2 liters of ascites-like fluid disgorged. Her hemodynamics and pulmonary ventilation improved immediately. This case report describes for the first time acute secondary abdominal compartment syndrome in a trauma patient, evolving in a very short time period. We hypothesize that the massive transfusion of blood products along with high doses of catecholamines triggered the acute

Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies

NARCIS (Netherlands)

Scholten-Peeters, Gwendolijne G.M; Verhagen, Arianne P; Bekkering, Geertruida E; van der Windt, Daniëlle A W M; Barnsley, Les; Oostendorp, Rob A B; Hendriks, Erik J M

2003-01-01

We present a systematic review of prospective cohort studies. Our aim was to assess prognostic factors associated with functional recovery of patients with whiplash injuries. The failure of some patients to recover following whiplash injury has been linked to a number of prognostic factors. However,

Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies.

NARCIS (Netherlands)

Scholten-Peeters, G.G.M.; Verhagen, A.P.; Bekkering, G.E.; Windt, D.A.W.M. van der; Barnsley, L.; Oostendorp, R.A.B.; Hendriks, E.

2003-01-01

We present a systematic review of prospective cohort studies. Our aim was to assess prognostic factors associated with functional recovery of patients with whiplash injuries. The failure of some patients to recover following whiplash injury has been linked to a number of prognostic factors. However,

Relationship between early somatic, radiological, cognitive and psychosocial findings and outcome during a one-year follow-up in 117 patients suffering from common whiplash.

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Radanov, B P; Sturzenegger, M; De Stefano, G; Schnidrig, A

1994-05-01

To analyse the significance of the interplay between somatic and psychosocial factors in influencing the course of recovery a non-selected well defined group of 117 whiplash patients was investigated. Initial examination was performed, on average, 7.2 +/- 4.2 days after trauma and follow-ups were carried out at 3, 6 and 12 months. At the initial investigation all patients were given a neurological examination, cognitive and psychosocial factor assessment and cervical spine X-rays. At each follow-up stepwise regression was performed to evaluate the relationship between initial findings and the course of recovery. Fifty-one (44%), 36 (31%) and 28 (24%) patients were symptomatic at 3, 6 and 12 months respectively. Poor improvement at all examinations was significantly correlated with factors associated with severity of injury such as initial symptoms of radicular irritation and intensity of neck pain. Moreover, results indicate that poor recovery is related to severity of injury in addition to some pre-traumatic factors (previous history of head trauma and headache) and initial injury-related reaction (i.e. sleep disturbances, reduced speed of information processing and nervousness). However, psychosocial factors did not prove predictive at any follow-up examination. These results indicate that symptoms suggesting a more severe neck injury appear to be particularly related to delayed recovery from common whiplash. Moreover these results may be of value in the objective evaluation of potentially difficult claims for compensation, which may in some cases be falsely based.

A narrative review on cervical interventions in adults with chronic whiplash-associated disorder

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Yeung, Euson; Tong, Tiffany; Reed, Nick

2018-01-01

Introduction Whiplash injuries are common in society, but clinical interventions are inconclusive on the most effective treatment. Research and reviews have been completed with the goal of determining clinical interventions that are effective for whiplash injuries and disorders, but literature has not recently been summarised on best practices for cervical spine interventions for adults with chronic whiplash. Purpose The objective of this narrative review is to update and expand on previous works, to provide recommendations for clinical interventions and future research in the area of cervical spine rehabilitation for adults with chronic whiplash-associated disorder. Method The Arskey and O’Malley methodology was used for this narrative review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched from 2003 to April 2017. Two reviewers screened titles and abstracts for relevance to the review, and content analysis summarised the study findings. A total of 14 citations were included in the final review. Findings Exercise-based interventions targeted at the cervical spine appear most beneficial for adults with chronic whiplash-associated disorder (WAD). Invasive interventions still require more rigorous studies to deem their effectiveness for this population. Conclusion Further research is required to investigate and determine clinically relevant results for cervical spine intervention in patients with chronic WAD. PMID:29719724

Managing Injuries of the Neck Trial (MINT): design of a randomised controlled trial of treatments for whiplash associated disorders

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Lamb, Sarah E; Gates, Simon; Underwood, Martin R; Cooke, Matthew W; Ashby, Deborah; Szczepura, Ala; Williams, Mark A; Williamson, Esther M; Withers, Emma J; Mt Isa, Shahrul; Gumber, Anil

2007-01-01

Background A substantial proportion of patients with whiplash injuries develop chronic symptoms. However, the best treatment of acute injuries to prevent long-term problems is uncertain. A stepped care treatment pathway has been proposed, in which patients are given advice and education at their initial visit to the emergency department (ED), followed by review at three weeks and physiotherapy for those with persisting symptoms. MINT is a two-stage randomised controlled trial to evaluate two components of such a pathway: 1. use of The Whiplash Book versus usual advice when patients first attend the emergency department; 2. referral to physiotherapy versus reinforcement of advice for patients with continuing symptoms at three weeks. Methods Evaluation of the Whiplash Book versus usual advice uses a cluster randomised design in emergency departments of eight NHS Trusts. Eligible patients are identified by clinicians in participating emergency departments and are sent a study questionnaire within a week of their ED attendance. Three thousand participants will be included. Patients with persisting symptoms three weeks after their ED attendance are eligible to join an individually randomised study of physiotherapy versus reinforcement of the advice given in ED. Six hundred participants will be randomised. Follow-up is at 4, 8 and 12 months after their ED attendance. Primary outcome is the Neck Disability Index (NDI), and secondary outcomes include quality of life and time to return to work and normal activities. An economic evaluation is being carried out. Conclusion This paper describes the protocol and operational aspects of a complex intervention trial based in NHS emergency and physiotherapy departments, evaluating two components of a stepped-care approach to the treatment of whiplash injuries. The trial uses two randomisations, with the first stage being cluster randomised and the second individually randomised. PMID:17257408

Whiplash and post-traumatic stress disorder

NARCIS (Netherlands)

Jaspers, JPC

1998-01-01

Purpose : This study examined the comorbidity of whiplash and post-traumatic stress disorder (PTSD) following motor vehicle accidents. A treatment strategy in cases with both disorders is proposed. Method: A review of the literature on psychological consequences of motor vehicle accidents and on

Whiplash and post-traumatic stress disorder

NARCIS (Netherlands)

Jaspers, JPC

Purpose : This study examined the comorbidity of whiplash and post-traumatic stress disorder (PTSD) following motor vehicle accidents. A treatment strategy in cases with both disorders is proposed. Method: A review of the literature on psychological consequences of motor vehicle accidents and on

Acute pulmonary injury induced by experimental muscle trauma Lesão pulmonar aguda induzida por trauma muscular experimental

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Márcia Andréa da Silva Carvalho Sombra

2011-01-01

Full Text Available PURPOSE: To develop an easily reproducible model of acute lung injury due to experimental muscle trauma in healthy rats. METHODS: Eighteen adult Wistar rats were randomized in 3 groups (n=6: G-1- control, G-2 - saline+trauma and G-3 - dexamethasone+trauma. Groups G-1 and G-2 were treated with saline 2,0ml i.p; G-3 rats were treated with dexamethasone (DE (2 mg/kg body weight i.p.. Saline and DE were applied 2h before trauma and 12h later. Trauma was induced in G-2 and G-3 anesthetized (tribromoethanol 97% 100 ml/kg i.p. rats by sharp section of anterior thigh muscles just above the knee, preserving major vessels and nerves. Tissue samples (lung were collected for myeloperoxidase (MPO assay and histopathological evaluation. RESULTS: Twenty-four hours after muscle injury there was a significant increase in lung neutrophil infiltration, myeloperoxidase activity and edema, all reversed by dexamethasone in G-3. CONCLUSION: Trauma by severance of thigh muscles in healthy rats is a simple and efficient model to induce distant lung lesions.OBJETIVO: Desenvolver um modelo facilmente reprodutível de lesão pulmonar aguda decorrente de trauma muscular experimental em ratos sadios. MÉTODOS: Dezoito ratos Wistar adultos foram randomizados em 3 grupos (n=6: G-1-controle, G-2 - trauma+salina e G-3 - trauma+dexametasona. Grupos G-1 e G-2 foram tratados com salina 2,0 ml ip, G-3 ratos foram tratados com dexametasona (DE (2 mg/kg peso corporal ip. Salina e DE foram aplicadas 2h antes e 12h depois do trauma. Trauma foi induzido em ratos G-2 e G-3 anestesiados (tribromoetanol 97% de 100 ml/kg, i.p. por secção da musculatura anterior da coxa logo acima da articulação do joelho, preservando os grandes vasos e nervos. Amostras de tecido (pulmão foram coletadas para avaliação da mieloperoxidase (MPO, e exames histopatológicos. RESULTADOS: Vinte e quatro horas após a indução da lesão muscular houve um aumento significativo na infiltração de neutr

Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting.

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Rydman, Eric; Ponzer, Sari; Ottosson, Carin; Järnbert-Pettersson, Hans

2017-04-01

To construct and validate a prediction instrument for early identification of patients with a high risk of delayed recovery after whiplash injuries (PPS-WAD) in an insurance company setting. Prospective cohort study. On the basis of a historic cohort (n = 130) of patients with a whiplash injury identified in an emergency room (ER, model-building set), we used logistic regression to construct an instrument consisting of two demographic variables (i.e. questions of educational level and work status) and the patient-rated physical and mental status during the acute phase to predict self-reported nonrecovery after 6 months. We evaluated the instrument's ability to predict nonrecovery in a new cohort (n = 204) of patients originating from an insurance company setting (IC, validation set). The prediction instrument had low reproducibility when the setting was changed from the ER cohort to the IC cohort. The overall percentage of correct predictions of nonrecovery in the ER cohort was 78 % compared with 62 % in the IC cohort. The sensitivity and specificity in relation to nonrecovery were both 78 % in the ER cohort. The sensitivity and specificity in the insurance company setting was lower, 67 and 50 %. Clinical decision rules need validation before they are used in a new setting. An instrument consisting of four questions with an excellent possibility of identifying patients with a high risk of nonrecovery after a whiplash injury in the emergency room was not as useful in an insurance company setting. The importance and type of the risk factors for not recovering probably differ between the settings, as well as the individuals.

Longitudinal magnetic resonance imaging study on whiplash injury patients. Minimum 10-year follow-up

International Nuclear Information System (INIS)

Ichihara, Daisuke; Okada, Eijiro; Chiba, Kazuhiro

2009-01-01

We conducted a prospective long-term follow-up study to assess associations between magnetic resonance imaging (MRI) findings and changes in clinical symptoms, as well as factors relating to the prognosis of symptoms. A total of 133 patients with acute whiplash injury between 1993 and 1996 participated in this follow-up study. They underwent neurological examinations by spine surgeons and second MRI scans of the cervical spine were obtained. They also filled out a questionnaire regarding cervical symptoms and the accident details. The items evaluated by MRI were a decrease in the signal intensity of the intervertebral disc; anterior compression of the dura and the spinal cord; posterior disc protrusion; disc space narrowing; and foraminal stenosis. Relations between the presence/absence of degenerative changes on MRI, accident details, and patients' symptoms were assessed by calculating the adjusted odds ratio (OR). Progression of some degenerative changes was recognized on MRI in 98.5% of the 133 whiplash injury patients, and clinical symptoms diminished in more than a half of the 133 patients. There were no statistically significant associations between MRI findings and changes in clinical symptoms. The prognosis for neck pain tended to be poor after accidents with double collisions (rear-end collision followed by front-end collision) [adjusted OR 5.83, 95% confidence interval (CI) 1.15-29.71] and accidents with serious car damage (2.87, 1.03-7.99). The prognosis for stiff shoulders tended to be poor in women (2.83, 1.23-6.51); and the prognosis for numbness in the upper extremities tended to be poor after accidents with serious car damage (3.39, 1.14-10.06). This study demonstrated that progression of degenerative changes of the cervical spine on MRI was not associated with clinical symptoms during the 10-year period after whiplash injury. (author)

A prospective study of perceived injustice in whiplash victims and its relationship to recovery.

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Ferrari, Robert

2015-05-01

The objectives of this paper are to to measure levels of perceived injustice in whiplash victims and determine the relationship to recovery at 6-month post-injury. Consecutive acute whiplash patients completed the Injustice Experience Questionnaire, at presentation, and also 3- and 6-month post-injury. At each of these two follow-up points, participants were examined for recovery. Of an initial 134 participants, 130 participants were followed up at 3 months and 124 at 6 months. At the 3-month follow-up, 62 % (80/130) of participants reported recovery from their injuries. At 6 months, 80 % (99/124) reported recovery. The initial Injustice Experience Questionnaire score was low, with a mean score of 6.0 ± 1.0 (range 5-10) out of a maximum of 48. The mean score at 3-month follow-up had increased in the cohort to 7.4 ± 1.6 (range 5-11). At 6-month post-injury, the mean of the Injustice Experience Questionnaire score for the cohort who still reported lack of recovery (25/124 participants) was 15.0 ± 6.0 (range 5-31), while that for the recovered group remained low at 8.2 ± 3.9 (range 5-11). In the primary care setting, a significant proportion of whiplash patients who have not recovered by 3-month post-injury subsequently develop higher levels of perceived injustice by 6-month post-injury. The development of high levels of perceived injustice at 6-month post-injury appears to follow the development of chronic pain and a lack of recovery at 3 months and, at that point, becomes a risk factor for lack of recovery thereafter.

Hyperextension strain of ''whiplash'' injuries to the cervical spine

International Nuclear Information System (INIS)

Griffiths, H.J.; Olson, P.N.; Everson, L.I.; Winemiller, M.

1995-01-01

A full cervical spine radiographic series (including flexion and extension views) was reviewed in 40 patients with clinically proven ''whiplash'' injuries and compared to the radiographs in 105 normal controls. The level and degree of kinking or kyphosis, subluxation, and the difference in the amount of fanning between spinous processes on flexion and extension films were measured in each patient. Localized kinking greater than 10 and over 12 mm of fanning, often occurring at the level below the kinking or kyphosis, occurred mainly in the group of whiplash patients (sensitivity 81%, specificity 76%, accuracy 80%). (orig./VHE)

Hyperextension strain of ``whiplash`` injuries to the cervical spine

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Griffiths, H.J. [Dept. of Radiology, Univ. of Minnesota Hospital and Clinic, Minneapolis, MN (United States); Olson, P.N. [Dept. of Radiology, Univ. of Minnesota Hospital and Clinic, Minneapolis, MN (United States); Everson, L.I. [Dept. of Radiology, Univ. of Minnesota Hospital and Clinic, Minneapolis, MN (United States); Winemiller, M. [Dept. of Radiology, Univ. of Minnesota Hospital and Clinic, Minneapolis, MN (United States)

1995-05-01

A full cervical spine radiographic series (including flexion and extension views) was reviewed in 40 patients with clinically proven ``whiplash`` injuries and compared to the radiographs in 105 normal controls. The level and degree of kinking or kyphosis, subluxation, and the difference in the amount of fanning between spinous processes on flexion and extension films were measured in each patient. Localized kinking greater than 10 and over 12 mm of fanning, often occurring at the level below the kinking or kyphosis, occurred mainly in the group of whiplash patients (sensitivity 81%, specificity 76%, accuracy 80%). (orig./VHE)

Acute unilateral foot drop as a result of direct blunt trauma to the ...

African Journals Online (AJOL)

This is a case report of an acute unilateral foot drop which occurred during a professional mixed martial arts (MMA) contest, specifically as a result of direct blunt trauma to the left peroneal nerve, without an accompanying fracture of the fibula. Keywords: foot extensor weakness, gait abnormality, contact sports, mixed martial ...

The Course of Serum Inflammatory Biomarkers Following Whiplash Injury and Their Relationship to Sensory and Muscle Measures: a Longitudinal Cohort Study

Science.gov (United States)

Sterling, Michele; Elliott, James M.; Cabot, Peter J.

2013-01-01

Tissue damage or pathological alterations are not detectable in the majority of people with whiplash associated disorders (WAD). Widespread hyperalgisa, morphological muscle changes and psychological distress are common features of WAD. However little is known about the presence of inflammation and its association with symptom persistence or the clinical presentation of WAD. This study aimed to prospectively investigate changes in serum inflammatory biomarker levels from the acute (3 months) stages of whiplash injury. It also aimed to determine relationships between biomarker levels and hyperalgesia, fatty muscle infiltrates of the cervical extensors identified on MRI and psychological factors. 40 volunteers with acute WAD and 18 healthy controls participated. Participants with WAD were classified at 3 months as recovered/mild disability or having moderate/severe disability using the Neck Disability Index. At baseline both WAD groups showed elevated serum levels of CRP but by 3 months levels remained elevated only in the moderate/severe group. The recovered/mild disability WAD group had higher levels of TNF-α at both time points than both the moderate/severe WAD group and healthy controls. There were no differences found in serum IL-1β. Moderate relationships were found between hyperalgesia and CRP at both time points and between hyperalgesia and IL-1β 3 months post injury. There was a moderate negative correlation between TNF-α and amount of fatty muscle infiltrate and pain intensity at 3 months. Only a weak relationship was found between CRP and pain catastrophising and no relationship between biomarker levels and posttraumatic stress symptoms. The results of the study indicate that inflammatory biomarkers may play a role in outcomes following whiplash injury as well as being associated with hyperalgesia and fatty muscle infiltrate in the cervical extensors. PMID:24147095

The course of serum inflammatory biomarkers following whiplash injury and their relationship to sensory and muscle measures: a longitudinal cohort study.

Directory of Open Access Journals (Sweden)

Michele Sterling

Full Text Available Tissue damage or pathological alterations are not detectable in the majority of people with whiplash associated disorders (WAD. Widespread hyperalgisa, morphological muscle changes and psychological distress are common features of WAD. However little is known about the presence of inflammation and its association with symptom persistence or the clinical presentation of WAD. This study aimed to prospectively investigate changes in serum inflammatory biomarker levels from the acute (3 months stages of whiplash injury. It also aimed to determine relationships between biomarker levels and hyperalgesia, fatty muscle infiltrates of the cervical extensors identified on MRI and psychological factors. 40 volunteers with acute WAD and 18 healthy controls participated. Participants with WAD were classified at 3 months as recovered/mild disability or having moderate/severe disability using the Neck Disability Index. At baseline both WAD groups showed elevated serum levels of CRP but by 3 months levels remained elevated only in the moderate/severe group. The recovered/mild disability WAD group had higher levels of TNF-α at both time points than both the moderate/severe WAD group and healthy controls. There were no differences found in serum IL-1β. Moderate relationships were found between hyperalgesia and CRP at both time points and between hyperalgesia and IL-1β 3 months post injury. There was a moderate negative correlation between TNF-α and amount of fatty muscle infiltrate and pain intensity at 3 months. Only a weak relationship was found between CRP and pain catastrophising and no relationship between biomarker levels and posttraumatic stress symptoms. The results of the study indicate that inflammatory biomarkers may play a role in outcomes following whiplash injury as well as being associated with hyperalgesia and fatty muscle infiltrate in the cervical extensors.

Increased neck muscle activity and impaired balance among females with whiplash-related chronic neck pain

DEFF Research Database (Denmark)

Juul-Kristensen, Birgit; Clausen, Brian; Ris Hansen, Inge

2013-01-01

To investigate neck muscle activity and postural control in patients with whiplash-associated disorder compared with healthy controls.......To investigate neck muscle activity and postural control in patients with whiplash-associated disorder compared with healthy controls....

The Effectiveness of Conservative Management for Acute Whiplash Associated Disorder (WAD II: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

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Taweewat Wiangkham

Full Text Available To evaluate the effectiveness of conservative management (except drug therapy for acute Whiplash Associated Disorder (WAD II.Systematic review and meta-analysis of Randomised Controlled Trials (RCTs using a pre-defined protocol. Two independent reviewers searched information sources, decided eligibility of studies, and assessed risk of bias (RoB of included trials. Data were extracted by one reviewer and checked by the other. A third reviewer mediated any disagreements throughout. Qualitative trial and RoB data were summarised descriptively. Quantitative syntheses were conducted across trials for comparable interventions, outcome measures and assessment points. Meta-analyses compared effect sizes with random effects, using STATA version 12.PEDro, Medline, Embase, AMED, CINAHL, PsycINFO, and Cochrane Library with manual searching in key journals, reference lists, British National Bibliography for Report Literature, Center for International Rehabilitation Research Information & Exchange, and National Technical Information Service were searched from inception to 15th April 2015. Active researchers in the field were contacted to determine relevant studies.RCTs evaluating acute (10 days interventions, there were no statistically significant differences in all outcome measures between interventions at any time.Conservative and active interventions may be useful for pain reduction in patients with acute WADII. Additionally, cervical horizontal mobility could be improved by conservative intervention. The employment of a behavioural intervention (e.g. act-as-usual, education and self-care including regularly exercise could have benefits for pain reduction and improvement in cervical movement in the coronal and horizontal planes. The evidence was evaluated as low/very low level according to the Grading of Recommendations Assessment, Development and Evaluation system.

Survey of 2582 Cases of Acute Orthopedic Trauma

Science.gov (United States)

Soleymanha, Mehran; Mobayen, Mohammadreza; Asadi, Kamran; Adeli, Alborz; Haghparast-Ghadim-Limudahi, Zahra

2014-01-01

Background: Orthopedic injuries are among the most common causes of mortality, morbidity, hospitalization, and economic burden in societies. Objectives: In this research, we study the prevalence of different types of trauma requiring orthopedic surgery. Patients and Methods: We conducted a cross-sectional study on 2582 patients with acute orthopedic injuries admitted to the orthopedic emergency ward at the Poursina Hospital (a referral center in Guilan province (northern Iran), during December 2010 through September 2011. Patients were examined and the data collection form was filled for each patient. Data were analyzed by SPSS software version 19 and were listed in tables. Results: Of 2582 included cases, 1940 were male and 642 were female, with a mean age of 34.5 years. Most injuries were seen in the 25 to 44 year age group from rural areas. The highest frequency of trauma related to falls. On the other hand, bicycling and shooting had the lowest frequencies. There were 18 cases with limb amputation. Overall, 66.5% of patients had fractures, 5% had soft tissue lacerations, and 10% had dislocations. Conclusions: Identification of risk factors and methods of prevention is one of the most important duties of healthcare systems. Devising plans to minimize these risk factors and familiarizing people with them is prudent. PMID:25717444

Headache and musculoskeletal complaints among subjects with self reported whiplash injury. The HUNT-2 study

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Nygaard Oystein

2011-06-01

Full Text Available Abstract Background To evaluate the life-time prevalence of self reported whiplash injury and the relationship to chronic musculoskeletal complaints (MSCs and headache in a large unselected adult population. Methods Between 1995 and 1997, all inhabitants 20 years and older in Nord-Trondelag county in Norway were invited to a comprehensive health survey. Out of 92,936 eligible for participation, a total of 59,104 individuals (63.6% answered the question about whiplash injury (whiplash. Among these, 46,895 (79.3% responded to the questions of musculoskeletal complaints and headache. Results The total life-time prevalence of self reported whiplash injury was 2.9%, for women 2.7% and for men 3.0%. There was a significant association between self reported whiplash injury and headache (OR = 2.1; 95% CI 1.8-2.4, and chronic MSCs (OR = 3.3; 95% CI 2.8-3.8, evident for all ten anatomical sites investigated. The association was most pronounced for those with a combination of headache and chronic MSC for both men (OR = 4.8; 95% CI 3.6-6.2 and women (OR = 5.2; 95% CI 3.7-7.1. Conclusions Subjects with self reported whiplash injury had significantly more headache and musculoskeletal complaints than those without, and may in part be due to selective reporting. The causal mechanism remains unclear and cannot be addressed in the present study design.

The evaluation of fat saturation fast spin-echo T2W1 for patients with acute spinal trauma

International Nuclear Information System (INIS)

Kim, Sung Gyu; Lee, Chang Jun; Lee, Myung Joon; Kang, Ik Won; Yoo, Jeong Hyun

2002-01-01

To determine the usefulness of fat saturation fast spin-echo T2W1 for patients with mild acute trauma of the spine. Between July 1998 and June 2002, 36 patients with acute spinal trauma underwent MRI within four months of injury. One, whose clinal symptoms indicated neurological paralysis, was excluded form our study. A superconductive 1.0-T MRI scanner was used, and conventional T1W1, T2W1, and additional fat-saturation fast spin-echo T2W1 were performed. Two radiologists compared conventional T2-weighted sagittal imaging and fat-saturation T2-weighted sagittal imaging in terms of the extension of increased high signal intensities in soft tissue and vertebral bodies, bone marrow signal change, disk herniation, and signal change of the disk. The detection rate of focal high signal intensities in soft tissue and bone marrow was significantly higher at fat-saturation fast spin-echo T2W1 than at conventional T2W1. Fat-saturation fast spin-echo T2W1 is useful for the evaluation of patients with mild acute spinal trauma without neurological impairment

[Literature review of whiplash injuries of the cervical spine].

Science.gov (United States)

Pavić, Roman

2011-01-01

The paper presents the latest information in world literature on whiplash injury of the cervical spine. This injury has been noted through history, mentioned as early as Ancient Egypt, and prevalent in the 19 century, the time before using the car, until today. The mechanism of injury is described, as well as treatment, and news in view of the frequency of injuries in different parts of the world and the impact of socio-cultural, economic, ethnic and geographic factors. Impacts of traffic laws, automobile production and automobile seats that would indicate the possibility of prevention as a result of a whiplash injury of the cervical spine are also presented.

Investigation of the Effect of Neck Muscle Active Force on Whiplash Injury of the Cervical Spine

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Yu Yan

2018-01-01

Full Text Available The objective of the present study is to investigate the influence of neck muscle activation on whiplash neck injury of the occupants of a passenger vehicle under different severities of frontal and rear-end impact collisions. The finite element (FE model has been used as a versatile tool to simulate and understand the whiplash injury mechanism for occupant injury prevention. However, whiplash injuries and injury mechanisms have rarely been investigated in connection with neck active muscle forces, which restricts the complete reappearance and understanding of the injury mechanism. In this manuscript, a mixed FE human model in a sitting posture with an active head-neck was developed. The response of the cervical spine under frontal and rear-end collision conditions was then studied using the FE model with and without neck muscle activation. The effect of the neck muscle activation on the whiplash injury was studied based on the results of the FE simulations. The results indicated that the neck active force influenced the head-neck dynamic response and whiplash injury during a collision, especially in a low-speed collision.

The Torg-Pavlov ratio for the prediction of acute spinal cord injury after a minor trauma to the cervical spine.

Science.gov (United States)

Aebli, Nikolaus; Wicki, Anina G; Rüegg, Tabea B; Petrou, Nassos; Eisenlohr, Heidrun; Krebs, Jörg

2013-06-01

Acute cervical spinal cord injury (SCI) has been observed in some patients after a minor trauma to the cervical spine. The discrepancy between the severity of the trauma and the clinical symptoms has been attributed to spinal canal stenosis. However, to date, there is no universally established radiological parameter for identifying critical spinal stenosis in these patients. The spinal canal-to-vertebral body ratio (Torg-Pavlov ratio) has been proposed for assessing developmental spinal canal stenosis. The relevance of the Torg-Pavlov ratio for predicting the occurrence and severity of acute cervical SCI after a minor trauma to the cervical spine has not yet been established. To investigate the Torg-Pavlov ratio values of the cervical spine in patients suffering from acute cervical SCI after a minor trauma to the cervical spine and the use of the Torg-Pavlov ratio for identifying patients at risk of cervical SCI and predicting the severity and course of symptoms. Retrospective radiological study of consecutive patients. Forty-five patients suffering from acute cervical SCI and 68 patients showing no neurologic symptoms after a minor trauma to the cervical spine. Midvertebral sagittal cervical spinal canal diameter and the sagittal vertebral body diameter. Calculation of the Torg-Pavlov ratio values. Conventional lateral radiographs of the cervical spine (C3-C7) were analyzed to determine the Torg-Pavlov ratio values. Receiver operating characteristic curves were calculated for evaluating the classification accuracy of the Torg-Pavlov ratio for predicting SCI. The Torg-Pavlov ratio values in the SCI group were significantly (pPavlov ratio cutoff value of 0.7 yielded the greatest positive likelihood ratio for predicting the occurrence of SCI. However, there were no significant differences in the Torg-Pavlov ratio values between the different American Spinal Injury Association Impairment Score groups and between patients with complete, partial, and no recovery of

The return-to-work process of individuals sick-listed because of whiplash-associated disorder

DEFF Research Database (Denmark)

Biering-Sørensen, Sarah; Møller, Anne; Stoltenberg, C.

2014-01-01

BACKGROUND: The chronic course of whiplash-associated disorder (WAD) has implications for both the individual and society. It has been shown that up to 50% of patients have not yet returned to work six months after a whiplash injury. We wanted to study the return-to-work (RTW) process in individu...

Differential Predictors of Pain and Disability in Patients with Whiplash Injuries

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Michael JL Sullivan

2002-01-01

Full Text Available The psychological predictors of pain and disability were examined in a sample of people who sustained whiplash injuries during rear-end motor vehicle accidents. Sixty-five patients referred to a specialty pain clinic with a diagnosis of whiplash injury completed measures of depression, anxiety, catastrophizing, pain and perceived disability. Regression analysis revealed that psychological variables accounted for 18% of the variance in pain ratings. The magnification subscale of the Pain Catastrophizing Scale was the only variable that contributed significant, unique variance to the prediction of pain. Psychological variables accounted for 37% of the variance in perceived disability scores. In the latter analysis, however, none of the independent variables contributed significant, unique variance to the prediction of perceived disability. Psychological variables accounted for significant variance in disability ratings, even when controlling for pain intensity. Discussion focuses on the need to draw clearer distinctions between determinants of pain and disability, and directions for interventions aimed at minimizing disability following whiplash injury are suggested.

Natural evolution of late whiplash syndrome outside the medicolegal context.

Science.gov (United States)

Schrader, H; Obelieniene, D; Bovim, G; Surkiene, D; Mickeviciene, D; Miseviciene, I; Sand, T

1996-05-04

In Lithuania, few car drivers and passengers are covered by insurance and there is little awareness among the general public about the potentially disabling consequences of a whiplash injury. We took this opportunity to study the natural course of head and neck symptoms after rear-end car collisions. In a retrospective questionnaire-based cohort study, 202 individuals (157 men; 45 women) were identified from the records of the traffic police department in Kaunas, Lithuania. These individuals were interviewed 1-3 years after experiencing a rear-end car collision. Neck pain, headache, subjective cognitive dysfunction, psychological disorders, and low back pain in this group were compared with the same complaints in a sex-matched and age-matched control group of uninjured individuals selected randomly from the population register of the same geographic area. Neck pain was reported by 71 (35% [95% CI 29-42]) accident victims and 67 (33% [27-40]) controls. Headache was reported by 107 (53% [46-60]) accident victims and 100 (50% [42-57]) controls. Chronic neck pain and chronic headache (more than 7 days per month) were also reported in similar proportions (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 neck pain or daily headache after the accident, substantial proportions had had similar symptoms before the accident (7/17 for chronic neck pain; 10/12 for daily headache). There was no significant difference found. 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 most important risk factor for current neck symptoms in logistic regression analyses. Our results suggest that chronic symptoms were not usually caused by the car accident. Expectation of disability, a family history, and attribution of pre-existing symptoms to the trauma may be more

Assessing the gap between the acute trauma workload and the capacity of a single rural health district in South Africa. What are the implications for systems planning?

Science.gov (United States)

Clarke, D L; Aldous, C; Thomson, S R

2014-06-01

This study focuses on a single rural health district in South Africa, and attempts to establish the burden of disease and to review the capacity of the district hospitals to deal with this load. Ethical approval to undertake this study was obtained from both the University of Kwa-Zulu Natal and the Department of Health. The audit was performed over a 6-month period in the four district hospitals of rural Sisonke District. There were four components to this audit. 1. Information on the hospital incidence of acute trauma in Sisonke was also sourced from the epidemiology unit of the Department of Health in Pietermaritzburg 2. Each of the district hospitals was visited and the medical manager was interviewed. The medical manager was asked to complete the World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. (SAT). 3. The operative registers were reviewed to determine the number of index cases for trauma. This information was used to determine the unmet need of acute trauma in the district. 4. Each hospital was classified according to the Trauma Society of South Africa (TSSA) guidelines for levels of trauma care. The annual incidence of trauma in the Sisonke District is estimated to be 1,590 per 100,000 population. Although there appeared to be adequate infrastructure in the district hospitals, the SAT revealed significant deficits in terms of capacity of staff to adequately treat and triage acute trauma patients. There is a significant unmet need for trauma care in Sisonke. The four district hospitals can best be classified as Level IV centers of trauma care. There is a significant burden of trauma in the Sisonke District, yet the capacity to deal with this burden is inadequate. Although the physical infrastructure is adequate, the deficits relate to human resources. The strategic choices are between enhancing the district hospitals' capacity to deal with acute trauma, or deciding to bypass them completely and

Modic changes of the cervical spine in patients with whiplash injury: a prospective 11-year follow-up study.

Science.gov (United States)

Matsumoto, Morio; Ichihara, Daisuke; Okada, Eijiro; Toyama, Yoshiaki; Fujiwara, Hirokazu; Momoshima, Suketaka; Nishiwaki, Yuji; Takahata, Takeshi

2013-06-01

There are few studies on Modic changes of the cervical spine in patients suffering from whiplash. This study compared Modic changes seen in whiplash patients 10 years after the injury with those observed in asymptomatic volunteers. This is a follow-up study of 133 patients who suffered whiplash injuries in 1994-1996 and underwent MRI with a superconductive imager (63 men, 70 women, mean age 49.6±15.3 years, mean follow-up 11.4 years). In addition, 223 healthy volunteers who underwent MRI during the same period were included as controls (123 men, 100 women, mean age 50.5±15.0 years, mean follow-up 11.6 years). All participants underwent follow-up MRI. We examined all participants for Modic changes, and investigated relationships between Modic changes and clinical symptoms or potentially related factors. Modic changes were observed in 4 patients (3%) and at 7 intervertebral levels in the initial study, and in 17 patients (12.8%) and at 30 intervertebral levels at the follow-up. Modic Type 2 changes were the most prevalent in the whiplash patients in both the initial and follow-up studies. There was no significant difference in the percentage of whiplash patients versus control subjects with positive Modic changes, either at the initial study or at follow-up. Modic changes were not related to clinical symptoms present at follow-up, but were associated with preexisting disc degeneration. There was no association between Modic changes and the details of the car accident that caused the injury. While Modic changes became more common in whiplash patients in the 10-year period after the accident, they occurred with a similar frequency in control subjects. We did not find any association between Modic changes and the nature of the car accident in which the whiplash occurred. Modic changes found in whiplash patients may be a result of the physiological ageing process rather than pathological findings relating to the whiplash injury. Copyright © 2012 Elsevier Ltd. All

Validation of a new questionnaire to assess the impact of Whiplash Associated Disorders: The Whiplash Activity and participation List (WAL)

NARCIS (Netherlands)

Stenneberg, Martijn S.; Schmitt, Maarten A.; van Trijffel, Emiel; Schröder, Carin D.; Lindeboom, Robert

2015-01-01

Valid questionnaires for measuring functional limitations in patients with Whiplash Associated Disorders (WAD) are lacking, since existing measures are not suitable for addressing the specific limitations of these patients and because of cross contamination between theoretical constructs. The

Immediate impact of 'penalty points legislation' on acute hospital trauma services.

LENUS (Irish Health Repository)

Lenehan, Brian

2012-02-03

Road traffic accident (RTA) related mortality and injury may be reduced by up to 40% with the introduction of \\'road safety\\' legislation. Little is known regarding changes in pattern of injury and overall resource impact on acute trauma services. This prospective study examines RTA related admissions, injuries sustained and resultant sub-speciality operative workload in a Level 1 Trauma Centre during the 12 months immediately prior to and following the introduction of \\'penalty points\\' legislation. Eight hundred and twenty RTA related admissions were identified over the 24-month period from 01\\/11\\/2001 to 31\\/10\\/2003. There was a 36.7% decrease in RTA related admissions subsequent to the introduction of new legislation. Bed occupancy was almost halved. However, the relative Orthopaedic workload increased from 34% to 41% with a 10% increase in relative bed occupancy. The pattern of orthopaedic injury was significantly altered with a >50% absolute reduction in high velocity injuries. Curiously, there was no change in the absolute number of spinal fractures seen. This favourable early Irish experience of \\'penalty points\\' legislation mirrors that of worldwide published literature. Our findings demonstrate that the injury reduction effects were primarily enjoyed by non-orthopaedic sub-specialities. Such findings mandate consideration when allocating vital resources to sub-specialities within busy trauma units.

Functional survival after acute care for severe head injury at a designated trauma center in Hong Kong

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Benedict B.T. Taw

2012-07-01

Conclusion: Multidisciplinary neurorehabilitation service is an important component of comprehensive trauma care. Despite significant early mortalities, a proportion of severely head-injured patients who survive acute care may achieve good long-term functional recovery.

MRI assessment of the alar ligaments in the late stage of whiplash injury - a study of structural abnormalities and observer agreement

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Krakenes, J.; Moen, G.; Nordli, H. [Section of Neuroradiology, Department of Radiology, Haukeland University Hospital, University of Bergen Medical School (Norway); Kaale, B.R. [Firda Medical Centre, Sandane (Norway); Gilhus, N.E. [Department of Neurology, Haukeland University Hospital, University of Bergen Medical School (Norway); Rorvik, J. [Department of Radiology, Haukeland University Hospital, University of Bergen Medical School (Norway)

2002-07-01

Our aim was to characterise and classify structural changes in the alar ligaments in the late stage of whiplash injuries by use of a new MRI protocol, and to evaluate the reliability and the validity of this classification. We studied 92 whiplash-injured and 30 uninjured individuals who underwent proton density-weighted MRI of the craniovertebral junction in three orthogonal planes. Changes in the alar ligaments (grades 0-3) based on the ratio between the high signal area and the total cross-sectional area were rated twice at a 4-month interval, independently by three radiologists. Inter- and intraobserver statistics were calculated by ordinary and weighted kappa. Cases classified differently were reviewed to identify potential causes for disagreement. The alar ligaments were satisfactorily demonstrated in all cases (244 ligaments in 122 individuals). The lesions, 2-9 years after the injury, varied from small high-signal spots to high signal throughout the cross-sectional area. Signal was highest near the condylar insertion in 82 of 94 ligaments, indicating a lesion near that insertion, and near the dental insertion in eight, indicating a medial lesion. No grade 2 or 3 lesion was found in the control group. At least two observers assigned the same grade to 214 ligaments (87.7%) on the second occasion. In 30 ligaments (12.3%) this agreement was not obtained. Pair-wise interobserver agreement (weighted kappa) was fair to moderate (0.31-0.54) in the first grading, improving to moderate (0.49-0.57) in the second. Intraobserver agreement (weighted kappa) was moderate to good (0.43-0.70). Whiplash trauma can cause permanent damage to the alar ligaments, which can be shown by high-resolution proton density-weighted MRI. Reliability of classification of alar ligament lesions needs to be improved. (orig.)

MRI assessment of the alar ligaments in the late stage of whiplash injury - a study of structural abnormalities and observer agreement

International Nuclear Information System (INIS)

Krakenes, J.; Moen, G.; Nordli, H.; Kaale, B.R.; Gilhus, N.E.; Rorvik, J.

2002-01-01

Our aim was to characterise and classify structural changes in the alar ligaments in the late stage of whiplash injuries by use of a new MRI protocol, and to evaluate the reliability and the validity of this classification. We studied 92 whiplash-injured and 30 uninjured individuals who underwent proton density-weighted MRI of the craniovertebral junction in three orthogonal planes. Changes in the alar ligaments (grades 0-3) based on the ratio between the high signal area and the total cross-sectional area were rated twice at a 4-month interval, independently by three radiologists. Inter- and intraobserver statistics were calculated by ordinary and weighted kappa. Cases classified differently were reviewed to identify potential causes for disagreement. The alar ligaments were satisfactorily demonstrated in all cases (244 ligaments in 122 individuals). The lesions, 2-9 years after the injury, varied from small high-signal spots to high signal throughout the cross-sectional area. Signal was highest near the condylar insertion in 82 of 94 ligaments, indicating a lesion near that insertion, and near the dental insertion in eight, indicating a medial lesion. No grade 2 or 3 lesion was found in the control group. At least two observers assigned the same grade to 214 ligaments (87.7%) on the second occasion. In 30 ligaments (12.3%) this agreement was not obtained. Pair-wise interobserver agreement (weighted kappa) was fair to moderate (0.31-0.54) in the first grading, improving to moderate (0.49-0.57) in the second. Intraobserver agreement (weighted kappa) was moderate to good (0.43-0.70). Whiplash trauma can cause permanent damage to the alar ligaments, which can be shown by high-resolution proton density-weighted MRI. Reliability of classification of alar ligament lesions needs to be improved. (orig.)

A clinical study of multiple trauma combined with acute lung injury

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Tao Liang

2016-11-01

Full Text Available Objective: To study the changes of the contents of inflammatory mediators in serum of polytrauma patients with acute lung injury (ALI and their correlation with the disease. Methods: Patients suffering from multiple trauma combined with ALI were selected as ALI group (n = 54. Patients suffering from multiple trauma without ALI were considered as the control group (n = 117. The severity of the disease of patients in the two groups was assessed. Arterial blood was extracted for blood gas analysis. Venous blood was extracted to detect the contents of inflammatory mediators tumor necrosis factor-a, interleukin-1b (IL-1b, IL-10, granulocyte-macrophage colony stimulating factor, NO, endothelin-1. Results: The scores of injury severity score [(25.42 ± 3.58 vs. (17.03 ± 2.25], systemic inflammatory response syndrome [(3.85 ± 0.52 vs. (2.20 ± 0.36] and acute physiology and chronic health evaluation II [(92.63 ± 11.04 vs. (60.46 ± 8.87] in patients in ALI group were all significantly higher than those in the control group and its correcting shock time [(8.39 ± 1.05 vs. (5.15 ± 0.72 h] was longer than that of the control group. The amount of blood transfusion [(674.69 ± 93.52 vs. (402.55 ± 57.65 mL] was greater than that in the control group. The contents of the arterial partial pressure of oxygen [(76.65 ± 9.68 vs. (86.51 ± 10.56 mmHg], arterial blood pressure of carbon dioxide [(27.76 ± 4.82 vs. (36.78 ± 5.82 mmHg] and arterial partial pressure of oxygen/fraction of inspired oxygen [(236.94 ± 36.49 vs. (353.95 ± 47.76] were all significantly lower than those in the control group. The contents of serum tumor necrosis factor-a, IL-1b, IL- 10, granulocyte-macrophage colony stimulating factor, NO and endothelin-1 were obviously higher than those of control group and also positively correlated with the scores of injury severity score, systemic inflammatory response syndrome and acute physiology and chronic health evaluation II. Conclusions

Acute Knee Trauma: Analysis of Multidetector Computed Tomography Findings and Comparison with Conventional Radiography

International Nuclear Information System (INIS)

Mustonen, A.O.T.; Kiuru, M.J.

2005-01-01

Purpose: To evaluate the multidetector computed tomography (MDCT) findings of acute knee trauma and to compare radiography with MDCT in patients referred ta level 1 trauma center. Material and Methods: During a 5-year period, a total of 415 MDCT examinations were performed on 409 patients with acute knee trauma to reveal complex fracture anatomy or rule out a fracture. MDCT and primary radiographs were re-evaluated with respect to fracture location and trauma mechanism. Tibial plateau fractures were further analyzed depending on anatomical location: anterior-medial, anterior-lateral, posterior-lateral, and posterior-medial regions. Maximal depression of the tibial articular surface was measured. Findings on the primary knee radiographs were compared with MDCT findings. Results: Of the 409 patients, 356 (87%) had a knee fracture. A total of 451 fractures were found in all anatomic regions: distal femur ( n = 49), proximal tibia ( n 307), patella ( n = 23), and proximal fibula ( n = 72). Primary radiographs were available in 316 (76%) cases. Of these, 225 (71%) had MDCT in order to reveal the fracture anatomy better, and 91 (29%) had a subsequent MDCT after negative plain radiographs. Overall sensitivity of radiography was 83%, while negative predictive value was 49%. On radiography, tibial plateau articular depression was underestimated in all regions except when the fracture consisted of the whole half of the anterior or posterior plateau. The three main injury mechanisms were traffic accident, a simple fall, and sport. In 49 cases (15%), primary radiographs were suboptimal due to positioning. Conclusion: In severely injured patients, diagnostically sufficient radiographs are difficult to obtain, and therefore a negative radiograph is not reliable in ruling out a fracture. In these patients, MDCT is a fast and accurate examination and is also recommended in patients with tibial plateau fractures or complex knee injuries in order to evaluate the fracture adequately

X-ray signs of traumas of the cervical region of the spinal cord in the acute period

International Nuclear Information System (INIS)

Brodskaya, Z.L.

1983-01-01

The results are analyzed of an X-ray examination of 208 patients with traumas of the cervical region of the spinal column and spinal cord in the acute period of trauma. The authors proposed a scheme that included telespondylography in standard and oblique projections, flebospondylography, discography and pneumomyelography in the Schantz collar with a patient lying on the back. Four types of the spinal cord traumas were diagnosed: compression with osseous elements (76.92%), with sharp discs and strained epidural hematomas (3.85%), isolated contusion of the spinal cord (10.1%) and disorder of the spinal circulation (9.13%). Special emphasis was laid on clinicospondylographic correlations, a critical distance, congenital narrowing of the vertebral canal. The concept of traumatic decompression of the spinal cord was stressed. Symptoms of its contusion and trauma of the spinal circulation were indicated

Trauma-associated tinnitus: audiological, demographic and clinical characteristics.

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Peter M Kreuzer

Full Text Available BACKGROUND: Tinnitus can result from different etiologies. Frequently, patients report the development of tinnitus after traumatic injuries. However, to which extent this specific etiologic factor plays a role for the phenomenology of tinnitus is still incompletely understood. Additionally, it remains a matter of debate whether the etiology of tinnitus constitutes a relevant criterion for defining tinnitus subtypes. OBJECTIVE: By investigating a worldwide sample of tinnitus patients derived from the Tinnitus Research Initiative (TRI Database, we aimed to identify differences in demographic, clinical and audiological characteristics between tinnitus patients with and without preceding trauma. MATERIALS: A total of 1,604 patients were investigated. Assessment included demographic data, tinnitus related clinical data, audiological data, the Tinnitus Handicap Inventory, the Tinnitus Questionnaire, the Beck Depression Inventory, various numeric tinnitus rating scales, and the World Health Organisation Quality of Life Scale (WHOQoL. RESULTS: Our data clearly indicate differences between tinnitus patients with and without trauma at tinnitus onset. Patients suffering from trauma-associated tinnitus suffer from a higher mental burden than tinnitus patients presenting with phantom perceptions based on other or unknown etiologic factors. This is especially the case for patients with whiplash and head trauma. Patients with posttraumatic noise-related tinnitus experience more frequently hyperacousis, were younger, had longer tinnitus duration, and were more frequently of male gender. CONCLUSIONS: Trauma before tinnitus onset seems to represent a relevant criterion for subtypization of tinnitus. Patients with posttraumatic tinnitus may require specific diagnostic and therapeutic management. A more systematic and - at best - standardized assessment for hearing related sequelae of trauma is needed for a better understanding of the underlying pathophysiology and

Trauma-associated tinnitus: audiological, demographic and clinical characteristics.

Science.gov (United States)

Kreuzer, Peter M; Landgrebe, Michael; Schecklmann, Martin; Staudinger, Susanne; Langguth, Berthold

2012-01-01

Tinnitus can result from different etiologies. Frequently, patients report the development of tinnitus after traumatic injuries. However, to which extent this specific etiologic factor plays a role for the phenomenology of tinnitus is still incompletely understood. Additionally, it remains a matter of debate whether the etiology of tinnitus constitutes a relevant criterion for defining tinnitus subtypes. By investigating a worldwide sample of tinnitus patients derived from the Tinnitus Research Initiative (TRI) Database, we aimed to identify differences in demographic, clinical and audiological characteristics between tinnitus patients with and without preceding trauma. A total of 1,604 patients were investigated. Assessment included demographic data, tinnitus related clinical data, audiological data, the Tinnitus Handicap Inventory, the Tinnitus Questionnaire, the Beck Depression Inventory, various numeric tinnitus rating scales, and the World Health Organisation Quality of Life Scale (WHOQoL). Our data clearly indicate differences between tinnitus patients with and without trauma at tinnitus onset. Patients suffering from trauma-associated tinnitus suffer from a higher mental burden than tinnitus patients presenting with phantom perceptions based on other or unknown etiologic factors. This is especially the case for patients with whiplash and head trauma. Patients with posttraumatic noise-related tinnitus experience more frequently hyperacousis, were younger, had longer tinnitus duration, and were more frequently of male gender. Trauma before tinnitus onset seems to represent a relevant criterion for subtypization of tinnitus. Patients with posttraumatic tinnitus may require specific diagnostic and therapeutic management. A more systematic and - at best - standardized assessment for hearing related sequelae of trauma is needed for a better understanding of the underlying pathophysiology and for developing more tailored treatment approaches as well.

Sociale, økonomiske og kulturelle aspekter ved whiplash

DEFF Research Database (Denmark)

Rasmussen, Claus; Stenager, Elsebeth; Nielsen, Claus Vinther

2010-01-01

The sequelae following whiplash injuries (WL) entail considerable human costs and expenses for both treatment and social services, especially public income benefits. Frequently, many players are involved after WL and good intersectional collaboration is therefore essential to counter the WL...

Recovery in whiplash-associated disorders: do you get what you expect?

Science.gov (United States)

Carroll, Linda J; Holm, Lena W; Ferrari, Robert; Ozegovic, Dejan; Cassidy, J David

2009-05-01

Positive expectations predict better outcome in a number of health conditions, but the role of expectations in predicting health recovery after injury is not well understood. We investigated whether early expectations of recovery in whiplash associated disorders (WAD) predict subsequent recovery, and studied the role of "expectations" to predict recovery as determined by pain cessation and resolution of pain-related limitations in daily activities. A cohort of 6,015 adults with traffic-related whiplash injuries was assessed, using multivariable Cox proportional hazards analysis, for association between these expectations and self-perceived recovery over a 1-year period following the injury. Recovery was assessed using 3 indices: self-perceived global recovery (primary outcome); resolution of neck pain severity; and resolution of pain-related limitations in daily activities. After adjusting for the effect of sociodemographic characteristics, post-crash symptoms and pain, prior health status and collision-related factors, those who expected to get better soon recovered over 3 times as quickly (hazard rate ratio = 3.62, 95% confidence interval 2.55-5.13) as those who expected that they would never get better. Findings were similar for resolution of pain-related limitations and resolution of neck pain intensity, although the effect sizes for the latter outcome were smaller. Patients' early expectations for recovery are an important prognostic factor in recovery after whiplash injury, and are potentially modifiable. Clinicians should assess these expectations in order to identify those patients at risk of chronic whiplash, and future studies should focus on the effect of changing these early expectations.

Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia.

Science.gov (United States)

Curtis, Kate; Lam, Mary; Mitchell, Rebecca; Black, Deborah; Taylor, Colman; Dickson, Cara; Jan, Stephen; Palmer, Cameron S; Langcake, Mary; Myburgh, John

2014-01-01

Accurate economic data are fundamental for improving current funding models and ultimately in promoting the efficient delivery of services. The financial burden of a high trauma casemix to designated trauma centres in Australia has not been previously determined, and there is some evidence that the episode funding model used in Australia results in the underfunding of trauma. To describe the costs of acute trauma admissions in trauma centres, identify predictors of higher treatment costs and cost variance in New South Wales (NSW), Australia. Data linkage of admitted trauma patient and financial data provided by 12 Level 1 NSW trauma centres for the 08/09 financial year was performed. Demographic, injury details and injury scores were obtained from trauma registries. Individual patient general ledger costs (actual trauma patient costs), Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs (which form the basis of funding) were obtained. The actual costs incurred by the hospital were then compared with the state-wide AR-DRG average costs. Multivariable multiple linear regression was used for identifying predictors of costs. There were 17,522 patients, the average per patient cost was $10,603 and the median was $4628 (interquartile range: $2179-10,148). The actual costs incurred by trauma centres were on average $134 per bed day above AR-DRG costs-determined costs. Falls, road trauma and violence were the highest causes of total cost. Motor cyclists and pedestrians had higher median costs than motor vehicle occupants. As a result of greater numbers, patients with minor injury had comparable total costs with those generated by patients with severe injury. However the median cost of severely injured patients was nearly four times greater. The count of body regions injured, sex, length of stay, serious traumatic brain injury and admission to the Intensive Care Unit were significantly associated with increased costs (p<0.001). This

Blunt abdominal trauma with handlebar injury: A rare cause of traumatic amputation of the appendix associated with acute appendicitis

Directory of Open Access Journals (Sweden)

Amanda Jensen

2016-04-01

Full Text Available We describe traumatic appendicitis in a 7-year-old boy who presented after sustaining blunt abdominal trauma to his right lower abdomen secondary to bicycle handlebar injury. With diffuse abdominal pain following injury, he was admitted for observation. Computed axial tomography (CT obtained at an outside hospital demonstrated moderate stranding of the abdomen in the right lower quadrant. The CT was non-contrasted and therefore significant appendiceal distention could not be confirmed. However, there was a calcified structure in the right pelvis with trace amount of free fluid. Patient was observed with conservative management and over the course of 15 h his abdominal pain continued to intensify. With his worsening symptoms, we elected to take him for diagnostic laparoscopy. In the operating room we found an inflamed traumatically amputated appendix with the mesoappendix intact. We therefore proceeded with laparoscopic appendectomy. Pathology demonstrated acute appendicitis with fecalith. It was unclear as to whether the patient's appendicitis and perforation were secondary to fecalith obstruction, his blunt abdominal trauma or if they concurrently caused his appendicitis. Acute appendicitis is a common acute surgical condition in the pediatric population and continues to be a rare and unique cause of operative intervention in the trauma population.

MR imaging in cervical hyperextension injuries

International Nuclear Information System (INIS)

Davis, S.J.; Teresi, L.M.; Bradley, W.G. Jr.; Ziemba, M.R.

1990-01-01

This paper reports on cervical hyperextension injuries that are common and often show minimal radiographic abnormalities, even with severe or unstable lesions. MR images and clinical records of 14 patients scanned within 4 months of hyperextension cervical injuries were reviewed. Clinical, radiographic, and MR findings were correlated. Nine patients had acceleration hyperextension whiplash injuries, four with acute cervical disk herniations developing radiculopathy after several weeks. Five patients injured by direct frontal head trauma presented with myelopathy and had MR evidence of cord injury, and four had acute disk herniation

The iliotibial band in acute knee trauma: patterns of injury on MR imaging

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Mansour, Ramy; Yoong, Philip; McKean, David; Teh, James L. [Oxford University Hospitals NHS Trust, Department of Radiology, Nuffield Orthopaedic Centre, Oxford (United Kingdom)

2014-10-15

To delineate the spectrum of knee injuries associated with sprains and tears of the distal iliotibial band (ITB). A retrospective review of 200 random MRI scans undertaken for acute knee trauma was performed. Scans were excluded if there was a history of injury over 4 weeks from the time of the scan, septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. In each scan, the ITB was scored as normal, minor sprain (grade 1), severe sprain (grade 2), and torn (grade 3). The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 27.4 years (range, 9-69 years) and 71.5 % (n = 143) of the patients were male. The ITB was injured in 115 cases (57.5 %). The next most common soft tissue structure injured was the anterior cruciate ligament (ACL) in 53.5 % of cases (n = 107). Grade 1 ITB injury was seen in 90 of these 115 cases (45 %), grade 2 injury in 20 cases, and grade 3 injury in only five cases. There is a significant association between ITB injury and ACL rupture (p < 0.05), as well as acute patellar dislocation (p < 0.05). There were ten cases of significant posterolateral corner injury, and all were associated with ITB injury, including four ITB tears. Only two cases of isolated ITB injury were seen (1 %). ITB injury is common in acute knee trauma and is associated with significant internal derangement of the knee, especially cruciate ligament rupture, posterolateral corner injury, and patellar dislocation. (orig.)

Five years after the accident, whiplash casualties still have poorer quality of life in the physical domain than other mildly injured casualties: analysis of the ESPARR cohort.

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Tournier, Charlène; Hours, Martine; Charnay, Pierrette; Chossegros, Laetitia; Tardy, Hélène

2016-01-05

This study aims to compare health status and quality of life five years after a road accident between casualties with whiplash versus other mild injuries, to compare evolution of quality of life at 1 and 5 years after the accident, and to explore the relation between initial injury (whiplash vs. other) and quality of life. The study used data from the ESPARR cohort (a representative cohort of road accident casualties) and included 167 casualties with "pure" whiplash and a population of 185 casualties with other mild injuries (MAIS-1). All subjects with lesions classified as cervical contusion (AIS code 310402) or neck sprain (AIS code 640278) were considered as whiplash casualties. Diagnosis was made by physicians, at the outset of hospital care, based on interview, clinical findings and X-ray. Whiplash injuries were then classified following the Quebec classification (grades 1 and 2). Quality of life was assessed on the WHOQoL-Bref questionnaire. Correlations between explanatory variables and quality of life were explored by Poisson regression and variance analysis. Between 1 and 5 years, global QoL improved for both whiplash and non-whiplash casualties; but, considering the two whiplash groups separately, improvement in grade 2 was much less than in grade 1. At 5 years, grade-2 whiplash casualties were more dissatisfied with their health (39.4%; p whiplash (24.3%) or grade-1 whiplash casualties (27.0%). Deteriorated quality of life in the mental, social and environmental domains was mainly related to psychological and socioeconomic factors for both whiplash and other mildly injured road-accident casualties. While PTSD was a major factor for the physical domain, whiplash remained a predictive factor after adjustment on PTSD; unsatisfactory health at 5 years, with deteriorated quality of life in the physical domain, was observed specifically in the whiplash group, pain playing a predominant intermediate role. Deteriorated quality of life in the physical domain

Computed tomography in trauma

International Nuclear Information System (INIS)

Toombs, B.D.; Sandler, C.M.

1987-01-01

This book begins with a chapter dealing with the epidemiology and mechanisms of trauma. Trauma accounts for more lives lost in the United States than cancer and heart disease. The fact that 30%-40% of trauma-related deaths are caused by improper or delayed diagnoses or treatment emphasizes the importance of rapid and accurate methods to establish a diagnosis. Acute thoracic, abdominal, and pelvic trauma and their complications are discussed. A chapter on high-resolution CT of spinal and facial trauma and the role of three-dimensional reconstruction images is presented

Computed tomography in trauma

Energy Technology Data Exchange (ETDEWEB)

Toombs, B.D.; Sandler, C.M.

1987-01-01

This book begins with a chapter dealing with the epidemiology and mechanisms of trauma. Trauma accounts for more lives lost in the United States than cancer and heart disease. The fact that 30%-40% of trauma-related deaths are caused by improper or delayed diagnoses or treatment emphasizes the importance of rapid and accurate methods to establish a diagnosis. Acute thoracic, abdominal, and pelvic trauma and their complications are discussed. A chapter on high-resolution CT of spinal and facial trauma and the role of three-dimensional reconstruction images is presented.

Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial

OpenAIRE

C?t?, Pierre; Cassidy, J David; Carette, Simon; Boyle, Eleanor; Shearer, Heather M; Stupar, Maja; Ammendolia, Carlo; van der Velde, Gabrielle; Hayden, Jill A; Yang, Xiaoqing; van Tulder, Maurits; Frank, John W

2008-01-01

Abstract Background Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these findings have not been tested in a randomized controlled trial. The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in...

Pseudofracture: an acute peripheral tissue trauma model.

Science.gov (United States)

Darwiche, Sophie S; Kobbe, Philipp; Pfeifer, Roman; Kohut, Lauryn; Pape, Hans-Christoph; Billiar, Timothy

2011-04-18

Following trauma there is an early hyper-reactive inflammatory response that can lead to multiple organ dysfunction and high mortality in trauma patients; this response is often accompanied by a delayed immunosuppression that adds the clinical complications of infection and can also increase mortality. Many studies have begun to assess these changes in the reactivity of the immune system following trauma. Immunologic studies are greatly supported through the wide variety of transgenic and knockout mice available for in vivo modeling; these strains aid in detailed investigations to assess the molecular pathways involved in the immunologic responses. The challenge in experimental murine trauma modeling is long term investigation, as fracture fixation techniques in mice, can be complex and not easily reproducible. This pseudofracture model, an easily reproduced trauma model, overcomes these difficulties by immunologically mimicking an extremity fracture environment, while allowing freedom of movement in the animals and long term survival without the continual, prolonged use of anaesthesia. The intent is to recreate the features of long bone fracture; injured muscle and soft tissue are exposed to damaged bone and bone marrow without breaking the native bone. The pseudofracture model consists of two parts: a bilateral muscle crush injury to the hindlimbs, followed by injection of a bone solution into these injured muscles. The bone solution is prepared by harvesting the long bones from both hindlimbs of an age- and weight-matched syngeneic donor. These bones are then crushed and resuspended in phosphate buffered saline to create the bone solution. Bilateral femur fracture is a commonly used and well-established model of extremity trauma, and was the comparative model during the development of the pseudofracture model. Among the variety of available fracture models, we chose to use a closed method of fracture with soft tissue injury as our comparison to the

The Catalan version of the Pain Catastrophizing Scale: a useful instrument to assess catastrophic thinking in whiplash patients.

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Miró, Jordi; Nieto, Rubén; Huguet, Anna

2008-05-01

The main aims of this work were to test the psychometric properties of the Catalan version of the Pain Catastrophizing Scale (PCS) and to assess the usefulness of the scale when used with whiplash patients. This article reports results from 2 complementary studies. In the first one, the PCS was administered to 280 students and 146 chronic pain patients to examine the psychometric properties of a new Catalan version of the instrument. A confirmatory factor analysis supported a second-order structure, in which 3 second-order factors (ie, rumination, helplessness, and magnification) load in a higher-order factor (ie, catastrophizing). The reliability of the Catalan version was supported by an acceptable internal consistency and test-retest values. Validity was supported by the correlations found among the PCS and pain intensity, pain interference, and depression. The objective of the second study was to evaluate the PCS when used with whiplash patients. In this second study, 141 patients with whiplash disorders participated. In general, the psychometric properties of the PCS were found appropriate, with factor analysis supporting the structure described in patients with chronic pain. Our data suggest that the PCS is a good instrument to assess catastrophic thinking in whiplash patients. The usefulness of the PCS in whiplash disorders has been explored in this study. Results of our work show that the PCS can be a very useful tool to assess catastrophic thinking about pain in whiplash patients.

A randomised clinical trial of a comprehensive exercise program for chronic whiplash: trial protocol

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Latimer Jane

2009-12-01

Full Text Available Abstract Background Whiplash is the most common injury following a motor vehicle accident. Approximately 60% of people suffer persistent pain and disability six months post injury. Two forms of exercise; specific motor relearning exercises and graded activity, have been found to be effective treatments for this condition. Although the effect sizes for these exercise programs, individually, are modest, pilot data suggest much larger effects on pain and disability are achieved when these two treatments are combined. The aim of this study is to investigate the effectiveness and cost-effectiveness of this comprehensive exercise approach for chronic whiplash. Methods/Design A multicentre randomised controlled trial will be conducted. One hundred and seventy-six participants with chronic grade I to II whiplash will be recruited in Sydney and Brisbane, Australia. All participants will receive an educational booklet on whiplash and in addition, those randomised to the comprehensive exercise group (specific motor relearning and graded activity exercises will receive 20 progressive and individually-tailored, 1 hour exercise sessions over a 12 week period (specific motor relearning exercises: 8 sessions over 4 weeks; graded activity: 12 sessions over 8 weeks. The primary outcome to be assessed is pain intensity. Other outcomes of interest include disability, health-related quality of life and health service utilisation. Outcomes will be measured at baseline, 14 weeks, 6 months and 12 months by an assessor who is blinded to the group allocation of the subjects. Recruitment is due to commence in late 2009. Discussion The successful completion of this trial will provide evidence on the effectiveness and cost-effectiveness of a simple treatment for the management of chronic whiplash. Trial registration ACTRN12609000825257

Investigation of whiplash injuries in the upper cervical spine using a detailed neck model.

Science.gov (United States)

Fice, Jason B; Cronin, Duane S

2012-04-05

Whiplash injuries continue to have significant societal cost; however, the mechanism and location of whiplash injury is still under investigation. Recently, the upper cervical spine ligaments, particularly the alar ligament, have been identified as a potential whiplash injury location. In this study, a detailed and validated explicit finite element model of a 50th percentile male cervical spine in a seated posture was used to investigate upper cervical spine response and the potential for whiplash injury resulting from vehicle crash scenarios. This model was previously validated at the segment and whole spine levels for both kinematics and soft tissue strains in frontal and rear impact scenarios. The model predicted increasing upper cervical spine ligament strain with increasing impact severity. Considering all upper cervical spine ligaments, the distractions in the apical and alar ligaments were the largest relative to their failure strains, in agreement with the clinical findings. The model predicted the potential for injury to the apical ligament for 15.2 g frontal or 11.7 g rear impacts, and to the alar ligament for a 20.7 g frontal or 14.4 g rear impact based on the ligament distractions. Future studies should consider the effect of initial occupant position on ligament distraction. Copyright © 2012 Elsevier Ltd. All rights reserved.

Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial

Directory of Open Access Journals (Sweden)

Ammendolia Carlo

2008-12-01

Full Text Available Abstract Background Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these findings have not been tested in a randomized controlled trial. The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in improving recovery of patients with recent whiplash associated disorders. Methods and Design We designed a pragmatic randomized clinical trial. A total of 444 participants (148 in each of three arms who reside in Southern Ontario, Canada will be recruited from a large insurer. We will include individuals who are 18 years of age or older and who are diagnosed with Grade I or II Whiplash-associated Disorders. Participants will be randomized to physician-based education and activation or one of two rehabilitation programs of care currently in use in Ontario. Our primary outcome, self-rated global recovery and all secondary outcomes (neck pain intensity, whiplash disability, health-related quality of life, depressive symptomatology and satisfaction with care will be measured at baseline by a trial coordinator and at 6 weeks, 3, 6, 9 and 12 months follow-up by an interviewer who is blind to the participants' baseline characteristics and treatment allocation. We will also collect information on general health status, other injuries, comorbidities, expectation of recovery, work status, pain coping, legal representation, and co-interventions. The primary intention-to-treat analysis will compare time to recovery between the three interventions. This trial will have 90% power at an alpha of 0.05 to detect a 20% difference in the rate of perceived recovery at one year. Secondary analyses will compare the health outcomes, rate of recurrence and the rate of adverse

Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial

Science.gov (United States)

Côté, Pierre; Cassidy, J David; Carette, Simon; Boyle, Eleanor; Shearer, Heather M; Stupar, Maja; Ammendolia, Carlo; van der Velde, Gabrielle; Hayden, Jill A; Yang, Xiaoqing; van Tulder, Maurits; Frank, John W

2008-01-01

Background Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these findings have not been tested in a randomized controlled trial. The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in improving recovery of patients with recent whiplash associated disorders. Methods and Design We designed a pragmatic randomized clinical trial. A total of 444 participants (148 in each of three arms) who reside in Southern Ontario, Canada will be recruited from a large insurer. We will include individuals who are 18 years of age or older and who are diagnosed with Grade I or II Whiplash-associated Disorders. Participants will be randomized to physician-based education and activation or one of two rehabilitation programs of care currently in use in Ontario. Our primary outcome, self-rated global recovery and all secondary outcomes (neck pain intensity, whiplash disability, health-related quality of life, depressive symptomatology and satisfaction with care) will be measured at baseline by a trial coordinator and at 6 weeks, 3, 6, 9 and 12 months follow-up by an interviewer who is blind to the participants' baseline characteristics and treatment allocation. We will also collect information on general health status, other injuries, comorbidities, expectation of recovery, work status, pain coping, legal representation, and co-interventions. The primary intention-to-treat analysis will compare time to recovery between the three interventions. This trial will have 90% power at an alpha of 0.05 to detect a 20% difference in the rate of perceived recovery at one year. Secondary analyses will compare the health outcomes, rate of recurrence and the rate of adverse events between intervention

Integrating technical and non-technical skills coaching in an acute trauma surgery team training: Is it too much?

Science.gov (United States)

Alken, Alexander; Luursema, Jan-Maarten; Weenk, Mariska; Yauw, Simon; Fluit, Cornelia; van Goor, Harry

2017-08-25

Research on effective integration of technical and non-technical skills in surgery team training is sparse. In a previous study we found that surgical teachers predominantly coached on technical and hardly on non-technical skills during the Definitive Surgical and Anesthetic Trauma Care (DSATC) integrated acute trauma surgery team training. This study aims to investigate whether the priming of teachers could increase the amount of non-technical skills coaching during such a training. Coaching activities of 12 surgical teachers were recorded on audio and video. Six teachers were primed on non-technical skills coaching prior to the training. Six others received no priming and served as controls. Blind observers reviewed the recordings of 2 training scenario's and scored whether the observed behaviors were directed on technical or non-technical skills. We compared the frequency of the non-technical skills coaching between the primed and the non-primed teachers and analyzed for differences according to the trainees' level of experience. Surgical teachers coached trainees during the highly realistic DSATC integrated acute trauma surgery team training. Trainees performed damage control surgery in operating teams on anesthetized porcine models during 6 training scenario's. Twelve experienced surgical teachers participated in this study. Coaching on non-technical skills was limited to about 5%. The primed teachers did not coach more often on non-technical skills than the non-primed teachers. We found no differences in the frequency of non-technical skills coaching based on the trainees' level of experience. Priming experienced surgical teachers does not increase the coaching on non-technical skills. The current DSATC acute trauma surgery team training seems too complex for integrating training on technical and non-technical skills. Patient care, Practice based learning and improvement. Copyright © 2017 Elsevier Inc. All rights reserved.

Traumatic-event headaches

Directory of Open Access Journals (Sweden)

Haas David C

2004-10-01

Full Text Available Abstract Background Chronic headaches from head trauma and whiplash injury are well-known and common, but chronic headaches from other sorts of physical traumas are not recognized. Methods Specific information was obtained from the medical records of 15 consecutive patients with chronic headaches related to physically injurious traumatic events that did not include either head trauma or whiplash injury. The events and the physical injuries produced by them were noted. The headaches' development, characteristics, duration, frequency, and accompaniments were recorded, as were the patients' use of pain-alleviative drugs. From this latter information, the headaches were classified by the diagnostic criteria of the International Headache Society as though they were naturally-occurring headaches. The presence of other post-traumatic symptoms and litigation were also recorded. Results The intervals between the events and the onset of the headaches resembled those between head traumas or whiplash injuries and their subsequent headaches. The headaches themselves were, as a group, similar to those after head trauma and whiplash injury. Thirteen of the patients had chronic tension-type headache, two had migraine. The sustained bodily injuries were trivial or unidentifiable in nine patients. Fabrication of symptoms for financial remuneration was not evident in these patients of whom seven were not even seeking payments of any kind. Conclusions This study suggests that these hitherto unrecognized post-traumatic headaches constitute a class of headaches characterized by a relation to traumatic events affecting the body but not including head or whiplash traumas. The bodily injuries per se can be discounted as the cause of the headaches. So can fabrication of symptoms for financial remuneration. Altered mental states, not systematically evaluated here, were a possible cause of the headaches. The overall resemblance of these headaches to the headaches after

Is temporomandibular pain in chronic whiplash-associated disorders part of a more widespread pain syndrome?

Science.gov (United States)

Visscher, Corine; Hofman, Nico; Mes, Carola; Lousberg, Richel; Naeije, Machiel

2005-01-01

The prevalence of temporomandibular disorders in patients with chronic whiplash-associated disorder is a controversial issue that may be influenced by the widespread pain character and psychologic distress frequently observed in patients with chronic pain. The aim of this study was to determine the prevalence of temporomandibular disorder pain, widespread pain, and psychologic distress in persons with chronic whiplash-associated disorder pain, using a controlled, single blind study design. The prevalence of temporomandibular disorder pain in the chronic whiplash-associated disorder pain group was compared with 2 control groups: a chronic neck pain group and a no neck pain group. From 65 persons, a standardized oral history was taken, a physical examination of the neck and the masticatory system was performed, widespread pain was investigated by tender point palpation, and psychologic distress was measured with a questionnaire (SCL-90). Because the recognition of temporomandibular disorder pain and neck pain remains a matter of debate, 3 well-defined classification systems were used: one based on the oral history, a second on a combination of oral history and pain on active movements and palpation, and a third one based on a combination of oral history and function tests. Irrespective of the classification system used, the chronic whiplash-associated disorder pain group more often suffered from temporomandibular disorder pain (0.001neck pain group. Moreover, patients with whiplash-associated disorder showed more psychologic distress (0.000disorder suggests that the higher prevalence of temporomandibular disorder pain in these patients is part of a more widespread chronic pain disorder.

One year after mild injury: comparison of health status and quality of life between casualties with whiplash versus other injuries

OpenAIRE

HOURS, Martine; KHATI, Inès; CHARNAY, Pierrette; CHOSSEGROS, Laetitia; TARDY, Hélène; TOURNIER, Charlène; PERRINE, Anne-Laure; LUAUTE, Jacques; LAUMON, Bernard

2014-01-01

Objectives: To compare health status, family and occupational impact and quality of life one year after an accident between casualties with whiplash versus other mild injuries, and to explore the relation between initial injury (whiplash vs. other) and quality of life. Design: Prospective cohort study. Subjects: The study used data from the ESPARR cohort (a representative cohort of road accident casualties) and included 173 casualties with 'pure' whiplash and a population of 207 casualties wi...

What information do patients need following a whiplash injury? The perspectives of patients and physiotherapists.

Science.gov (United States)

Maujean, Annick; Sterling, Joanna; Sterling, Michele

2018-05-01

The aims of the present study were to identify information that individuals with whiplash associated disorders (WAD) need to know in the early stages of recovery and to establish whether there is a difference between what physiotherapists and whiplash-injured patients perceive as important information. Forty-one participants were recruited (20 whiplash-injured patients, 21 physiotherapists). Participants were asked to provide five statements to one open-ended question about what they believe is the most important information individuals with WAD need to know in the early stages of recovery. Participants provided 182 statements which were reviewed independently and organised into themes by two of the authors. Six key themes emerged from the statements. These included general information about whiplash injury, treatment and recovery, reassurance, provision of poor information and patients' interaction with general practitioners, maintaining daily activities, and compensation claims and litigation. Both patients and physiotherapists agreed on the type of general whiplash information that should be provided however, major differences were found with regard to information pertaining to compensation claims and litigation and maintaining daily activities. The findings of this study provide some insight into the type of information that WAD individuals require in the early stages of recovery. Implications for Rehabilitation The provision of reassurance can be an effective communication tool to decrease patients concerns about their injury and help strengthen the patient-health practitioner relationship. Although clinical guidelines for the management of whiplash injuries recommend that individuals must remain physically active post-injury, statements from the patient group indicate that this information is not always provided and clearly explained to patients. Keeping in line with the patient centred care approach of being responsive to patient needs and values, it is

Acute diagnosis of spinal trauma; Akutdiagnostik des Wirbelsaeulentraumas

Energy Technology Data Exchange (ETDEWEB)

Rieger, M.; Mallouhi, A.; Jaschke, W. [Medizinische Universitaet, Universitaetsklinik fuer Radiodiagnostik, Innsbruck (Austria); El Attal, R.; Kathrein, A.; Knop, C.; Blauth, M. [Medizinische Universitaet, Universitaetsklinik fuer Unfallchirurgie, Innsbruck (Austria)

2006-06-15

Most traumatic spinal injuries result from a high-energy process and are accompanied by other injuries. Following the CCSPR study, the presence of all low-risk factors (simple trauma mechanism, fully conscious, ambulatory at any time since trauma, neck rotation exceeding 45 bilaterally) obviates the need to acutely image the cervical spine. Imaging is indicated in all other patients. Emergency spiral CT should be performed as the first imaging method in high-risk and moderate-risk patients; only in low-risk patients should conventional radiography be performed and trusted as the sole modality. The AO classification according to Magerl et al. is used for the subaxial spine, whereas the upper cervical spine should be classified separately because the anatomy is different at each level. Radiological evaluation of traumatic spinal injuries should be done systematically using the ''ABCS'' scheme. (orig.) [German] Wirbelsaeulentraumen entstehen zumeist infolge hochenergetischer Mechanismen und sind haeufig von weiteren Verletzungen begleitet. Auf eine Diagnostik der Wirbelsaeule kann laut CCSPR-Studie nur dann verzichtet werden, wenn alle Niedrigrisikofaktoren (bewusstseinsklar, gehfaehig, ausreichender Bewegungsumfang, einfacher Unfallmechanismus) erfuellt sind. Alle anderen Patienten muessen radiologisch abgeklaert werden. Dabei sollten Patienten mit einer hohen und mittleren Verletzungswahrscheinlichkeit primaer computertomographisch untersucht werden, nur bei einer geringen Verletzungswahrscheinlichkeit kann der konventionellen Diagnostik vertraut werden. Die Frakturen der subaxialen Wirbelsaeule werden nach der Magerl-AO-Klassifikation eingeteilt, wohingegen fuer die obere HWS separate Einteilungen angewandt werden. Die radiologische Beurteilung des Wirbelsaeulentraumas sollte systematisch anhand des ''ABCS''-Schemas erfolgen. (orig.)

Alar ligaments: radiological aspects in the diagnosis of patients with whiplash injuries

International Nuclear Information System (INIS)

Muhle, C.; Brossmann, J.; Biederer, J.; Jahnke, Th.; Grimm, J.; Heller, M.

2002-01-01

Post-traumatic changes of the alar ligaments have been proposed to be the cause of chronic pain in patients after whiplash injury of the cervical spine. In addition to an asymmetric dens position, widening of the atlantodental distance to more than 12 mm can be an indirect sign of an alar ligament rupture. CT is recommended for detection of a avulsion fracture of the occipital condyle. Isolated ruptures of the alar ligaments are best visualized on MRI. In patients with chronic impairments after whiplash injuries changes of the alar ligaments on MRI must be differentiated from normal variants in healthy individuals. (orig.) [de

Risk factors for chronic disability in a cohort of patients with acute whiplash associated disorders seeking physiotherapy treatment for persisting symptoms.

Science.gov (United States)

Williamson, Esther; Williams, Mark A; Gates, Simon; Lamb, Sarah E

2015-03-01

(1) To identify risk factors for chronic disability in people with acute whiplash associated disorders (WAD). (2) To estimate the impact of the numbers of risk factors present. Prospective cohort study. Data were collected, on average, 32 days after injury (SD=10.9) and 12 months later. Baseline measures of pain, disability, neck movement, psychological and behavioural factors were independent variables and chronic disability at 12 months was the dependent variable in a multivariable logistic regression analysis. National Health Service physiotherapy departments. Participants (n=599) with symptoms 3 weeks after injury, self-referred to physiotherapy as part of a randomised controlled trial. 430 (72%) participants provided complete data for this analysis. Chronic disability based on Neck Disability Index scores. 136 (30%) participants developed chronic disability. High baseline disability (OR 3.3, 95% CI 1.97 to 5.55), longer predicted recovery time (OR 2.4, 95% CI 1.45 to 3.87), psychological distress (OR 1.9, 95%CI 1.05 to 3.51), passive coping (OR 1.8, 95% CI 1.07 to 2.97) and greater number of symptoms (OR 1.7, 95% CI 1.07 to 2.78) were associated with chronic disability. One risk factor resulted in 3.5 times the risk (95% CI 1.04 to 11.45) of chronic disability but this risk increased to 16 times (95%CI 5.36 to 49.27) in those with four or five risk factors. Baseline disability had the strongest association with chronic disability but psychological and behavioural factors were also important. Treatment strategies should reflect this which may require a change to current physiotherapy approaches for acute WAD. The number of risk factors present should be considered when evaluating potential for poor outcome. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Trauma memory characteristics and the development of acute stress disorder and post-traumatic stress disorder in youth.

Science.gov (United States)

McKinnon, A; Brewer, N; Meiser-Stedman, R; Nixon, R D V

2017-03-01

The present study addresses gaps in knowledge regarding the association between trauma memory processes and posttraumatic stress responses in youth. Our primary goal was to explore the relative contribution of perceptions of trauma memory quality versus narrative trauma memory characteristics to explain overall adjustment. Children (N = 67) were interviewed within four weeks (T1) of an injury leading to hospital treatment and then again eight weeks later (T2). In each interview, the child told a trauma narrative (which were later coded), and answered the Trauma Memory Quality Questionnaire (Meiser-Stedman, Smith, Yule, & Dalgleish, 2007a), a self-report measure indexing the sensory, fragmented, and disorganised characteristics of trauma memory. They then completed measures of Acute Stress Disorder (ASD) symptoms and associated psychopathology at T1 and measures of Posttraumatic Stress (PTS) symptoms and associated psychopathology at T2. Self-reported trauma memory characteristics predicted ASD symptoms cross-sectionally at T1 and PTS symptoms prospectively over time. At both time points, self-reported trauma memory characteristics accounted for all of the unique variance in symptoms initially explained by narrative characteristics. A reduction in self-report ratings, but not the hypothesised narrative features (e.g., disorganised or lexical elements of the narrative), significantly predicted a reduction in PTS symptoms over time. The small sample size and the absence of a within-subjects narrative control were the main limitations of the study. These findings underscore the importance of self-reported trauma memory characteristics to the aetiology of PTSD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Prognosis of patients with whiplash-associated disorders consulting physiotherapy

DEFF Research Database (Denmark)

Bohman, Tony; Côté, Pierre; Boyle, Eleanor

2012-01-01

BACKGROUND: Patients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists....

Recruitment bias in chronic pain research: whiplash as a model.

Science.gov (United States)

Nijs, Jo; Inghelbrecht, Els; Daenen, Liesbeth; Hachimi-Idrissi, Said; Hens, Luc; Willems, Bert; Roussel, Nathalie; Cras, Patrick; Wouters, Kristien; Bernheim, Jan

2011-11-01

In science findings which cannot be extrapolated to other settings are of little value. Recruitment methods vary widely across chronic whiplash studies, but it remains unclear whether this generates recruitment bias. The present study aimed to examine whether the recruitment method accounts for differences in health status, social support, and personality traits in patients with chronic whiplash-associated disorders (WAD). Two different recruitment methods were compared: recruiting patients through a local whiplash patient support group (group 1) and local hospital emergency department (group 2). The participants (n=118) filled in a set of questionnaires: the Neck Disability Index, Medical Outcome Study Short-Form General Health Survey, Anamnestic Comparative Self-Assessment measure of overall well-being, Symptom Checklist-90, Dutch Personality Questionnaire, and the Social Support List. The recruitment method (either through the local emergency department or patient support group) accounted for the differences in insufficiency, somatization, disability, quality of life, self-satisfaction, and dominance (all p values recruitment methods generated chronic WAD patients comparable for psychoneurotism, social support, self-sufficiency, (social) inadequacy, rigidity, and resentment (p>.01). The recruitment of chronic WAD patients solely through patient support groups generates bias with respect to the various aspects of health status and personality, but not social support. In order to enhance the external validity of study findings, chronic WAD studies should combine a variety of recruitment procedures.

Magnetic Resonance Imaging-Based Prediction of the Relationship between Whiplash Injury and Temporomandibular Disorders.

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Lee, Yeon-Hee; Lee, Kyung Mi; Auh, Q-Schick; Hong, Jyung-Pyo

2017-01-01

Whiplash injury can cause internal derangement of the temporomandibular joint (TMJ) and lead to temporomandibular disorders (TMDs). Our aim was to evaluate whether the initial clinical findings in TMD patients with whiplash injury are correlated with their magnetic resonance imaging (MRI) characteristics. This case-control study involved 219 patients (135 women, 84 men; mean age: 37.84 years) who visited our orofacial pain clinic with TMD; TMD was diagnosed using the diagnostic criteria for TMD Axis I. Patients were categorized into three groups based on the presence and type of macrotrauma: in the "wTMD" group, patients had suffered whiplash injury; patients in the "pTMD" group had post-traumatic TMD; the "iTMD" group comprised patients who had presented with TMD symptoms and had sustained no macrotrauma. We investigated the presence of disk displacement, effusion, disk deformity, and condylar degeneration, and changes in the lateral pterygoid muscle (LPM). To evaluate the severity of TMD pain and objectively analyze symptoms, we used a visual analog scale (VAS), palpation index (PI), neck PI, dysfunction index, and craniomandibular index (CMI). The VAS scores, and the severity indexes of the TMD including PI, neck PI, and CMI were highest in the wTMD patients. Atrophy of the LPM was most commonly seen in the wTMD group, as was disk deformity. In wTMD patients only, VAS score was significantly correlated with stress; it was correlated with headache in wTMD and iTMD patients. The clinical symptoms of TMD were not correlated with MRI findings in the wTMD group. However, alterations in the LPM were strongly correlated with disk displacement. If clinicians recognize alterations in the LPM and disk displacement in the TMJ, they will better understand the clinical symptoms and pathophysiology of TMD with whiplash injury. Whiplash injury may lead to TMD via different mechanisms from other macrotraumas.

Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia after acute foot trauma

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Tobias Wienemann

2014-11-01

Full Text Available Introduction and objective: Acute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e. history of foot ulcer or Charcot arthropathy. Design and methods: A case–control study was done on 25 unselected clinical routine patients with acute unilateral foot trauma (cases: elective bone surgery; controls: sprain, toe fracture. Cases were 12 patients (11 diabetic subjects with severe painless neuropathy and chronic foot pathology. Controls were 13 non-neuropathic persons. Over 1 week after the trauma, cutaneous pressure pain perception threshold (CPPPT and deep pressure pain perception threshold (DPPPT were measured repeatedly, adjacent to the injury and at the opposite foot (pinprick stimulators, Algometer II®. Results: In the control group, post-traumatic DPPPT (but not CPPPT at the injured foot was reduced by about 15–25%. In the case group, pre- and post-operative CPPPT and DPPPT were supranormal. Although DPPPT fell post-operatively by about 15–20%, it remained always higher than the post-traumatic DPPPT in the control group: over musculus abductor hallucis 615 kPa (kilopascal versus 422 kPa, and over metatarsophalangeal joint 518 kPa versus 375 kPa (medians; case vs. control group; CPPPT did not decrease post-operatively. Conclusion: Physiological nociception and post-traumatic hyperalgesia to pressure are diminished at the foot with severe painless (diabetic neuropathy. A degree of post-traumatic hypersensitivity required to ‘pull away’ from any one, even innocuous, mechanical impact in order to avoid additional damage is, therefore, lacking.

Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia) after acute foot trauma

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Wienemann, Tobias; Chantelau, Ernst A.; Koller, Armin

2014-01-01

Introduction and objective Acute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic) neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e. history of foot ulcer or Charcot arthropathy). Design and methods A case–control study was done on 25 unselected clinical routine patients with acute unilateral foot trauma (cases: elective bone surgery; controls: sprain, toe fracture). Cases were 12 patients (11 diabetic subjects) with severe painless neuropathy and chronic foot pathology. Controls were 13 non-neuropathic persons. Over 1 week after the trauma, cutaneous pressure pain perception threshold (CPPPT) and deep pressure pain perception threshold (DPPPT) were measured repeatedly, adjacent to the injury and at the opposite foot (pinprick stimulators, Algometer II®). Results In the control group, post-traumatic DPPPT (but not CPPPT) at the injured foot was reduced by about 15–25%. In the case group, pre- and post-operative CPPPT and DPPPT were supranormal. Although DPPPT fell post-operatively by about 15–20%, it remained always higher than the post-traumatic DPPPT in the control group: over musculus abductor hallucis 615 kPa (kilopascal) versus 422 kPa, and over metatarsophalangeal joint 518 kPa versus 375 kPa (medians; case vs. control group); CPPPT did not decrease post-operatively. Conclusion Physiological nociception and post-traumatic hyperalgesia to pressure are diminished at the foot with severe painless (diabetic) neuropathy. A degree of post-traumatic hypersensitivity required to ‘pull away’ from any one, even innocuous, mechanical impact in order to avoid additional damage is, therefore, lacking. PMID:25397867

Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia) after acute foot trauma.

Science.gov (United States)

Wienemann, Tobias; Chantelau, Ernst A; Koller, Armin

2014-01-01

Acute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic) neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e. history of foot ulcer or Charcot arthropathy). A case-control study was done on 25 unselected clinical routine patients with acute unilateral foot trauma (cases: elective bone surgery; controls: sprain, toe fracture). Cases were 12 patients (11 diabetic subjects) with severe painless neuropathy and chronic foot pathology. Controls were 13 non-neuropathic persons. Over 1 week after the trauma, cutaneous pressure pain perception threshold (CPPPT) and deep pressure pain perception threshold (DPPPT) were measured repeatedly, adjacent to the injury and at the opposite foot (pinprick stimulators, Algometer II(®)). In the control group, post-traumatic DPPPT (but not CPPPT) at the injured foot was reduced by about 15-25%. In the case group, pre- and post-operative CPPPT and DPPPT were supranormal. Although DPPPT fell post-operatively by about 15-20%, it remained always higher than the post-traumatic DPPPT in the control group: over musculus abductor hallucis 615 kPa (kilopascal) versus 422 kPa, and over metatarsophalangeal joint 518 kPa versus 375 kPa (medians; case vs. control group); CPPPT did not decrease post-operatively. Physiological nociception and post-traumatic hyperalgesia to pressure are diminished at the foot with severe painless (diabetic) neuropathy. A degree of post-traumatic hypersensitivity required to 'pull away' from any one, even innocuous, mechanical impact in order to avoid additional damage is, therefore, lacking.

Long-term Labour Market Performance of Whiplash Claimants

DEFF Research Database (Denmark)

Leth-Petersen, Søren; Rotger, Gabriel Pons

financial incentive to not reduce earnings. This suggests that moderate injuries tend to be chronic, and that compensation-seeking behaviour is not the main explanation for this group. We find that claimants with chronic WADs used more health care in the year prior to the whiplash than claimants with non...

Long term labour market performance of whiplash claimants

DEFF Research Database (Denmark)

Leth-Petersen, Søren; Rotger, Gabriel Pons

2009-01-01

financial incentive to not reduce earnings. This suggests that moderate injuries tend to be chronic, and that compensation-seeking behaviour is not the main explanation for this group. We find that claimants with chronic WADs used more health care in the year prior to the whiplash than claimants with non...

One year after mild injury: comparison of health status and quality of life between patients with whiplash versus other injuries.

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Hours, Martine; Khati, Inès; Charnay, Pierrette; Chossegros, Laetitia; Tardy, Hélène; Tournier, Charlène; Perrine, Anne-Laure; Luauté, Jacques; Laumon, Bernard

2014-03-01

To compare health status, effect on family, occupational consequences, and quality of life (QOL) 1 year after an accident between patients with whiplash versus other mild injuries, and to explore the relationship between initial injury (whiplash vs other) and QOL. This was a prospective cohort study. The study used data from the ESPARR cohort (a representative cohort of road accident victims) and included 173 individuals with "pure" whiplash and 207 with other mild injuries. QOL at 1-year followup was assessed on the World Health Organization Quality of Life questionnaire. Correlations between explanatory variables and QOL were explored by Poisson regression to provide adjusted relative risks, with ANOVA for the various QOL scores explored. One year post-accident, more patients who had whiplash than other casualties complained of nonrecovery of health status (56% vs 43%) and of the occupational effect of pain (31% vs 23%). QOL and posttraumatic stress disorder (PTSD) were similar in the 2 groups. Impaired QOL did not correlate with whiplash when models were adjusted on sociodemographic variables and history of psychological distress. Whatever the initial lesion, PTSD was a determining factor for poorer QOL. Sociodemographic factors, preaccident psychological history prior to the accident, and PTSD were the main factors influencing QOL, rather than whether the injury was whiplash. PTSD may also be related to pain.

Evaluation of SOCOM Wireless Monitor in Trauma Patients

Science.gov (United States)

2016-02-01

justified in polytrauma patients? Presented at 2014 American College of Surgeons Florida Committee on Trauma Paper Competition Jacksonville, FL Oct...Model of Polytrauma , Hemorrhage and Traumatic Brain Injury” J Trauma Acute Care Surg 2013 Dec 75(6):974-975 4) Thorson CM, Dubose JJ, Rhee P, Knuth TE...injury increase the risk for venous thromboembolism in polytrauma patients? J Trauma Acute Care Surg 2014 Aug;77(2):243-50. 26) Ryan ML, Van Haren RM

Does cervical kyphosis relate to symptoms following whiplash injury?

DEFF Research Database (Denmark)

Johansson, Mats Peter; Baann Liane, Martin Skogheim; Bendix, Tom

2011-01-01

The mechanisms for developing long-lasting neck pain after whiplash injuries are still largely unrevealed. In the present study it was investigated whether a kyphotic deformity of the cervical spine, as opposed to a straight or a lordotic spine, was associated with the symptoms at baseline...... appearance of the cervical spine in supine MRI. In relation to symptoms it was seen that a kyphotic deformity was associated with reporting the highest intensities of headache at baseline, but not with an increased risk of long-lasting neck pain or headache. In conclusion, a kyphotic deformity...... is not significantly associated with chronic whiplash associated pain. Moreover, it is a clear clinical implication that pain should not be ascribed to a straight spine on MRI. We suggest that future trials on cervical posture focus upon the presence of kyphotic deformity rather than just on the absence of lordosis....

Burnout in Patients with Chronic Whiplash-Associated Disorders

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Clementz, Gunilla; Borsbo, Bjorn; Norrbrink, Cecilia

2012-01-01

This study sought to assess burnout and its relation to pain, disability, mood and health-related quality of life in a group of patients with chronic whiplash-associated disorders (WAD). Forty-five patients with chronic WAD ([greater than or equal to] 3 months) referred to a multidisciplinary rehabilitation centre were included. A questionnaire…

Post-traumatic acute kidney injury: a cross-sectional study of trauma patients.

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Lai, Wei-Hung; Rau, Cheng-Shyuan; Wu, Shao-Chun; Chen, Yi-Chun; Kuo, Pao-Jen; Hsu, Shiun-Yuan; Hsieh, Ching-Hua; Hsieh, Hsiao-Yun

2016-11-22

The causes of post-traumatic acute kidney injury (AKI) are multifactorial, and shock associated with major trauma has been proposed to result in inadequate renal perfusion and subsequent AKI in trauma patients. This study aimed to investigate the true incidence and clinical presentation of post-traumatic AKI in hospitalized adult patients and its association with shock at a Level I trauma center. Detailed data of 78 trauma patients with AKI and 14,504 patients without AKI between January 1, 2009 and December 31, 2014 were retrieved from the Trauma Registry System. Patients with direct renal trauma were excluded from this study. Two-sided Fisher's exact or Pearson's chi-square tests were used to compare categorical data, unpaired Student's t-test was used to analyze normally distributed continuous data, and Mann-Whitney's U test was used to compare non-normally distributed data. Propensity score matching with a 1:1 ratio with logistic regression was used to evaluate the effect of shock on AKI. Patients with AKI presented with significantly older age, higher incidence rates of pre-existing comorbidities, higher odds of associated injures (subdural hematoma, intracerebral hematoma, intra-abdominal injury, and hepatic injury), and higher injury severity than patients without AKI. In addition, patients with AKI had a longer hospital stay (18.3 days vs. 9.8 days, respectively; P < 0.001) and intensive care unit (ICU) stay (18.8 days vs. 8.6 days, respectively; P < 0. 001), higher proportion of admission into the ICU (57.7% vs. 19.0%, respectively; P < 0.001), and a higher odds ratio (OR) of short-term mortality (OR 39.0; 95% confidence interval, 24.59-61.82; P < 0.001). However, logistic regression analysis of well-matched pairs after propensity score matching did not show a significant influence of shock on the occurrence of AKI. We believe that early and aggressive resuscitation, to avoid prolonged untreated shock, may help to prevent the occurrence

The craniocervical connection: a retrospective analysis of 300 whiplash patients with cervical and temporomandibular disorders.

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Friedman, M H; Weisberg, J

2000-07-01

Because the concept of whiplash as a causative factor for temporomandibular disorders (TMD) is highly controversial, we decided to do a retrospective analysis of patients treated in our office who had sustained whiplash injuries and were treated for cervical and temporomandibular disorders. The records of 300 patients with TMD preceded by a motor vehicle accident were examined retrospectively. The most common presenting symptoms, in order, were: jaw pain, neck pain, post-traumatic headache, jaw fatigue, and severe temporomandibular joint (TMJ) clicking. The most common TMD diagnoses were: masseter trigger points, closing jaw muscle hyperactivity, TMJ synovitis, opening jaw muscle hyperactivity, and advanced TMJ disk derangement. Based primarily on the physical examination, we concluded that the TMJ and surrounding musculature should be examined similarly to other joints, with no preconceived notion that TMD pathology after whiplash is unlikely.

Acute Pancreatitis as a Model to Predict Transition of Systemic Inflammation to Organ Failure in Trauma and Critical Illness

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2017-10-01

models ); • clinical interventions; • new business creation; and • other. Nothing to report. Nothing to report. Nothing to report. 17...AWARD NUMBER: W81XWH-14-1-0376 TITLE: Acute Pancreatitis as a Model to Predict Transition of Systemic Inflammation to Organ Failgure in Trauma...COVERED 22 Sep 2016 - 21 Sep 2017 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Acute Pancreatitis as a Model to Predict Transition of Systemic

Pre- and post-operative gait analysis for evaluation of neck pain in chronic whiplash

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Ginsburg Glen M

2009-07-01

Full Text Available Abstract Introduction Chronic neck pain after whiplash is notoriously refractory to conservative treatment, and positive radiological findings to explain the symptoms are scarce. The apparent disproportionality between subjective complaints and objective findings is significant for the planning of treatment, impairment ratings, and judicial questions on causation. However, failure to identify a symptom's focal origin with routine imaging studies does not invalidate the symptom per se. It is therefore of a general interest both to develop effective therapeutic strategies in chronic whiplash, and to establish techniques for objectively evaluation of treatment outcomes. Methods Twelve patients with chronic neck pain after whiplash underwent pre- and postoperative computerized 3D gait analysis. Results Significant improvement was found in all gait parameters, cervical range-of-motion, and self reported pain (VAS. Conclusion Chronic neck pain is associated with abnormal cervical spine motion and gait patterns. 3D gait analysis is a useful instrument to assess the outcome of treatment for neck pain.

Expectancies mediate the relationship between perceived injustice and return to work following whiplash injury: A 1-year prospective study.

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Carriere, J S; Thibault, P; Adams, H; Milioto, M; Ditto, B; Sullivan, M J L

2017-08-01

Emerging evidence suggests that perceived injustice is a risk factor for work disability in individuals with whiplash injury. At present, however, little is known about the processes by which perceived injustice impacts on return to work. The purpose of this study was to examine whether expectancies mediated the relationship between perceived injustice and return to work in patients with whiplash injury. One hundred and fifty-two individuals (81 men, 71 women) with a primary diagnosis of whiplash injury completed self-report measures of pain intensity, perceived injustice and return-to-work expectancies following admission to a rehabilitation programme. Work status was assessed 1 year after discharge. Consistent with previous research, high scores on a measure of perceived injustice were associated with prolonged work disability. Results indicated that high perceptions of injustice were associated with low return-to-work expectancies. Causal mediation analyses revealed that expectancies fully mediated the relationship between perceived injustice and return to work. The findings suggest that intervention techniques designed to target expectancies could improve return-to-work outcomes in patients with whiplash injury. Discussion addresses the processes by which expectancies might impact on return-to-work outcomes and the manner in which negative return-to-work expectancies might be modified through intervention. The study confirms that expectancies are the mechanism through which perceived injustice impacts return to work following whiplash injury. The findings suggest that interventions designed to specifically target return-to-work expectancies might improve rehabilitation outcomes in patients with whiplash injury. © 2017 European Pain Federation - EFIC®.

Predisposing, precipitating and perpetuating factors and the common sense model of illness

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Carstensen, Tina; Kasch, Helge; Frostholm, Lisbeth

2017-01-01

Background: Various predisposing, precipitating and perpetuating factors are found to be associated with development of persistent symptoms and disability after whiplash trauma. According to the commonsense model of illness, people use commonsense knowledge to develop individual illness models when...... facing health threat. Question: Can we use the common-sense model as a unifying model to encompass the impact of predisposing, precipitating, and perpetuating factors in the development of chronic whiplash? Looking into specific factors and their interaction: Do illness perceptions mediate the effect...... of precollision sick leave on chronic whiplash? Methods: This presentation will integrate findings from research on predisposing, precipitating, perpetuating factors that are associated with poor outcome after whiplash trauma and propose the common-sense model as a unifying model. Data from a study including 740...

Determination of fibromyalgia syndrome after whiplash injuries: methodologic issues.

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Robinson, James P; Theodore, Brian R; Wilson, Hilary D; Waldo, Peter G; Turk, Dennis C

2011-06-01

Problems in diagnosing fibromyalgia syndrome (FM) among motor vehicle collision (MVC) patients with whiplash (WL) include the following: the predominance of tender points (TPs) in the neck/shoulder girdle region; the 3-month duration of widespread pain criterion; and, the stability of diagnosis. The present study examined the prevalence of FM in a cohort (N = 326) patients with persistent neck pain 3 months after WL injury who were enrolled in a treatment program. Physical examinations were performed at baseline and at the end of treatment. Results indicated that WL patients had a greater proportion of neck/shoulder girdle TPs, relative to distal TPs. Compared with a matched cohort of treatment-seeking FM patients, WL patients indicated less distal TPs (mean = 7.3 TPs vs. mean = 5.6 TPs, P whiplash patients because of persistent localized tenderness after motor vehicle collisions. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Persistent pseudomyopia following a whiplash injury in a previously emmetropic woman

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Fintan E. Hughes

2017-12-01

It is important that such cases are identified at presentation, as early intervention can improve outcomes in accommodative spasm and reduce the long term psychological effects often associated with whiplash injuries.

A CASE OF SELF-INDUCED ACUTE HYDROPS IN A PATIENT WITH IMPULSE CONTROL DISORDER ASSOCIATED WITH COMPULSIVE EYE TRAUMA

OpenAIRE

Bindu Madhavi; Soumya

2016-01-01

PURPOSE To describe acute hydrops in a patient with impulse control disorder (not otherwise specified) secondary to self-induced repetitive eye trauma. METHODS A 22-year-old male patient was referred from a psychiatrist with a diagnosis of impulse control disorder not otherwise specified (compulsive impulse self-mutilating behaviour) for opacity and watering of both eyes (left eye more than right eye). Left eye showed features of acute hydrops with Descemet’s tear and rig...

Five years post whiplash injury: Symptoms and psychological factors in recovered versus non-recovered

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Stålnacke Britt-Marie

2010-07-01

Full Text Available Abstract Background Few studies have focused on the differences between persons who are recovered after whiplash injury and those who suffer from persistent disability. The primary aim of this study was therefore to examine differences in symptoms, psychological factors and life satisfaction between subjects classified as recovered and those with persistent disability five years after whiplash injury based on the Neck Disability Index (NDI. Methods A set of questionnaires was answered by 158 persons (75 men, 83 women to assess disability (NDI, pain intensity (VAS, whiplash-related symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ, post-traumatic stress (Impact of Event Scale, IES, depression (Beck's depression inventory, BDI and life satisfaction (LiSat-11. The participants were divided into three groups based on the results of the NDI: recovered (34.8%, mild disability (37.3% and moderate/severe disability (27.3%. Results The moderate/severe group reported significantly higher VAS, BDI and IES scores and lower level of physical health and psychological health compared to the mild and the recovered groups. Less significant differences were reported between the mild and the recovered groups. Conclusions The group with the highest disability score reported most health problems with pain, symptoms, depression, post-traumatic stress and decreased life satisfaction. These findings indicate that classifying these subjects into subgroups based on disability levels makes it possible to optimize the management and treatment after whiplash injury.

Pharmacist's impact on acute pain management during trauma resuscitation.

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Montgomery, Kayla; Hall, A Brad; Keriazes, Georgia

2015-01-01

The timely administration of analgesics is crucial to the comprehensive management of trauma patients. When an emergency department (ED) pharmacist participates in trauma resuscitation, the pharmacist acts as a medication resource for trauma team members and facilitates the timely administration of analgesics. This study measured the impact of a pharmacist on time to first analgesic dose administered during trauma resuscitation. All adult (>18 years) patients who presented to this level II trauma center via activation of the trauma response system between January 1, 2009, and May 31, 2013, were screened for eligibility. For inclusion, patients must have received intravenous fentanyl, morphine, or hydromorphone in the trauma bay. The time to medication administration was defined as the elapsed time from ED arrival to administration of first analgesic. There were 1328 trauma response system activations during the study period; of which 340 patients were included. The most common analgesic administered was fentanyl (62% in both groups). When a pharmacist was participating, the mean time to first analgesic administered was decreased (17 vs 21 minutes; P = .03). Among the 78% of patients with documented pain scores, the overall mean reduction in pain scores from ED arrival to ED discharge was similar between the 2 groups. There was a 2.4 point reduction with a pharmacist versus 2.7 without a pharmacist, using a 0 to 10 numeric pain rating scale. The participation of a clinical pharmacist during trauma resuscitation significantly decreased the time to first analgesic administration in trauma patients. The results of this study supplement the literature supporting the integration of clinical ED pharmacists on trauma teams.

The relationship of whiplash injury and temporomandibular disorders: a narrative literature review☆

Science.gov (United States)

Fernandez, Charles E.; Amiri, Abid; Jaime, Joseph; Delaney, Paul

2009-01-01

Objective The purpose of this article is to offer a narrative review and discuss the possible relationship between temporomandibular disorders (TMDs) and whiplash injuries. Methods Databases from 1966 to present were searched including PubMed; Manual, Alternative, and Natural Therapy Index System; and Cumulative Index for Nursing and Allied Health Literature. Search terms used included whiplash injury, temporomandibular disorders and craniomandibular disorders. Inclusion criteria consisted of studies on orofacial pain of a musculoskeletal origin addressing the following topics: posttraumatic temporomandibular disorder (pTMD) incidence and prevalence, mechanism of injury, clinical findings and characteristics, prognosis (including psychologic factors). Excluded were studies of orofacial pain from nontraumatic origin, as well as nonmusculoskeletal causes including neurologic, vascular, neoplastic, or infectious disease. Results Thirty-two studies describing the effects of whiplash on TMD were reviewed based on inclusion/exclusion criteria. The best evidence from prospective studies indicates a low to moderate incidence and prevalence. Only 3 studies addressed mechanism of injury theories. Most studies focusing on clinical findings and characteristics suggest significant differences when comparing pTMD to idiopathic/nontraumatic patients. Regarding prognosis, most studies suggest a significant difference when comparing pTMD to idiopathic/nontraumatic TMD patients, with pTMD having a poorer prognosis. Conclusions There is conflicting evidence regarding the effects of whiplash on the development of TMD. Furthermore, because of lack of homogeneity in the study populations and lack of standardization of data collection procedures and outcomes measured, this review cannot conclusively resolve the controversies that exist concerning this relationship. This review of the literature is provided to clarify the issues and to provide useful clinical information for health care

Magnetic Resonance Imaging-Based Prediction of the Relationship between Whiplash Injury and Temporomandibular Disorders

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Yeon-Hee Lee

2018-01-01

Full Text Available PurposeWhiplash injury can cause internal derangement of the temporomandibular joint (TMJ and lead to temporomandibular disorders (TMDs. Our aim was to evaluate whether the initial clinical findings in TMD patients with whiplash injury are correlated with their magnetic resonance imaging (MRI characteristics.Materials and methodsThis case–control study involved 219 patients (135 women, 84 men; mean age: 37.84 years who visited our orofacial pain clinic with TMD; TMD was diagnosed using the diagnostic criteria for TMD Axis I. Patients were categorized into three groups based on the presence and type of macrotrauma: in the “wTMD” group, patients had suffered whiplash injury; patients in the “pTMD” group had post-traumatic TMD; the “iTMD” group comprised patients who had presented with TMD symptoms and had sustained no macrotrauma. We investigated the presence of disk displacement, effusion, disk deformity, and condylar degeneration, and changes in the lateral pterygoid muscle (LPM. To evaluate the severity of TMD pain and objectively analyze symptoms, we used a visual analog scale (VAS, palpation index (PI, neck PI, dysfunction index, and craniomandibular index (CMI.ResultsThe VAS scores, and the severity indexes of the TMD including PI, neck PI, and CMI were highest in the wTMD patients. Atrophy of the LPM was most commonly seen in the wTMD group, as was disk deformity. In wTMD patients only, VAS score was significantly correlated with stress; it was correlated with headache in wTMD and iTMD patients. The clinical symptoms of TMD were not correlated with MRI findings in the wTMD group. However, alterations in the LPM were strongly correlated with disk displacement.ConclusionIf clinicians recognize alterations in the LPM and disk displacement in the TMJ, they will better understand the clinical symptoms and pathophysiology of TMD with whiplash injury. Whiplash injury may lead to TMD via different mechanisms from other macrotraumas.

Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center.

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Katzberg, R W; Benedetti, P F; Drake, C M; Ivanovic, M; Levine, R A; Beatty, C S; Nemzek, W R; McFall, R A; Ontell, F K; Bishop, D M; Poirier, V C; Chong, B W

1999-10-01

To determine the weighted average sensitivity of magnetic resonance (MR) imaging in the prospective detection of acute neck injury and to compare these findings with those of a comprehensive conventional radiographic assessment. Conventional radiography and MR imaging were performed in 199 patients presenting to a level 1 trauma center with suspected cervical spine injury. Weighted sensitivities and specificities were calculated, and a weighted average across eight vertebral levels from C1 to T1 was formed. Fourteen parameters indicative of acute injury were tabulated. Fifty-eight patients had 172 acute cervical injuries. MR imaging depicted 136 (79%) acute abnormalities and conventional radiography depicted 39 (23%). For assessment of acute fractures, MR images (weighted average sensitivity, 43%; CI: 21%, 66%) were comparable to conventional radiographs (weighted average sensitivity, 48%; CI: 30%, 65%). MR imaging was superior to conventional radiography in the evaluation of pre- or paravertebral hemorrhage or edema, anterior or posterior longitudinal ligament injury, traumatic disk herniation, cord edema, and cord compression. Cord injuries were associated with cervical spine spondylosis (P < .05), acute fracture (P < .001), and canal stenosis (P < .001). MR imaging is more accurate than radiography in the detection of a wide spectrum of neck injuries, and further study is warranted of its potential effect on medical decision making, clinical outcome, and cost-effectiveness.

Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? A prospective observational study

DEFF Research Database (Denmark)

Johansson, Per Ingemar; Sorensen, Anne Marie; Perner, Anders

2011-01-01

the prevalence of overt DIC and ACoTS in trauma patients and characterized these conditions based on their biomarker profiles. METHODS: Observational study at a single Level I Trauma Centre. Inclusion of 80 adult trauma patients ([greater than or equal to]18 years) who met criteria for full trauma team...

Appendicitis following blunt abdominal trauma.

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Cobb, Travis

2017-09-01

Appendicitis is a frequently encountered surgical problem in the Emergency Department (ED). Appendicitis typically results from obstruction of the appendiceal lumen, although trauma has been reported as an infrequent cause of acute appendicitis. Intestinal injury and hollow viscus injury following blunt abdominal trauma are well reported in the literature but traumatic appendicitis is much less common. The pathophysiology is uncertain but likely results from several mechanisms, either in isolation or combination. These include direct compression/crush injury, shearing injury, or from indirect obstruction of the appendiceal lumen by an ileocecal hematoma or traumatic impaction of stool into the appendix. Presentation typically mirrors that of non-traumatic appendicitis with nausea, anorexia, fever, and right lower quadrant abdominal tenderness and/or peritonitis. Evaluation for traumatic appendicitis requires a careful history and physical exam. Imaging with ultrasound or computed tomography is recommended if the history and physical do not reveal an acute surgical indication. Treatment includes intravenous antibiotics and surgical consultation for appendectomy. This case highlights a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident. Appendicitis must be considered as part of the differential diagnosis in any patient who presents to the ED with abdominal pain, including those whose pain begins after sustaining blunt trauma to the abdomen. Because appendicitis following trauma is uncommon, timely diagnosis requires a high index of suspicion. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors associated with work ability in patients with chronic whiplash-associated disorder grade II-III: A cross-sectional analysis.

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Agnew, Louise; Johnston, Venerina; Landén Ludvigsson, Maria; Peterson, Gunnel; Overmeer, Thomas; Johansson, Gun; Peolsson, Anneli

2015-06-01

To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III. Cross-sectional analysis. A total of 166 working age patients with chronic whiplash-associated disorder. A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability. The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R2 = 0.65, p whiplash-associated disorder.

Elevated [11C]-D-Deprenyl Uptake in Chronic Whiplash Associated Disorder Suggests Persistent Musculoskeletal Inflammation

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Linnman, Clas; Appel, Lieuwe; Fredrikson, Mats; Gordh, Torsten; Söderlund, Anne; Långström, Bengt; Engler, Henry

2011-01-01

There are few diagnostic tools for chronic musculoskeletal pain as structural imaging methods seldom reveal pathological alterations. This is especially true for Whiplash Associated Disorder, for which physical signs of persistent injuries to the neck have yet to be established. Here, we sought to visualize inflammatory processes in the neck region by means Positron Emission Tomography using the tracer 11C-D-deprenyl, a potential marker for inflammation. Twenty-two patients with enduring pain after a rear impact car accident (Whiplash Associated Disorder grade II) and 14 healthy controls were investigated. Patients displayed significantly elevated tracer uptake in the neck, particularly in regions around the spineous process of the second cervical vertebra. This suggests that whiplash patients have signs of local persistent peripheral tissue inflammation, which may potentially serve as a diagnostic biomarker. The present investigation demonstrates that painful processes in the periphery can be objectively visualized and quantified with PET and that 11C-D-deprenyl is a promising tracer for these purposes. PMID:21541010

Elevated [11C]-D-deprenyl uptake in chronic Whiplash Associated Disorder suggests persistent musculoskeletal inflammation.

Directory of Open Access Journals (Sweden)

Clas Linnman

Full Text Available There are few diagnostic tools for chronic musculoskeletal pain as structural imaging methods seldom reveal pathological alterations. This is especially true for Whiplash Associated Disorder, for which physical signs of persistent injuries to the neck have yet to be established. Here, we sought to visualize inflammatory processes in the neck region by means Positron Emission Tomography using the tracer (11C-D-deprenyl, a potential marker for inflammation. Twenty-two patients with enduring pain after a rear impact car accident (Whiplash Associated Disorder grade II and 14 healthy controls were investigated. Patients displayed significantly elevated tracer uptake in the neck, particularly in regions around the spineous process of the second cervical vertebra. This suggests that whiplash patients have signs of local persistent peripheral tissue inflammation, which may potentially serve as a diagnostic biomarker. The present investigation demonstrates that painful processes in the periphery can be objectively visualized and quantified with PET and that (11C-D-deprenyl is a promising tracer for these purposes.

Does cervical kyphosis relate to symptoms following whiplash injury?

DEFF Research Database (Denmark)

Johansson, Mats Peter; Baann Liane, Martin Skogheim; Bendix, Tom

2011-01-01

is not significantly associated with chronic whiplash associated pain. Moreover, it is a clear clinical implication that pain should not be ascribed to a straight spine on MRI. We suggest that future trials on cervical posture focus upon the presence of kyphotic deformity rather than just on the absence of lordosis....

Underestimation of Severity of Previous Whiplash Injuries

Science.gov (United States)

Naqui, SZH; Lovell, SJ; Lovell, ME

2008-01-01

INTRODUCTION We noted a report that more significant symptoms may be expressed after second whiplash injuries by a suggested cumulative effect, including degeneration. We wondered if patients were underestimating the severity of their earlier injury. PATIENTS AND METHODS We studied recent medicolegal reports, to assess subjects with a second whiplash injury. They had been asked whether their earlier injury was worse, the same or lesser in severity. RESULTS From the study cohort, 101 patients (87%) felt that they had fully recovered from their first injury and 15 (13%) had not. Seventy-six subjects considered their first injury of lesser severity, 24 worse and 16 the same. Of the 24 that felt the violence of their first accident was worse, only 8 had worse symptoms, and 16 felt their symptoms were mainly the same or less than their symptoms from their second injury. Statistical analysis of the data revealed that the proportion of those claiming a difference who said the previous injury was lesser was 76% (95% CI 66–84%). The observed proportion with a lesser injury was considerably higher than the 50% anticipated. CONCLUSIONS We feel that subjects may underestimate the severity of an earlier injury and associated symptoms. Reasons for this may include secondary gain rather than any proposed cumulative effect. PMID:18201501

Altered Regional Cerebral Blood Flow in Chronic Whiplash Associated Disorders

NARCIS (Netherlands)

Vállez García, David; Doorduin, Janine; Willemsen, Antoon T.M.; Dierckx, Rudi A.j.o.; Otte, Andreas

There is increasing evidence of central hyperexcitability in chronic whiplash-associated disorders (cWAD). However, little is known about how an apparently simple cervical spine injury can induce changes in cerebral processes. The present study was designed (1) to validate previous results showing

Pain, perceived injustice and the persistence of post-traumatic stress symptoms during the course of rehabilitation for whiplash injuries.

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Sullivan, Michael J L; Thibault, Pascal; Simmonds, Maureen J; Milioto, Maria; Cantin, André-Philippe; Velly, Ana M

2009-10-01

The present study assessed the role of pain and pain-related psychological variables in the persistence of post-traumatic stress symptoms following whiplash injury. Individuals (N=112) with whiplash injuries who had been admitted to a standardized multidisciplinary rehabilitation program were asked to complete measures of pain, post-traumatic stress symptoms, physical function and pain-related psychological variables at three different points during their treatment program. The findings are consistent with previous research showing that indicators of injury severity such as pain, reduced function and disability, and scores on pain-related psychological were associated with more severe post-traumatic stress symptoms in individuals with whiplash injuries. Contrary to expectations, indicators of pain severity did not contribute to the persistence of post-traumatic stress symptoms. Univariate analyses revealed that self-reported disability, pain catastrophizing and perceived injustice were significant determinants of the persistence of post-traumatic stress symptoms. In multivariate analyses, only perceived injustice emerged as a unique predictor of the persistence of post-traumatic stress symptoms. The results suggest that early adequate management of pain symptoms and disability consequent to whiplash injury might reduce the severity of post-traumatic stress symptoms. The development of effective intervention techniques for targeting perceptions of injustice might be important for promoting recovery of post-traumatic stress symptoms consequent to whiplash injury.

Radiology in chest trauma

International Nuclear Information System (INIS)

Wenz, W.; Kloehn, I.; Wolfart, W.; Freiburg Univ.

1979-01-01

In chest trauma, a routine chest film, preferably in the lateral as well as the frontal projection, is the basic part of the work-up. Occasionally valuable additional methods are fluoroscopy, tomography, bronchography, contrast studies of the GI Tract and angiography and angiocardiography. In 679 chest trauma patients, traffic accidents and falls were the main reason for the trauma. There were 248 fractures; then - in order of frequency - hemopneumothorax (76), lung contusion (58), subcutaneous emphysema (33) cardiac (16) and vascular trauma (12) and damage to other organs. While 20-30% mistakes are made in diagnosing rib fractures in acute trauma, there is high accuracy in the diagnosis of the other injuries. Many cases are shown to demonstrate the value of diagnostic radiology. (orig.) [de

Rear impact whiplash neck injury reduction technology; Jidosha komen shototsu ni okeru muchiuchisho teigen gijutsu

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Watanabe, Y.; Ichikawa, H.; Kayama, O. [Nissan Motor Co. Ltd., Tokyo (Japan)

1999-11-01

Even though whiplash neck injuries suffered in low-speed rear impacts are one of the major concern in traffic accidents, the mechanism of the injuries is not fully understood at present. Hence, the countermeasures have not been clear, yet. The bio-mechanical research was done to understand the injuries and three different modes of occupant's motion related to the mechanism were found. Based on this research, Nissan Active Head Restraint has been developed to reduce whiplash neck injuries in low-speed rear impacts. (author)

Trauma team activation criteria in managing trauma patients at an emergency room in Thailand.

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Wuthisuthimethawee, P

2017-02-01

Trauma team activation (TTA) criteria were first implemented in the Emergency Department (ED) of Songklanagarind Hospital in 2009 to treat severe trauma patients. To determine the efficacy of the TTA criteria on the acute trauma care process in the ED and the 28-day mortality rate. A 1-year prospective cohort study was conducted at the ED. Trauma patients who were 18 years old and over who met the TTA criteria were enrolled. Demographic data, physiologic parameters, ED length of stay (EDLOS), and the injury severity score (ISS) were recorded. Multiple logistic regression was used to determine the factors affecting 28-day mortality. Institutional review board approval was obtained from the Prince of Songkla University. A total of 80 patients (74 male and 6 female) were eligible with a mean age of 34.3 years old. Shock, penetrating torso injury, and pulse rate >120 beats per minute were the three most common criteria for trauma team consultation. At the ED, 9 patients (11.3 %) were non-survivors, 30 patients (37.5 %) needed immediate operation, and 41 patients (51.2 %) were admitted. All of the arrest patients died (p team activation criteria improved acute trauma care in the ED which was demonstrated by the decreased EDLOS and mortality rate. A high ISS is the sole parameter predicting mortality.

Endovascular treatment of peripheral and visceral arterial injuries in patients with acute trauma.

Science.gov (United States)

Erbahçeci Salık, Aysun; Saçan İslim, Filiz; Çil, Barbaros Erhan

2016-11-01

The present study is an evaluation of the efficacy of endovascular treatment in emergency setting for patients with acute peripheral and visceral arterial injury secondary to penetrating or blunt trauma. Twelve patients (11 men) aged 35.8±11.3 years (range: 18-56 years) with penetrating or blunt trauma who underwent endovascular treatment in our department between March 2010 and June 2014 for peripheral and visceral arterial injury were retrospectively reviewed. Selective coil embolization was performed on 11 patients and particle embolization of the injured vessel was performed on 1 patient. Criteria for endovascular treatment included active extravasation or pseudoaneurysm on contrast-enhanced computed tomography and decrease in hemoglobin level or temporary hemodynamic instability. Arterial injuries were secondary to penetrating injury due to gunshot wound in 4 patients and stab wound in 5, and blunt abdominal injury as result of traffic accident in 3 patients. Traumatic lesions were in the right hepatic artery (n=3), left hepatic (n=2), right hepatic and right renal (n=1), left inferior epigastric (n=2), left facial (n=1), anterior tibial (n=1), and deep femoral (n=1) arteries. Technical success with no procedural complications was seen in all cases. Two patients died due to coexisting injuries on 29th and 43rd days of hospitalization. Median hospitalization period was 6.0 days (range: 1-43 days) and mean intensive care unit hospitalization was 7.7 days (range: 0-43 days). In our experience, endovascular treatment was a safe and effective option for acute traumatic peripheral and visceral arterial lesions.

MR imaging of spinal trauma

International Nuclear Information System (INIS)

Buchberger, W.; Springer, P.; Birbamer, G.; Judmaier, W.; Kathrein, A.; Daniaux, H.

1995-01-01

To assess the value of MR imaging in the acute and chronic stages of spinal trauma. 126 MR examinations of 120 patients were evaluated retrospectively. In 15 cases of acute spinal cord injury, correlation of MR findings with the degree of neurological deficit and eventual recovery was undertaken. Cord anomalies in the acute stage were seen in 16 patients. Intramedullary haemorrhage (n=6) and cord transection (n=2) were associated with complete injuries and poor prognosis, whereas patients with cord oedema (n=7) had incomplete injuries and recovered significant neurological function. In the chronic stage, MR findings included persistent cord compression in 8 patients, syringomyelia or post-traumatic cyst in 12, myelomalacia in 6, cord atrophy in 9, and cord transection in 7 patients. In acute spinal trauma, MR proved useful in assessing spinal cord compression and instability. In addition, direct visualisation and characterisation of posttraumatic changes within the spinal cord may offer new possibilities in establishing the prognosis for neurological recovery. In the later stages, potentially remediable causes of persistent or progressive symptoms, such as chronic spinal cord compression or syringomyelia can be distinguished from other sequelae of spinal trauma, such as myelomalacia, cord transection or atrophy. (orig.) [de

Maintaining a balance: a focus group study on living and coping with chronic whiplash-associated disorder

Directory of Open Access Journals (Sweden)

Ihlebæk Camilla

2010-07-01

Full Text Available Abstract Background There is little qualitative insight into how persons with chronic Whiplash-Associated Disorder cope on a day to day basis. This study seeks to identify the symptoms persons with Whiplash-Associated Disorder describe as dominating and explore their self-initiated coping strategies. Methods Qualitative study using focus groups interviews. Fourteen Norwegian men and women with Whiplash-Associated Disorder (I or II were recruited to participate in two focus groups. Data were analyzed according to a phenomenological approach, and discussed within the model of Cognitive Activation Theory of Stress (CATS. Results Participants reported neck and head pain, sensory hypersensitivity, and cognitive dysfunction following their whiplash injury. Based on the intensity of symptoms, participants divided everyday life into good and bad periods. In good periods the symptoms were perceived as manageable. In bad periods the symptoms intensified and took control of the individual. Participants expressed a constant notion of trying to balance their three main coping strategies; rest, exercise, and social withdrawal. In good periods participants experienced coping by expecting good results from the strategies they used. In bad periods they experienced no or negative relationships between their behavioral strategies and their complaints. Conclusions Neck and head pain, sensory hypersensitivity, and cognitive dysfunction were reported as participants' main complaints. A constant notion of balancing between their three main coping strategies; rest, exercise, and social withdrawal, was described.

Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy.

Science.gov (United States)

Davenport, Ross; Brohi, Karim

2013-09-24

Fibrinogen is fundamental to hemostasis and falls rapidly in trauma hemorrhage, although levels are not routinely measured in the acute bleeding episode. Prompt identification of critically low levels of fibrinogen and early supplementation has the potential to correct trauma-induced coagulation and improve outcomes. Early estimation of hypofibrinogenemia is possible using surrogate markers of shock and hemorrhage; for example, hemoglobin and base excess. Rapid replacement with fibrinogen concentrate or cryoprecipitate should be considered a clinical priority in major trauma hemorrhage.

Sex Differences in Patients with Chronic Pain Following Whiplash Injury: The Role of Depression, Fear, Somatization, Social Support, and Personality Traits.

Science.gov (United States)

Malfliet, Anneleen; De Kooning, Margot; Inghelbrecht, Els; Hachimi-Idrissi, Said; Willems, Bert; Bernheim, Jan; Nijs, Jo

2015-11-01

Chronic whiplash-associated disorders (chronic WAD) cover a large variety of clinical manifestations that can occur after a whiplash injury. Women have an increased risk of developing chronic WAD, and it is suggested that psychosocial factors are related to long-term pain and functioning following whiplash injury and persistence of chronic pain. This leads to the question whether there are sex differences in psychosocial factors in chronic WAD. This study included 117 subjects who had experienced a whiplash injury at least 3 months before the start of the study (mean duration of pain: 67.29 ± 63.86 months, range: 297 months). They were selected as chronically symptomatic, by excluding those who had recovered from their whiplash injury. Psychosocial aspects (including depression, fear, somatization, social support, and personality traits) were assessed by validated questionnaires, and sex differences were tested using a univariate analysis of variance (ANCOVA), with age and time from whiplash injury as covariates. No differences in depression, fear, somatization, discrepancy in social support personality trait, Neck Disability Index scores, physical functioning, bodily pain, or general health were present between women and men with chronic WAD. Women with chronic WAD reported higher levels of emotional support in problem situations and social companionship. Except for emotional support in problem situations and social companionship, psychosocial factors do not differ between men and women with chronic WAD. These findings imply little to no risk for sex bias in studies investigating psychosocial issues in patients with chronic WAD. © 2014 World Institute of Pain.

Patient perspectives of care in a regionalised trauma system: lessons from the Victorian State Trauma System.

Science.gov (United States)

Gabbe, Belinda J; Sleney, Jude S; Gosling, Cameron M; Wilson, Krystle; Hart, Melissa J; Sutherland, Ann M; Christie, Nicola

2013-02-18

To explore injured patients' experiences of trauma care to identify areas for improvement in service delivery. Qualitative study using in-depth, semi-structured interviews, conducted from 1 April 2011 to 31 January 2012, with 120 trauma patients registered by the Victorian State Trauma Registry and the Victorian Orthopaedic Trauma Outcomes Registry and managed at the major adult trauma services (MTS) in Victoria. Emergent themes from patients' experiences of acute, rehabilitation and post-discharge care in the Victorian State Trauma System (VSTS). Patients perceived their acute hospital care as high quality, although 3s with communication and surgical management delays were common. Discharge from hospital was perceived as stressful, and many felt ill prepared for discharge. A consistent emerging theme was the sense of a lack of coordination of post-discharge care, and the absence of a consistent point of contact for ongoing management. Most patients' primary point of contact after discharge was outpatient clinics at the MTS, which were widely criticised because of substantial delays in receiving an appointment, prolonged waiting times, limited time with clinicians, lack of continuity of care and inability to see senior clinicians. This study highlights perceived 3s in the patient care pathway in the VSTS, especially those relating to communication, information provision and post-discharge care. Trauma patients perceived the need for a single point of contact for coordination of post-discharge care.

Trauma quality improvement: The Pietermaritzburg Metropolitan Trauma Service experience with the development of a comprehensive structure to facilitate quality improvement in rural trauma and acute care in KwaZulu-Natal, South Africa.

Science.gov (United States)

Clarke, Damian Luiz

2015-01-03

Improving the delivery of efficient and effective surgical care in rural South Africa is a mammoth task bedevilled by conflict between the stakeholders, who include rural doctors, surgeons, ancillary staff, researchers, educators and administrators. Management training is not part of most medical school curricula, yet as they progress in their careers, many clinicians are required to manage a health system and find the shift from caring for individual patients to managing a complex system difficult. Conflict arises when management-type interventions are imposed in a top-down manner on surgical staff suspicious of an unfamiliar field of study. Another area of conflict concerns the place of surgical research. Researchers are often accused of not being sufficiently focused on or concerned about the tasks of service delivery. This article provides an overview of management theory and describes a comprehensive management structure that integrates a model for health systems with a strategic planning process, strategic planning tools and appropriate quality metrics, and shows how the Pietermaritzburg Metropolitan Trauma Service in KwaZulu-Natal Province, South Africa, successfully used this structure to facilitate and contextualise a diverse number of quality improvement programmes and research initiatives in the realm of rural acute surgery and trauma. We have found this structure to be useful, and hope that it may be applied to other acute healthcare systems.

Eye movements in patients with Whiplash Associated Disorders: A systematic review

NARCIS (Netherlands)

B.K. Ischebeck (B.); J. de Vries (Jurryt); J.N. van der Geest (Jos); M. Janssen (Malou); J.-P. van Wingerden (Jan-Paul); G.J. Kleinrensink (Gert Jan); M.A. Frens (Maarten)

2016-01-01

textabstractBackground: Many people with Whiplash Associated Disorders (WAD) report problems with vision, some of which may be due to impaired eye movements. Better understanding of such impaired eye movements could improve diagnostics and treatment strategies. This systematic review surveys the

Endovascular Treatment of Acute Arterial Hemorrhage in Trauma Patients Using Ethylene Vinyl Alcohol Copolymer (Onyx)

International Nuclear Information System (INIS)

Müller-Wille, R.; Heiss, P.; Herold, T.; Jung, E. M.; Schreyer, A. G.; Hamer, O. W.; Rennert, J.; Hoffstetter, P.; Stroszczynski, C.; Zorger, N.

2012-01-01

Purpose: This study was designed to determine the feasibility and efficacy of endovascular embolization with liquid embolic agent ethylene vinyl alcohol copolymer (Onyx) in patients with acute traumatic arterial bleeding. Methods: This is a retrospective review of 13 patients (9 men and 4 women; mean age 45 years) with severe trauma who underwent embolotherapy using Onyx from November 2003 to February 2009. Bleeding was located in the pelvis (5 patients), kidney (3 patients), mesenteric region (2 patients), retroperitoneal space (2 patients), neck (1 patient), and thigh (1 patient). In three cases (23.1%), Onyx was used in conjunction with coils. We evaluate the technical and clinical success, procedural and embolization time, occurrence of rebleeding, and embolotherapy-related complications, such as necrosis or migration of Onyx into nontarget vessels. Results: In all patients, embolotherapy was technically and clinically successful on the first attempt. Control of bleeding could be reached with a mean time of 19 (range, 4–63) min after correct placement of the microcatheter in the feeding artery. No recurrent bleeding was detected. No unintended necrosis or migration of Onyx into a nontarget region was observed. During the follow-up period, three patients (23.1%) died due to severe intracranial hemorrhage, cardiac arrest, and sepsis. Conclusions: Transcatheter embolization with new liquid embolic agent Onyx is technically feasible and effective in trauma patients with acute arterial hemorrhage.

Imaging of laryngeal trauma

Energy Technology Data Exchange (ETDEWEB)

Becker, Minerva, E-mail: Minerva.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Leuchter, Igor, E-mail: Igor.Leuchter@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Platon, Alexandra, E-mail: Alexandra.Platon@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Becker, Christoph D., E-mail: Christoph.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Dulguerov, Pavel, E-mail: Pavel.Dulguerov@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Varoquaux, Arthur, E-mail: Arthur.Varoquaux@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland)

2014-01-15

External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.

Imaging of laryngeal trauma

International Nuclear Information System (INIS)

Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D.; Dulguerov, Pavel; Varoquaux, Arthur

2014-01-01

External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed

Spontaneous Recanalization of the Obstructed Right Coronary Artery Caused by Blunt Chest Trauma.

Science.gov (United States)

Haraguchi, Yumiko; Sakakura, Kenichi; Yamamoto, Kei; Taniguchi, Yousuke; Nakashima, Ikue; Wada, Hiroshi; Sanui, Masamitsu; Momomura, Shin-Ichi; Fujita, Hideo

2018-03-30

Blunt chest trauma can cause a wide variety of injuries including acute myocardial infarction (AMI). Although AMI due to coronary artery dissection caused by blunt chest trauma is very rare, it is associated with high morbidity and mortality. In the vast majority of patients with AMI, primary percutaneous coronary interventions (PCI) are performed to recanalize obstructed arteries, but PCI carries a substantial risk of hemorrhagic complications in the acute phase of trauma. We report a case of AMI due to right coronary artery (RCA) dissection caused by blunt chest trauma. The totally obstructed RCA was spontaneously recanalized with medical therapy. We could avoid primary PCI in the acute phase of blunt chest trauma because electrocardiogram showed early reperfusion signs. We performed an elective PCI in the subacute phase when the risk of bleeding subsided. Since the risk of severe hemorrhagic complications is greater in the acute phase of blunt chest trauma as compared with the late phase, deferring emergency PCI is reasonable if signs of recanalization are observed.

Tratamiento osteopático en una lesión por Whiplash. Caso clínico

OpenAIRE

Ruiz Morcillo, Irene

2008-01-01

Introducción: El caso que presentamos a continuación se trata de un hombre de 25 años. Acude a consulta a los diez días de sufrir un accidente de tráfico y con un diagnóstico médico de whiplash o latigazo cervical. El paciente refiere dolor y disminución de la movilidad en la región cervical, dorsal alta, lumbosacra y mareos leves desde el accidente. Objetivos: Explicar el mecanismo de la lesión por Whiplash; valoración de los resultados obtenidos tras el tratamiento osteopátic...

Expectancies Mediate the Relations Among Pain Catastrophizing, Fear of Movement, and Return to Work Outcomes After Whiplash Injury.

Science.gov (United States)

Carriere, Junie S; Thibault, Pascal; Milioto, Maria; Sullivan, Michael J L

2015-12-01

Pain catastrophizing and fear of movement have been identified as key predictors of prolonged work disability after whiplash injury. However, little is known about the processes by which pain catastrophizing and fear of movement affect return to work. This study investigated the mediating role of expectancies on the relations between pain catastrophizing and return to work, and between fear of movement and return to work after whiplash injury. The study sample consisted of 154 individuals with whiplash injury who were enrolled in a multidisciplinary pain rehabilitation program. Participants completed measures of pain catastrophizing, fear of movement, and return-to-work expectancies after admission to a rehabilitation program. A follow-up telephone interview was used to assess work status 1 year after discharge. Consistent with previous research, analyses revealed that expectancies, pain catastrophizing, and fear of movement were significant predictors of return to work at 1-year follow-up. Regression analyses (bootstrapping) revealed that expectancies partially mediated the relation between catastrophizing and return to work. Expectancies completely mediated the relation between fear of movement and return to work. The significant predictive and mediating role of expectancies on return to work argues for the inclusion of expectancies as a specific target of intervention for individuals with whiplash injury. The findings suggest that expectancies might be part of the pathways by which pain catastrophizing and fear of movement affect return-to-work outcomes after whiplash injury. The findings argue for greater attention to return-to-work expectancies as a risk factor for problematic recovery outcomes as well as a target of intervention. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

Reduced butyrylcholinesterase activity is an early indicator of trauma-induced acute systemic inflammatory response

Directory of Open Access Journals (Sweden)

Zivkovic AR

2016-11-01

Full Text Available Aleksandar R Zivkovic, Jochen Bender, Thorsten Brenner, Stefan Hofer,* Karsten Schmidt* Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany *These authors contributed equally to this work Purpose: Early diagnosis of systemic inflammatory response syndrome is fundamentally important for an effective and a goal-directed therapy. Various inflammation biomarkers have been used in clinical and experimental practice. However, a definitive diagnostic tool for an early detection of systemic inflammation remains to be identified. Acetylcholine (Ach has been shown to play an important role in the inflammatory response. Serum cholinesterase (butyrylcholinesterase [BChE] is the major Ach hydrolyzing enzyme in blood. The role of this enzyme during inflammation has not yet been fully understood. This study tests whether a reduction in the BChE activity could indicate the onset of the systemic inflammatory response upon traumatic injury. Patients and methods: This observational study measured BChE activity in patients with traumatic injury admitted to the emergency room by using point-of-care-test system (POCT. In addition, the levels of routine inflammation biomarkers during the initial treatment period were measured. Injury Severity Score was used to assess the trauma severity. Results: Altered BChE activity was correlated with trauma severity, resulting in systemic inflammation. Reduction in the BChE activity was detected significantly earlier compared to those of routinely measured inflammatory biomarkers. Conclusion: This study suggests that the BChE activity reduction might serve as an early indicator of acute systemic inflammation. Furthermore, BChE activity, measured using a POCT system, might play an important role in the early diagnosis of the trauma-induced systemic inflammation. Keywords: trauma, injury, early diagnostics, cholinergic, pseudocholinesterase, SIRS

Reappraising the concept of massive transfusion in trauma

DEFF Research Database (Denmark)

Stanworth, Simon J; Morris, Timothy P; Gaarder, Christine

2010-01-01

ABSTRACT : INTRODUCTION : The massive-transfusion concept was introduced to recognize the dilutional complications resulting from large volumes of packed red blood cells (PRBCs). Definitions of massive transfusion vary and lack supporting clinical evidence. Damage-control resuscitation regimens...... of modern trauma care are targeted to the early correction of acute traumatic coagulopathy. The aim of this study was to identify a clinically relevant definition of trauma massive transfusion based on clinical outcomes. We also examined whether the concept was useful in that early prediction of massive...... transfusion as a concept in trauma has limited utility, and emphasis should be placed on identifying patients with massive hemorrhage and acute traumatic coagulopathy....

The value of trauma registries.

Science.gov (United States)

Moore, Lynne; Clark, David E

2008-06-01

Trauma registries are databases that document acute care delivered to patients hospitalised with injuries. They are designed to provide information that can be used to improve the efficiency and quality of trauma care. Indeed, the combination of trauma registry data at regional or national levels can produce very large databases that allow unprecedented opportunities for the evaluation of patient outcomes and inter-hospital comparisons. However, the creation and upkeep of trauma registries requires a substantial investment of money, time and effort, data quality is an important challenge and aggregated trauma data sets rarely represent a population-based sample of trauma. In addition, trauma hospitalisations are already routinely documented in administrative hospital discharge databases. The present review aims to provide evidence that trauma registry data can be used to improve the care dispensed to victims of injury in ways that could not be achieved with information from administrative databases alone. In addition, we will define the structure and purpose of contemporary trauma registries, acknowledge their limitations, and discuss possible ways to make them more useful.

Are altered smooth pursuit eye movements related to chronic pain and disability following whiplash injuries? A prospective trial with one-year follow-up

DEFF Research Database (Denmark)

Kongsted, Alice; Jørgensen, Lars Vincents; Leboeuf-Yde, Charlotte

2008-01-01

collision were determined. RESULTS: Results of early eye movement tests were not associated with the prognosis. Reduced smooth pursuit performance when tested in static cervical rotation at the one-year follow-up was significantly associated with higher neck pain intensity at that time (regression...... with electrooculography (EOG) an average of 12 days after a whiplash trauma and again after one year. Analyses of EOG recordings were computerized. Associations between test results both from baseline and one-year tests and self-reported neck pain, headache, neck disability and working ability one year after the car...... coefficient 0.8, 95% confidence interval (CI) 0.04-1.5), but the association was too weak for the test to discriminate between recovered participants and those with lasting symptoms. CONCLUSIONS: Although reduced smooth pursuit performance at one-year follow-up was associated with persistent neck pain, smooth...

The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

Energy Technology Data Exchange (ETDEWEB)

McKean, D.; Thomee, E.; Grant, D.; Teh, J.L.; Mansour, R. [Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Headington, Oxford (United Kingdom); Yoong, P. [Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading (United Kingdom); Yanny, S. [Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury (United Kingdom)

2015-10-15

To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2 % (n = 130) patients were male. The PFL was injured in 36 cases (20 %). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25 %) were associated with further injuries of posterolateral corner structures and in 27 cases (75 %) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner. (orig.)

Validity of the neck disability index, Northwick Park neck pain questionnaire, and problem elicitation technique for measuring disability associated with whiplash-associated disorders

NARCIS (Netherlands)

Hoving, Jan Lucas; O'Leary, Elizabeth F.; Niere, Ken R.; Green, Sally; Buchbinder, Rachelle

2003-01-01

The Neck Disability Index (NDI) and Northwick Park Neck Pain Questionnaire (NPQ) were developed to measure self-perceived disability from neck pain, including that which may arise from whiplash injury. However, there is little data specifically concerning their validity for whiplash-associated

Using Trauma and Injury Severity Score (TRISS)-based analysis in the development of regional risk adjustment tools to trend quality in a voluntary trauma system: the experience of the Trauma Foundation of Northeast Ohio.

Science.gov (United States)

Mancuso, C; Barnoski, A; Tinnell, C; Fallon, W

2000-04-01

Presently, no trauma system exists in Ohio. Since 1993, all hospitals in Cuyahoga County (CUY), northeast Ohio (n = 22) provide data to a trauma registry. In return, each received hospital-specific data, comparison data by trauma care level and a county-wide aggregate summary. This report describes the results of this approach in our region. All cases were entered by paper abstract or electronic download. Interrater reliability audits and z score analysis was performed by using the Major Trauma Outcome Study and the CUY 1994 baseline groups. Risk adjustment of mortality data was performed using statistical modeling and logistic regression (Trauma and Injury Severity Score, Major Trauma Outcome Study, CUY). Trauma severity measures were defined. In 1995, 3,375 patients were entered. Two hundred ninety-one died (8.6%). Severity measures differed by level of trauma care, indicating differences in case mix. Probability of survival was lowest in the Level I centers, highest in the acute care hospitals. Outcomes z scores demonstrated survival differences for all levels. In a functioning trauma system, the most severely injured patients should be cared for at the trauma centers. A low volume at acute care hospitals is desirable. By using Trauma and Injury Severity Score with community-specific constants, NE Ohio is accomplishing these goals. The Level I performance data are an interesting finding compared with the data from the Level II centers in the region

Physiotherapists' Beliefs About Whiplash-associated Disorder: A Comparison Between Singapore and Queensland, Australia.

Science.gov (United States)

Ng, Tze Siong; Pedler, Ashley; Vicenzino, Bill; Sterling, Michele

2015-06-01

Healthcare providers' beliefs may play a role in the outcome of whiplash-associated disorders (WAD), a condition which is proposed to be culturally dependent. Clinical practice guidelines recommend an active approach for the management of WAD, which is often delivered by physiotherapists. However, there is no data on physiotherapists' whiplash beliefs. Our primary objective was to determine physiotherapists' beliefs from Queensland (Australia) and Singapore, two cultures with differing prevalence of chronic musculoskeletal pain and chronic WAD. A pen and paper survey of musculoskeletal physiotherapists practicing in Queensland and Singapore was conducted. Participants completed questionnaires consisting of patient vignettes and statements inquiring knowledge and attitudes towards WAD. Chi-square tests of significance were used to compare the responses of physiotherapists from both samples. Ninety-one (response rate 45%) Queensland-based and 94 (response rate 98%) Singapore-based physiotherapists participated in the study. The beliefs in the management strategies for the patient vignettes were generally consistent with practice guidelines. A higher proportion of Queensland-based physiotherapists expected permanent disabilities for the patient vignette depicting chronic WAD (Queensland: 55% Singapore: 28% Pearson chi-sq 18.76, p Queensland and Singapore were similar but there were specific differences. Physiotherapists' whiplash beliefs in Queensland and Singapore did not clearly reflect the difference in prevalence of chronic musculoskeletal pain or chronic WAD in Queensland and Singapore. Copyright © 2014 John Wiley & Sons, Ltd.

MRI of car occupants with whiplash injury

Energy Technology Data Exchange (ETDEWEB)

Voyvodic, F [Dept. of Radiology, Flinders Medical Centre, Bedford Park, SA (Australia); Dolinis, J [National Injury Surveillance Unit, Bedford Park, SA (Australia); [National Health and Medical Research Council Road Accident Research Unit, Univ. of Adelaide, SA (Australia); Moore, V M [National Health and Medical Research Council Road Accident Research Unit, Univ. of Adelaide, SA (Australia); Ryan, G A [National Health and Medical Research Council Road Accident Research Unit, Univ. of Adelaide, SA (Australia); Slavotinek, J P [Dept. of Radiology, Flinders Medical Centre, Bedford Park, SA (Australia); Whyte, A M [Ashford Hospital Specialist Centre, SA (Australia); Hoile, R D [Ashford Hospital Specialist Centre, SA (Australia); Taylor, G W [National Health and Medical Research Council Road Accident Research Unit, Univ. of Adelaide, SA (Australia)

1997-01-01

Our purpose was to document and investigate the prognostic significance of features seen on MRI of patients with whiplash injury following relatively minor road traffic crashes. MRI was obtained shortly and at 6 months after the crash using a 0.5 T imager. The images were assessed independently by two radiologists for evidence of fracture or other injury; loss of lordosis and spondylosis were also recorded. Clinical examinations were used to assess the status of patients initially and at 6 months. The results of the independent MRI and clinical investigations were then examined for association using statistical tests. Initial MRI was performed on 29 patients, of whom 19 had repeat studies at 6 months; 48 examinations were thus examined. Apart from spondylosis and loss of lordosis, only one abnormality was detected: an intramedullary lesion consistent with a small cyst or syrinx. There were no statistically significant associations between the outcome of injury and spondylosis or loss of lordosis. No significant changes were found when comparing the initial and follow-up MRI. It appears that MRI of patients with relatively less severe whiplash symptoms reveals a low frequency of abnormalities, apart from spondylosis and loss of lordosis, which have little short-term prognostic value. Routine investigation of such patients with MRI is not justified in view of the infrequency of abnormalities detected, the lack of prognostic value and the high cost of the procedure. (orig.). With 1 fig., 1 tab.

MRI of car occupants with whiplash injury

International Nuclear Information System (INIS)

Voyvodic, F.; Dolinis, J.; Moore, V.M.; Ryan, G.A.; Slavotinek, J.P.; Whyte, A.M.; Hoile, R.D.; Taylor, G.W.

1997-01-01

Our purpose was to document and investigate the prognostic significance of features seen on MRI of patients with whiplash injury following relatively minor road traffic crashes. MRI was obtained shortly and at 6 months after the crash using a 0.5 T imager. The images were assessed independently by two radiologists for evidence of fracture or other injury; loss of lordosis and spondylosis were also recorded. Clinical examinations were used to assess the status of patients initially and at 6 months. The results of the independent MRI and clinical investigations were then examined for association using statistical tests. Initial MRI was performed on 29 patients, of whom 19 had repeat studies at 6 months; 48 examinations were thus examined. Apart from spondylosis and loss of lordosis, only one abnormality was detected: an intramedullary lesion consistent with a small cyst or syrinx. There were no statistically significant associations between the outcome of injury and spondylosis or loss of lordosis. No significant changes were found when comparing the initial and follow-up MRI. It appears that MRI of patients with relatively less severe whiplash symptoms reveals a low frequency of abnormalities, apart from spondylosis and loss of lordosis, which have little short-term prognostic value. Routine investigation of such patients with MRI is not justified in view of the infrequency of abnormalities detected, the lack of prognostic value and the high cost of the procedure. (orig.). With 1 fig., 1 tab

Facilitators and barriers to doing workplace mental health research: Case study of acute psychological trauma in a public transit system.

Science.gov (United States)

Links, Paul S; Bender, Ash; Eynan, Rahel; O'Grady, John; Shah, Ravi

2016-03-10

The Acute Psychological Trauma (APT) Study was a collaboration between an acute care hospital, a specialized multidisciplinary program designed to meet the mental health needs of injured workers, and a large urban public transit system. The overall purpose was to evaluate a Best Practices Intervention (BPI) for employees affected by acute psychological trauma compared to a Treatment as Usual (TAU) group. The specific purpose is to discuss facilitators and barriers that were recognized in implementing and carrying out mental health research in a workplace setting. Over the course of the APT study, a joint implementation committee was responsible for day-to-day study operations and made regular observations on the facilitators and barriers that arose throughout the study. The facilitators to this study included the longstanding relationships among the partners, increased recognition for the need of mental health research in the workplace, and the existence of a community advisory committee. The significant barriers to doing this study of mental health research in the workplace included differences in organizational culture, inconsistent union support, co-interventions, and stigma. Researchers and funding agencies need to be flexible and provide additional resources in order to overcome the barriers that can exist doing workplace mental health research.

Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy

OpenAIRE

Davenport, Ross; Brohi, Karim

2013-01-01

Fibrinogen is fundamental to hemostasis and falls rapidly in trauma hemorrhage, although levels are not routinely measured in the acute bleeding episode. Prompt identification of critically low levels of fibrinogen and early supplementation has the potential to correct trauma-induced coagulation and improve outcomes. Early estimation of hypofibrinogenemia is possible using surrogate markers of shock and hemorrhage; for example, hemoglobin and base excess. Rapid replacement with fibrinogen con...

Morphological changes in the cervical muscles of women with chronic whiplash can be modified with exercise-A pilot study.

Science.gov (United States)

O'leary, Shaun; Jull, Gwendolen; Van Wyk, Luke; Pedler, Ashley; Elliott, James

2015-11-01

In this preliminary study we determined whether MRI markers of cervical muscle degeneration [elevated muscle fatty infiltration (MFI), cross-sectional area (CSA), and reduced relative muscle CSA (rmCSA)] could be modified with exercise in patients with chronic whiplash. Five women with chronic whiplash undertook 10 weeks of neck exercise. MRI measures of the cervical multifidus (posterior) and longus capitus/colli (anterior) muscles, neck muscle strength, and self-reported neck disability were recorded at baseline and at completion of the exercise program. Overall significant increases in CSA and rmCSA were observed for both muscles, but significant reductions in MFI were only evident in the cervical multifidus muscle. These changes coincided with increased muscle strength and reduced neck disability. MRI markers of muscle morphology in individuals with chronic whiplash appear to be modifiable with exercise. © 2015 Wiley Periodicals, Inc.

Mandibular condylar fractures and acute atlanto-axial subluxation Part 2 A physiopathological factor for the cervical spine sprain.

Science.gov (United States)

Cutilli, T; Corbacelli, A

2009-05-01

The aim of this study was to analyze the physiopathology of the acute cervical injure in the event of mandibular condylar fractures. As in the Part 1, 25 non-consecutive cases of condylar mandibular fractures (16 males and 9 females, mean age: 22.96/range 14-36 years) observed and treated in the Maxillofacial Surgery Department of the University of L'Aquila, have been studied. Types of fractures examined included: unilateral: 19 cases (solitary: 12; associated with other mandibular fractures: 7, homolateral: 2); bilateral: 6 cases (equivalent: 2, not equivalent: 4). A control group was constituted of 10 patients, 5 males and 5 females, aged from 19 to 24 years (mean range: 21.6) suffering from acute isolated cervical distorsion (whiplash). The study has been performed by means of the analysis of X-ray and computed tomography (CT)-CT/3D of the mandibular condylar regions, the occipital-atlanto-axial structures and the cervical region. In all the patients the following constant alterations that link up with these fractures have been observed: the rotation of atlas, the atlanto-axial subluxation and the derangement of the occipital-atlanto-epistropheal joint, homolateral to the side of the mandibular condylar fracture. The cervical spine shows the constant loss of physiological lordosis with hinge between C3 and C4. In the whiplash, as the authors have been able to assess in the control group, there are no alterations of occipital-atlanto-axial joint and the kinetic vector is placed on the longitudinal plane. In the mandibular condylar fractures the kinetic mechanism is completely different regarding the whiplash. The point of entry is the chin and the kinetic vector is oriented down-up, sometimes oblique in the opposite side. Subsequently the kinetic force is transmitted throughout the mandibular structure and causes the condylar or bicondylar fracture. The kinetic vector is placed before on the vertical plane, then on the horizontal plane and later on the vertical

Noise-intolerance and state-dependent factors in patients with whiplash associated disorder

NARCIS (Netherlands)

Blokhorst, M.G.B.G.; Meeldijk, S.J.; Luijtelaar, E.L.J.M. van; Toor, T. van; Lousberg, R.; Ganzevles, P.

2005-01-01

An experiment was carried out in which the level of noise-intolerance in patients with a Whiplash Associated Disorder (WAD) was compared to healthy matched control subjects. In addition, the relationship between state-dependent factors (as headache, neck pain, fatigue and tension) and

Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications.

Science.gov (United States)

Iacobellis, Francesca; Ierardi, Anna M; Mazzei, Maria A; Magenta Biasina, Alberto; Carrafiello, Gianpaolo; Nicola, Refky; Scaglione, Mariano

2016-01-01

Acute vascular injuries are the second most common cause of fatalities in patients with multiple traumatic injuries; thus, prompt identification and management is essential for patient survival. Over the past few years, multidetector CT (MDCT) using dual-phase scanning protocol has become the imaging modality of choice in high-energy deceleration traumas. The objective of this article was to review the role of dual-phase MDCT in the identification and management of acute vascular injuries, particularly in the chest and abdomen following multiple traumatic injuries. In addition, this article will provide examples of MDCT features of acute vascular injuries with correlative surgical and interventional findings.

Increasing climate whiplash in 21st century California

Science.gov (United States)

Swain, D. L.; Langenbrunner, B.; Neelin, J. D.; Hall, A. D.

2017-12-01

Temperate "Mediterranean" climate regimes across the globe are particularly susceptible to wide swings between drought and flood—of which California's rapid transition from record multi-year dryness between 2012-2016 to extreme wetness during 2016-2017 provides a dramatic example. The wide-ranging human and environmental impacts of this recent "climate whiplash" event in a highly-populated, economically critical, and biodiverse region highlight the importance of understanding weather and climate extremes at both ends of the hydroclimatic spectrum. Previous studies have examined the potential contribution of anthropogenic warming to recent California extremes, but findings to date have been mixed and primarily drought-focused. Here, we use specific historical California flood and drought events as thresholds for quantifying long-term changes in precipitation extremes using a large ensemble of multi-decadal climate model simulations (CESM-LENS). We find that greenhouse gas emissions are already responsible for a detectable increase in both wet and dry extremes across portions of California, and that increasing 21st century "climate whiplash" will likely yield large increases in the frequency of both rapid "dry-to-wet" transitions and severe flood events over a wide range of timescales. This projected intensification of California's hydrological cycle would seriously challenge the region's existing water storage, conveyance, and flood control infrastructure—even absent large changes in mean precipitation.

Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need

Directory of Open Access Journals (Sweden)

Faul, Mark

2014-11-01

Full Text Available Introduction: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care.   Methods: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443. The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need” as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need.     Results: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need.  Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the

Treatment of Whiplash-Associated Disorders - Part I: Non-Invasive Interventions

Directory of Open Access Journals (Sweden)

Anne Conlin

2005-01-01

Full Text Available BACKGROUND: A whiplash-associated disorder (WAD is an injury due to an acceleration-deceleration mechanism at the neck. WAD represents a very common and costly condition, both economically and socially. In 1995, the Quebec Task Force published a report that contained evidence-based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus-based recommendations.

Treatment of Whiplash-Associated Disorders - Part II: Medical and Surgical Interventions

Directory of Open Access Journals (Sweden)

Anne Conlin

2005-01-01

Full Text Available BACKGROUND: Whiplash-associated disorder (WAD is a term used to describe injury due to an acceleration-deceleration mechanism at the neck. In 1995, the Quebec Task Force published a report that contained evidence-based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus-based recommendations.

The cervical facet capsule and its role in whiplash injury: a biomechanical investigation.

Science.gov (United States)

Winkelstein, B A; Nightingale, R W; Richardson, W J; Myers, B S

2000-05-15

Cervical facet capsular strains were determined during bending and at failure in the human cadaver. To determine the effect of an axial pretorque on facet capsular strains and estimate the risk for subcatastrophic capsular injury during normal bending motions. Epidemiologic and clinical studies have identified the facet capsule as a potential site of injury and prerotation as a risk factor for whiplash injury. Unfortunately, biomechanical data on the cervical facet capsule and its role in whiplash injury are not available. Cervical spine motion segments were tested in a pure-moment test frame and the full-field strains determined throughout the facet capsule. Motion segments were tested with and without a pretorque in pure bending. The isolated facet was then elongated to failure. Maximum principal strains during bending were compared with failure strains, by paired t test. Statistically significant increases in principal capsular strains during flexion-extension loading were observed when a pretorque was applied. All measured strains during bending were significantly less than strains at catastrophic joint failure. The same was true for subcatastrophic ligament failure strains, except in the presence of a pretorque. Pretorque of the head and neck increases facet capsular strains, supporting its role in the whiplash mechanism. Although the facet capsule does not appear to be at risk for gross injury during normal bending motions, a small portion of the population may be at risk for subcatastrophic injury.

Imaging of blunt chest trauma

International Nuclear Information System (INIS)

Prosch, H.; Negrin, L.

2014-01-01

Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [de

Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution

Directory of Open Access Journals (Sweden)

Ionut Negoi

2015-08-01

Conclusions: The trimodal time distribution of mortality remains a milestone in trauma education and research. Nevertheless, it must be questioned in the modern and very efficient trauma systems, but still very actual for developing trauma care systems. In conclusion, the pattern of mortality due to major trauma seems decreasing continuously with time rather than presenting high peaks of frequency at some moments.

Return to work helps maintain treatment gains in the rehabilitation of whiplash injury.

Science.gov (United States)

Sullivan, Michael; Adams, Heather; Thibault, Pascal; Moore, Emily; Carriere, Junie S; Larivière, Christian

2017-05-01

This study examined the relation between return to work and the maintenance of treatment gains made over the course of a rehabilitation intervention. The study sample consisted of 110 individuals who had sustained whiplash injuries in rear collision motor vehicle accidents and were work-disabled at the time of enrolment in the study. Participants completed pre- and post-treatment measures of pain severity, disability, cervical range of motion, depression, posttraumatic stress symptoms, and catastrophizing. Pain severity was assessed again at 1-year follow-up. At 1-year follow-up, 73 participants had returned to work and 37 remained work-disabled. Analyses revealed that participants who returned to work were more likely to maintain treatment gains (77.5%) than participants who remained work-disabled (48%), χ = 6.3, P whiplash injury are maintained. Clinical implications of the findings are also addressed.

The trauma ecosystem: The impact and economics of new trauma centers on a mature statewide trauma system.

Science.gov (United States)

Ciesla, David J; Pracht, Etienne E; Leitz, Pablo T; Spain, David A; Staudenmayer, Kristan L; Tepas, Joseph J

2017-06-01

Florida serves as a model for the study of trauma system performance. Between 2010 and 2104, 5 new trauma centers were opened alongside 20 existing centers. The purpose of this study was to explore the impact of trauma system expansion on system triage performance and trauma center patients' profiles. A statewide data set was queried for all injury-related discharges from adult acute care hospitals using International Classification of Diseases, Ninth Revision (ICD-9) codes for 2010 and 2014. The data set, inclusion criteria, and definitions of high-risk injury were chosen to match those used by the Florida Department of Health in its trauma registry. Hospitals were classified as existing Level I (E1) or Level II (E2) trauma centers and new E2 (N2) centers. Five N2 centers were established 11.6 to 85.3 miles from existing centers. Field and overall trauma system triage of high-risk patients was less accurate with increased overtriage and no change in undertriage. Annual volume at N2 centers increased but did not change at E1 and E2 centers. In 2014, Patients at E1 and E2 centers were slightly older and less severely injured, while those at N2 centers were substantially younger and more severely injured than in 2010. The injured patient-payer mix changed with a decrease in self-pay and commercial patients and an increase in government-sponsored patients at E1 and E2 centers and an increase in self-pay and commercial patients with a decrease in government-sponsored patients at N2 centers. Designation of new trauma centers in a mature system was associated with a change in established trauma center demographics and economics without an improvement in trauma system triage performance. These findings suggest that the health of an entire trauma system network must be considered in the design and implementation of a regional trauma system. Therapeutic/care management study, level IV; epidemiological, level IV.

Isolated amnesia following a bilateral paramedian thalamic infarct. Possible etiologic role of a whiplash injury.

Science.gov (United States)

Barontini, F; Maurri, S

1992-04-01

A previously healthy 45 years old carpenter suffered a whiplash injury in a road accident on July, 18th, 1990. He continued to work in spite of occipital headache, episodic sweatening and slight hypersomnia. On August, 8th, 1990 while parking his car into the deck of a ferry-boat he was found slightly confuse and markedly amnestic. A post-traumatic subdural haematoma was suspected. As a CT-scan of the brain was normal, a toxic encephalopathy or an hysterical amnesia were proposed. However, a MRI performed on August, 22th, 1990, apart from a small infarct in the white matter of the left occipital lobe, showed two small bilateral paramedian thalamic infarcts. The last lesions usually follow a thrombotic or embolic occlusion of the "basilar communicating artery" (BCA) belonging to the vertebro-basilar system. The possible etiologic relationship between this syndrome and the previous whiplash injury has been considered. Six months later, while a control MRI showed a reduction of the brain lesions, a neuropsychological examination revealed a slight improvement of memory dysfunction evident also at a distance of further 6 months. This case is interesting because it tests the high sensitivity of MRI in amnestic syndromes and because of the possible role of a whiplash injury in the etiology of BPTI.

Isolated syndesmotic injury in acute ankle trauma: Comparison of plain film radiography with 3 T MRI

International Nuclear Information System (INIS)

Schoennagel, B.P.; Karul, M.; Avanesov, M.; Bannas, P.; Gold, G.; Großterlinden, L.G.; Rupprecht, M.; Adam, G.; Yamamura, J.

2014-01-01

Highlights: • Isolated syndesmotic injury is a frequent finding after acute ankle trauma. • Cut-off values and accuracy of plain film radiograph measurements were determined. • The TFCS and the MCS have the potential to detect isolated syndesmotic injury. • Appropriate cut-off values allow detection of isolated syndesmotic injury. • Only MRI reveals severity of isolated syndesmotic injury and concomitant injuries. - Abstract: Objectives: To determine cut-off values and the accuracy of plain film measurements for the detection of isolated syndesmotic injury after acute ankle trauma and to investigate MRI findings of concomitant ankle injury. Methods: Eighty-four consecutive patients with absent fracture in plain film radiographs were prospectively evaluated for isolated syndesmotic injury after acute ankle trauma. The tibiofibular clear space (TFCS), the tibiofibular overlap (TFO), and the medial clear space (MCS) were independently assessed in plain radiographs by two readers. MRI performed at 3 T within 24 h served as the reference standard. MRI was evaluated for syndesmotic injury, using a four-scale grading system (0 = normal syndesmosis, 1a = periligamentous edema, 1b = intraligamentous edema, 2 = partial rupture, 3 = complete rupture), and for concomitant ankle injury. Inter-observer variability for x-ray measurements was assessed using Bland–Altman diagrams. ROC analyses were performed to determine cut-off values and sensitivity and specificity for TFCS, TFO, and MCS. Results: Eleven of 84 patients (13.1%) revealed syndesmotic injury (Grade 2 or 3) according to MRI. Between patients with and without syndesmotic injury significantly different measurements were obtained for TFCS (p = 0.003) and MCS (p = 0.04). ROC derived cut-off values were 5.3 mm for TFCS, 2.8 mm for TFO, and 2.8 mm for MCS. Sensitivity and specificity was 82% and 75% for TFCS, 36% and 78% for TFO, and 73% and 59% for MCS. The bias and limits of agreement were −0.04 mm and [−1

Isolated syndesmotic injury in acute ankle trauma: Comparison of plain film radiography with 3 T MRI

Energy Technology Data Exchange (ETDEWEB)

Schoennagel, B.P., E-mail: b.schoennagel@uke.uni-hamburg.de [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Karul, M.; Avanesov, M.; Bannas, P.; Gold, G. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Großterlinden, L.G. [Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Rupprecht, M. [Department of Pediatric Orthopedics, Children' s Hospital Hamburg-Altona, Bleickenallee 38, 22763 Hamburg (Germany); Adam, G.; Yamamura, J. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany)

2014-10-15

Highlights: • Isolated syndesmotic injury is a frequent finding after acute ankle trauma. • Cut-off values and accuracy of plain film radiograph measurements were determined. • The TFCS and the MCS have the potential to detect isolated syndesmotic injury. • Appropriate cut-off values allow detection of isolated syndesmotic injury. • Only MRI reveals severity of isolated syndesmotic injury and concomitant injuries. - Abstract: Objectives: To determine cut-off values and the accuracy of plain film measurements for the detection of isolated syndesmotic injury after acute ankle trauma and to investigate MRI findings of concomitant ankle injury. Methods: Eighty-four consecutive patients with absent fracture in plain film radiographs were prospectively evaluated for isolated syndesmotic injury after acute ankle trauma. The tibiofibular clear space (TFCS), the tibiofibular overlap (TFO), and the medial clear space (MCS) were independently assessed in plain radiographs by two readers. MRI performed at 3 T within 24 h served as the reference standard. MRI was evaluated for syndesmotic injury, using a four-scale grading system (0 = normal syndesmosis, 1a = periligamentous edema, 1b = intraligamentous edema, 2 = partial rupture, 3 = complete rupture), and for concomitant ankle injury. Inter-observer variability for x-ray measurements was assessed using Bland–Altman diagrams. ROC analyses were performed to determine cut-off values and sensitivity and specificity for TFCS, TFO, and MCS. Results: Eleven of 84 patients (13.1%) revealed syndesmotic injury (Grade 2 or 3) according to MRI. Between patients with and without syndesmotic injury significantly different measurements were obtained for TFCS (p = 0.003) and MCS (p = 0.04). ROC derived cut-off values were 5.3 mm for TFCS, 2.8 mm for TFO, and 2.8 mm for MCS. Sensitivity and specificity was 82% and 75% for TFCS, 36% and 78% for TFO, and 73% and 59% for MCS. The bias and limits of agreement were −0.04 mm and [−1

Acute Whiplash Injury Study (AWIS): a protocol for a cluster randomised pilot and feasibility trial of an Active Behavioural Physiotherapy Intervention in an insurance private setting

Science.gov (United States)

Wiangkham, Taweewat; Duda, Joan; Haque, M Sayeed; Price, Jonathan; Rushton, Alison

2016-01-01

Introduction Whiplash-associated disorder (WAD) causes substantial social and economic burden internationally. Up to 60% of patients with WAD progress to chronicity. Research therefore needs to focus on effective management in the acute stage to prevent the development of chronicity. Approximately 93% of patients are classified as WADII (neck complaint and musculoskeletal sign(s)), and in the UK, most are managed in the private sector. In our recent systematic review, a combination of active and behavioural physiotherapy was identified as potentially effective in the acute stage. An Active Behavioural Physiotherapy Intervention (ABPI) was developed through combining empirical (modified Delphi study) and theoretical (social cognitive theory focusing on self-efficacy) evidence. This pilot and feasibility trial has been designed to inform the design of an adequately powered definitive randomised controlled trial. Methods and analysis Two parallel phases. (1) An external pilot and feasibility cluster randomised double-blind (assessor and participants), parallel two-arm (ABPI vs standard physiotherapy) clinical trial to evaluate procedures and feasibility. Six UK private physiotherapy clinics will be recruited and cluster randomised by a computer-generated randomisation sequence. Sixty participants (30 each arm) will be assessed at recruitment (baseline) and at 3 months postbaseline. The planned primary outcome measure is the neck disability index. (2) An embedded exploratory qualitative study using semistructured indepth interviews (n=3–4 physiotherapists) and a focus group (n=6–8 patients) and entailing the recruitment of purposive samples will explore perceptions of the ABPI. Quantitative data will be analysed descriptively. Qualitative data will be coded and analysed deductively (identify themes) and inductively (identify additional themes). Ethics and dissemination This trial is approved by the University of Birmingham Ethics Committee (ERN_15-0542). Trial

Alcohol acute intoxication before sepsis impairs the wound healing of intestinal anastomosis: rat model of the abdominal trauma patient

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Morais Pedro

2012-08-01

Full Text Available Abstract Introduction Most trauma patients are drunk at the time of injury. Up to 2% of traumatized patients develop sepsis, which considerably increases their mortality. Inadequate wound healing of the colonic repair can lead to postoperative complications such as leakage and sepsis. Objective To assess the effects of acute alcohol intoxication on colonic anastomosis wound healing in septic rats. Methods Thirty six Wistar rats were allocated into two groups: S (induction of sepsis and AS (alcohol intake before sepsis induction. A colonic anastomosis was performed in all groups. After 1, 3 or 7 days the animals were killed. Weight variations, mortality rate, histopathology and tensile breaking strength of the colonic anastomosis were evaluated. Results There was an overall mortality of 4 animals (11.1%, three in the group AS (16.6% and one in the S group (5.5%. Weight loss occurred in all groups. The colon anastomosis of the AS group didn’t gain strength from the first to the seventh postoperative day. On the histopathological analysis there were no differences in the deposition of collagen or fibroblasts between the groups AS and S. Conclusion Alcohol intake increased the mortality rate three times in septic animals. Acute alcohol intoxication delays the acquisition of tensile strength of colonic anastomosis in septic rats. Therefore, acute alcohol intoxication before sepsis leads to worse prognosis in animal models of the abdominal trauma patients.

The relationship between insurance claim closure and recovery after traffic injuries for individuals with whiplash associated disorders

DEFF Research Database (Denmark)

Boyle, Eleanor; Cassidy, J David; Côté, Pierre

2017-01-01

PURPOSE: The purpose of this study was to determine if time to claim closure was similar to time to self-reported recovery in a no fault motor vehicle collision insurance system. METHOD: A prospective cohort of traffic injured adults with a whiplash-associated disorder (WAD) was assembled. We...... Time to claim closure as an outcome measure for whiplash-associated disorders has been criticized in the literature because it is thought that closure is not reflective of the health status of the individual. We found that claim closure was associated with lower levels of disability, but the time...

Cervical Muscle Dysfunction in the Chronic Whiplash Associated Disorder Grade II (WAD-II)

NARCIS (Netherlands)

Nederhand, Marcus Johannes; IJzerman, Maarten Joost; Hermens, Hermanus J.; Baten, Christian T.M.; Zilvold, Gerrit

2000-01-01

Study Design: In a cross-sectional study, surface electromyography measurements of the upper trapezius muscles were obtained during different functional tasks in patients with a chronic whiplash associated disorder Grade II and healthy control subjects. - Objectives: To investigate whether muscle

Disc pathology after whiplash injury. A prospective magnetic resonance imaging and clinical investigation; Pathologie vertebrale apres le coup du lapin. Une investigation clinique et d` imagerie prospective par resonance magnetique

Energy Technology Data Exchange (ETDEWEB)

Pettersson, K.; Hildingsson, C.; Toolanen, G.; Fagerlund, M.; Bjornebrink, J. [University Hospital of Northem (Sweden)

1997-09-01

Although disc pathology seems to be one contributing factor in the development of chronic symptoms after whiplash injury, it may be unnecessary to examine these patients in the acute phase with magnetic resonance imaging ; correlating initial symptoms and signs to magnetic resonance imaging findings is difficult because of the relatively high proportion of false-positive results. Magnetic resonance imaging is indicated later in the course of treatment in patients with persistent arm pain, neurologic deficits, or clinical signs of nerve root compression to diagnose disc herniations requiring surgery. (authors).

Contemporary management of acute kidney trauma

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Inês Anselmo da Costa

2016-01-01

Full Text Available Renal injury occurs in 1%–5% of all traumas, causing disability or even death. The American Association for the Surgery of Trauma (AAST renal injury scale should be used when injuries are reported. Although there is a consensus regarding handling of lower-grade injuries conservatively, the same cannot be said for the higher-grades, for which different specialists handle either conservatively or surgically. A search of the MEDLINE database was undertaken by using the following filters: English language articles, full-text availability, last five years, humans. Pediatric studies were excluded. For most renal injuries in hemodynamically stable, patients can be safely handled conservatively. An organized assessment and treatment system can reduce the need for nephrectomy in most other cases, as has occurred in the last two decades. The AAST injury scale should be updated in light of the advancements in imaging techniques, in order to fine tune grading and treatment.

Early versus delayed decompression in acute subaxial cervical spinal cord injury: A prospective outcome study at a Level I trauma center from India

OpenAIRE

Gupta, Deepak Kumar; Vaghani, Gaurang; Siddiqui, Saquib; Sawhney, Chhavi; Singh, Pankaj Kumar; Kumar, Atin; Kale, S. S.; Sharma, B. S.

2015-01-01

Aims: This study was done with the aim to compare the clinical outcome and patients’ quality of life between early versus delayed surgically treated patients of acute subaxial cervical spinal cord injury. The current study was based on the hypothesis that early surgical decompression and fixations in acute subaxial cervical spinal cord trauma is safe and is associated with improved outcome as compared to delayed surgical decompression. Materials and Methods: A total of 69 patients were recrui...

Circulating histones are mediators of trauma-associated lung injury.

Science.gov (United States)

Abrams, Simon T; Zhang, Nan; Manson, Joanna; Liu, Tingting; Dart, Caroline; Baluwa, Florence; Wang, Susan Siyu; Brohi, Karim; Kipar, Anja; Yu, Weiping; Wang, Guozheng; Toh, Cheng-Hock

2013-01-15

Acute lung injury is a common complication after severe trauma, which predisposes patients to multiple organ failure. This syndrome largely accounts for the late mortality that arises and despite many theories, the pathological mechanism is not fully understood. Discovery of histone-induced toxicity in mice presents a new dimension for elucidating the underlying pathophysiology. To investigate the pathological roles of circulating histones in trauma-induced lung injury. Circulating histone levels in patients with severe trauma were determined and correlated with respiratory failure and Sequential Organ Failure Assessment (SOFA) scores. Their cause-effect relationship was studied using cells and mouse models. In a cohort of 52 patients with severe nonthoracic blunt trauma, circulating histones surged immediately after trauma to levels that were toxic to cultured endothelial cells. The high levels were significantly associated with the incidence of acute lung injury and SOFA scores, as well as markers of endothelial damage and coagulation activation. In in vitro systems, histones damaged endothelial cells, stimulated cytokine release, and induced neutrophil extracellular trap formation and myeloperoxidase release. Cellular toxicity resulted from their direct membrane interaction and resultant calcium influx. In mouse models, cytokines and markers for endothelial damage and coagulation activation significantly increased immediately after trauma or histone infusion. Pathological examinations showed that lungs were the predominantly affected organ with edema, hemorrhage, microvascular thrombosis, and neutrophil congestion. An anti-histone antibody could reduce these changes and protect mice from histone-induced lethality. This study elucidates a new mechanism for acute lung injury after severe trauma and proposes that circulating histones are viable therapeutic targets for improving survival outcomes in patients.

Circulating Histones Are Mediators of Trauma-associated Lung Injury

Science.gov (United States)

Abrams, Simon T.; Zhang, Nan; Manson, Joanna; Liu, Tingting; Dart, Caroline; Baluwa, Florence; Wang, Susan Siyu; Brohi, Karim; Kipar, Anja; Yu, Weiping

2013-01-01

Rationale: Acute lung injury is a common complication after severe trauma, which predisposes patients to multiple organ failure. This syndrome largely accounts for the late mortality that arises and despite many theories, the pathological mechanism is not fully understood. Discovery of histone-induced toxicity in mice presents a new dimension for elucidating the underlying pathophysiology. Objectives: To investigate the pathological roles of circulating histones in trauma-induced lung injury. Methods: Circulating histone levels in patients with severe trauma were determined and correlated with respiratory failure and Sequential Organ Failure Assessment (SOFA) scores. Their cause–effect relationship was studied using cells and mouse models. Measurements and Main Results: In a cohort of 52 patients with severe nonthoracic blunt trauma, circulating histones surged immediately after trauma to levels that were toxic to cultured endothelial cells. The high levels were significantly associated with the incidence of acute lung injury and SOFA scores, as well as markers of endothelial damage and coagulation activation. In in vitro systems, histones damaged endothelial cells, stimulated cytokine release, and induced neutrophil extracellular trap formation and myeloperoxidase release. Cellular toxicity resulted from their direct membrane interaction and resultant calcium influx. In mouse models, cytokines and markers for endothelial damage and coagulation activation significantly increased immediately after trauma or histone infusion. Pathological examinations showed that lungs were the predominantly affected organ with edema, hemorrhage, microvascular thrombosis, and neutrophil congestion. An anti-histone antibody could reduce these changes and protect mice from histone-induced lethality. Conclusions: This study elucidates a new mechanism for acute lung injury after severe trauma and proposes that circulating histones are viable therapeutic targets for improving survival

An Integrated Model of Chronic Whiplash-Associated Disorder.

Science.gov (United States)

Walton, David M; Elliott, James M

2017-07-01

Synopsis The development of persistent symptoms following whiplash injury from a motor vehicle collision is common and contributes substantially to societal and personal costs. The popular Quebec Task Force classification system of whiplash-associated disorders (WADs) was meant to function as a prognostic and intervention decision aid, but its usefulness has been questioned. Emerging evidence highlights the heterogeneity of WAD by demonstrating physical and psychological impairments that are unique to those who develop persistent symptoms. These impairments are not recognized in the Quebec Task Force classification system. The purpose of this clinical commentary is to describe an integrated model that focuses on how psychological and neurobiological factors interact with, and are influenced by, existing personal and environmental factors to contribute to the development of chronic WAD. The model has been developed through more than 20 years of work in the field, consultation with experts, in-depth synthesis of existing evidence, and new evidence from the authors' own research programs. A subtheme is that a point of convergence currently exists between the psychological, physiological, and social determinants of health literature that can further explain the complex presentation of WAD. The new model is proposed to orient future research toward more interdisciplinary efforts across nontraditional fields, including data scientists and consumers, to clarify the WAD condition. J Orthop Sports Phys Ther 2017;47(7):462-471. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7455.

Misdiagnosing absent pedicle of cervical spine in the acute trauma setting

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Fahad H. Abduljabbar

2015-09-01

Full Text Available Congenital absence of cervical spine pedicle can be easily misdiagnosed as facet dislocation on plain radiographs especially in the acute trauma setting. Additional imaging, including computed tomography (CT-scan with careful interpretation is required in order to not misdiagnose cervical posterior arch malformation with subsequent inappropriate management. A 39-year-old patient presented to the emergency unit of our university hospital after being trampled by a cow over her back and head followed by loss of consciousness, retrograde amnesia and neck pain. Her initial cervical CT-scan showed possible C5-C6 dislocation, then, it became clear that her problem was a misdiagnosed congenital cervical abnormality. Patient was treated symptomatically without consequences. The congenital absence of a cervical pedicle is a very unusual condition that is easily misdiagnosed. Diagnosis can be accurately confirmed with a CT-scan of the cervical spine. Symptomatic conservative treatment will result in resolution of the symptoms.

Whiplash-associated disorders: who gets depressed? Who stays depressed?

OpenAIRE

Phillips, Leah A.; Carroll, Linda J.; Cassidy, J. David; Côté, Pierre

2010-01-01

Depression is common in whiplash-associated disorders (WAD). Our objectives were to identify factors associated with depressive symptomatology occurring in the initial stages of WAD, and to identify factors predicting the course of depressive symptoms. A population-based cohort of adults sustaining traffic-related WAD was followed at 6 weeks, 3, 6, 9, and 12 months. Baseline measures (assessed a median of 11 days post-crash) included demographic and collision-related factors, prior health, an...

Cranium-brain trauma in computed tomographs - diagnosis and clinical correlation

International Nuclear Information System (INIS)

Wrasse, K.

1982-01-01

For the successful treatment of intracranial complications in the case of cranium-brain trauma a quick and exact diagnosis is necessary. The goal of this work was to test and evaluate the effectivity of computed tomography for neurotraumatology. Using 565 patients, who were acutely or at one time suffering from a cranium-brain trauma, the high validity of computed tomography for these injuries was proven. The following areas in question were studied with respect to the value of computed tomography in comparison to them: angiography, X-ray diagnostic, echoencephalography, brain scintigraphy, electroencephalography and neurological-psychopathological findings from cranium-brain trauma. Statement possibilities and difficulties of computed tomography are discussed in the cases of the following neurotraumatological diseases: extracranial hematomas; acute cranium-brain traumas; traumatic arachnoidal bleeding; diffuse brain edema; transtentorial herniation and brain contusions. At the end the diagnostic and therapeutic procedures in the case of cranium-brain trauma are presented. (orig.) [de

Pain-catastrophizing and fear-avoidance beliefs as mediators between post-traumatic stress symptoms and pain following whiplash injury - A prospective cohort study.

Science.gov (United States)

Andersen, T E; Karstoft, K-I; Brink, O; Elklit, A

2016-09-01

Knowledge about the course of recovery after whiplash injury is important. Most valuable is identification of prognostic factors that may be reversed by intervention. The mutual maintenance model outlines how post-traumatic stress symptoms (PTSS) and pain may be mutually maintained by attention bias, fear, negative affect and avoidance behaviours. In a similar vein, the fear-avoidance model describes how pain-catastrophizing (PCS), fear-avoidance beliefs (FA) and depression may result in persistent pain. These mechanisms still need to be investigated longitudinally in a whiplash cohort. A longitudinal cohort design was used to assess patients for pain intensity and psychological distress after whiplash injury. Consecutive patients were all contacted within 3 weeks after their whiplash injury (n = 198). Follow-up questionnaires were sent 3 and 6 months post-injury. Latent Growth Mixture Modelling was used to identify distinct trajectories of recovery from pain. Five distinct trajectories were identified. Six months post-injury, 64.6% could be classified as recovered and 35.4% as non-recovered. The non-recovered (the medium stable, high stable and very high stable trajectories) displayed significantly higher levels of PTSS, PCS, FA and depression at all time points compared to the recovered trajectories. Importantly, PCS and FA mediated the effect of PTSS on pain intensity. The present study adds important knowledge about the development of psychological distress and pain after whiplash injury. The finding, that PCS and FA mediated the effect of PTSS on pain intensity is a novel finding with important implications for prevention and management of whiplash-associated disorders. WHAT DOES THIS STUDY ADD?: The study confirms the mechanisms as outlined in the fear-avoidance model and the mutual maintenance model. The study adds important knowledge of pain-catastrophizing and fear-avoidance beliefs as mediating mechanisms in the effect of post-traumatic stress on pain

[Surgical tactics in duodenal trauma].

Science.gov (United States)

Ivanov, P A; Grishin, A V

2004-01-01

Results of surgical treatment of 61 patients with injuries of the duodenum are analyzed. The causes of injuries were stab-incised wounds in 24 patients, missile wound -- in 7, closed abdominal trauma -- in 26, trauma of the duodenum during endoscopic papillosphincterotomy -- in 4. All the patients underwent surgery. Complications were seen in 32 (52.5%) patients, 21 patients died, lethality was 34.4%. Within the first 24 hours since the trauma 7 patients died due to severe combined trauma, blood loss, 54 patients survived acute period of trauma, including 28 patients after open trauma, 26 -- after closed and 4 -- after trauma of the duodenum during endoscopic papillosphincterotomy. Diagnostic and surgical policies are discussed. Results of treatment depending on kind and time of surgery are regarded. It is demonstrated that purulent complications due to retroperitoneal phlegmona, traumatic pancreatitis, pneumonia are the causes of significant number of unfavorable outcomes. Therefore, it is important to adequately incise and drainage infected parts of retroperitoneal fat tissue with two-lumen drainages. Decompression through duodenal tube is the effective procedure for prophylaxis of suture insufficiency and traumatic pancreatitis. Suppression of pancreatic and duodenal secretion with octreotid improves significantly surgical treatment results.

Melatonin for chronic whiplash syndrome with delayed melatonin onset randomised, placebo-controlled trial

NARCIS (Netherlands)

Wieringen, S. van; Jansen, T.; Smits, M.G.; Nagtegaal, J.E.; Coenen, A.M.L.

2001-01-01

Objective: To assess the influence of melatonin in patients with chronic whiplash syndrome and delayed melatonin onset. Design: Randomised, double-blind, placebo-controlled, parallel-group trial. One-week baseline was followed by a 4-week treatment period with either melatonin or placebo. In the

Coronary artery dissection following chest trauma

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Manoj K Agarwala

2016-01-01

Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

Myth or reality : Hematocrit and hemoglobin differ in trauma

NARCIS (Netherlands)

Nijboer, Johanna M. M.; van der Horst, Iwan C. C.; Hendriks, Herman G. D.; ten Duis, Hendrik-Jan; Nijsten, Maarten W. N.

Background: Estimating blood loss in trauma patients usually involves the determination of hematocrit (Ht) or hemoglobin (Hb). However, in trauma patients, a poorly substantiated habit exists to determine both Ht and Hb in assessing acute blood loss. This suggests that Ht and Hb provide different

[Relevant factors in medico-legal prognosis of whiplash injury].

Science.gov (United States)

Pujol, Amadeo; Puig, Luisa; Mansilla, Joaquina; Idiaquez, Itziar

2003-07-12

Whiplash injury (WI) is commonly evaluated in medico-legal practice. With the aim of knowing the determining factors of WI's medico-legal prognosis, a prospective and observational study was carried out. One hundred and twenty consecutive patients who were clinically observed and evaluated in the Medico-Legal Clinic of Barcelona were studied. Socio-demographic, clinical, radiographic and evolutive factors were analyzed. We included 120 patients with a mean age of 35.6 (14) years (range, 4-74), with a homogeneous male/female distribution. An earlier cervical pathology was detected in 10% of patients; none of them had previous psychiatric pathology. 95% corresponded to road-traffic accident cases and there were 5 aggression cases. Over 50% of cases involved a rear-end collision. All patients had neck pain, almost 25% had headache and 13% had paresthesia. According to the Whiplash Association Disorders clinical classification, distribution in grades (G) was: G I 51%, G II 32% and G III 17%. Patients reported recovery within a mean time of 71.6 (46) days (range, 4-244), with 51,2 (45) no working days (range, 0-180 days). The 52% of the patients rest with complains. According to the recovery time, the following medico-legal prognostic factors were identified: age (p legal prognostic factors were age, being females, severity of initial clinical symptoms, previous cervical pathology and abnormal cervical MRI/CT.

Whole spine MRI in the assessment of acute vertebral body trauma

International Nuclear Information System (INIS)

Green, R.A.R.; Saifuddin, A.

2004-01-01

To determine the incidence and types of multilevel vertebral body injury in association with acute spinal trauma as assessed by whole spine MRI. All acute admissions to a regional spinal injury unit had whole spine MRI carried out, to detect occult vertebral body injury. Two radiologists assessed 127 cases prospectively, over a period of 3 years. All cases had T2-weighted sagittal imaging of the whole spine (where possible using a T2-weighted fat-suppressed sequence), with T1-weighted imaging in both sagittal and axial planes covering the primary injury. The incidence of secondary injury (defined as either bone bruising, wedge compression fracture or burst fracture) was determined and defined by type, site and relationship to the primary injury. Seventy-seven per cent of cases had a secondary injury level. Of these, bone bruising was the commonest but often occurred in combination with secondary wedge compression fracture or burst fracture. MRI detected 27 non-contiguous wedge compression fractures and 16 non-contiguous burst fractures, giving an incidence of secondary level, non-contiguous fracture of approximately 34%. A higher frequency of secondary vertebral body injury may be defined by MRI than has been described in previous studies based on radiographic evaluation of the whole spine. Whole spine MRI in assessment for occult vertebral body fracture enables increased confidence in the conservative or surgical management of patients with severe spinal injury. (orig.)

Implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT: protocol of a randomised, controlled trial

Directory of Open Access Journals (Sweden)

Trudy Rebbeck

2016-04-01

Discussion: This research is significant as it will be the first study to address the heterogeneity of whiplash by implementing a clinical pathway of care that matches evidence-based interventions to projected risk of poor recovery. The results of this trial have the potential to change clinical practice for WAD, thereby maximising treatment effects, improving patient outcomes, reducing costs and maintaining the compulsory third party system.

'A closer look upon whiplash, postconcussion syndrome and posttraumatic headache. Differences and similarities'

DEFF Research Database (Denmark)

Kasch, Helge

2017-01-01

Summary Post-whiplash, -concussion and -traumatic headache are all well-known entities described after accidents. Over the years they gave rise to discussion about the cause, treatment and consequences. Over the years the frequency of each of these diagnoses has varied. But are they really three...

Coping and emotional distress during acute hospitalization in older persons with earlier trauma: the case of Holocaust survivors.

Science.gov (United States)

Kimron, Lee; Cohen, Miri

2012-06-01

Older persons with earlier trauma are often more vulnerable to stresses of old age. To examine the levels of emotional distress in relation to cognitive appraisal of acute hospitalization and coping strategies in Holocaust survivors compared with an age- and education-matched group of elderly persons without Holocaust experience. This is a cross-sectional study of 63 Holocaust survivors, 65 years and older, hospitalized for an acute illness, and 57 age-, education- and hospital unit-matched people without Holocaust experience. Participants completed appraisal and coping strategies (COPE) questionnaires, and the brief symptoms inventory (BSI-18). Holocaust survivors reported higher levels of emotional distress, appraised the hospitalization higher as a threat and lower as a challenge, and used more emotion-focused and less problem-focused or support-seeking coping strategies than the comparison group. Study variables explained 65% of the variance of emotional distress; significant predictors of emotional distress in the final regression model were not having a partner and more use of emotion-focused coping. The latter mediated the relation of group variable and challenge appraisal to emotional distress. Health professionals must be aware of the potential impact of the hospital environment on the survivors of Holocaust as well as survivors of other trauma. Being sensitive to their specific needs may reduce the negative impact of hospitalization.

Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings.

Science.gov (United States)

Radanov, B P; Sturzenegger, M; Di Stefano, G

1995-09-01

With the increased incidence of whiplash injury following the introduction of compulsory car seat belts, a large number of reports have dealt with the aftermath of this condition. Previous studies, however, focused on somatic symptoms on the one hand or considered only psychological or neuropsychological variables on the other hand, often in loosely defined or selected groups of patients. No study so far has analyzed the long-term outcome in a nonselected group of patients using a clear injury definition considering patient history; somatic, radiologic, and neuropsychological findings; and features of the injury mechanisms assessed soon after trauma and during follow-up. the present investigation was designed to assess these combined factors. According to a strict definition of whiplash injury, we assessed a consecutive nonselected sample of 117 patients with recent injury who had similar sociocultural and educational backgrounds. The patients had been in automobile crashes and were all equally covered by accident insurance according to the country-wide scheme. Initial examination was performed 7.2 +/- 4.2 days after trauma, and follow-up examinations 3, 6, 12, and 24 months later. At baseline, features of injury mechanism, subjective complaints, and different aspects of patient history were documented and cervical spine X rays performed. At all examinations patients underwent neurologic examination and cognitive and psychosocial factor assessment. At 2 years, patients were divided into symptomatic and asymptomatic groups and then compared with regard to the initial findings. In addition, symptomatic patients who were disabled at the 2-year follow-up examination and symptomatic patients not disabled (that is, they were able to work at the pretraumatic level) were compared regarding initial and 2-year findings. At 2 years, 18% of patients still had injury-related symptoms. With regard to baseline findings the following significant differences were found: Symptomatic

Efficacies of various diagnostic modalities in acute trauma of the cervical spine

Energy Technology Data Exchange (ETDEWEB)

Tani, Ichiro (St. Marianna Univ., Kawasaki (Japan). School of Medicine)

1993-12-01

The author reviewed 71 consecutive cases of acute trauma of the cervical spine to define efficacies of various modalities such as plain film, CT and MRI. Pathologies on CT and/or MRI additionally found to plain films were analyzed and correlated to three groups divided according to neurological deficit. The following conclusions were obtained. The usefulness of plain films as the first modality of choice was confirmed. Both CT and MRI are necessary in addition to abnormal plain films in this group if patients have neurological deficit. MRI may be a modality of choice following plain films if they are negative. In the group of brachial plexus palsy MRI should be performed before CT to demonstrate traumatic meningocele. CT myelography is also useful although it is invasive. It is warranted to say that in the asymptomatic group CT and MRI are not indicated, because additionally found abnormalities are clinically insignificant. (author).

Effect of head restraint backset on head-neck kinematics in whiplash.

Science.gov (United States)

Stemper, Brian D; Yoganandan, Narayan; Pintar, Frank A

2006-03-01

Although head restraints were introduced in the 1960s as a countermeasure for whiplash, their limited effectiveness has been attributed to incorrect positioning. The effect of backset on cervical segmental angulations, which were previously correlated with spinal injury, has not been delineated. Therefore, the practical restraint position to minimize injury remains unclear. A parametric study of increasing head restraint backset between 0 and 140mm was conducted using a comprehensively validated computational model. Head retraction values increased with increasing backset, reaching a maximum value of 53.5mm for backsets greater than 60mm. Segmental angulation magnitudes, greatest at levels C5-C6 and C6-C7, reached maximum values during the retraction phase and increased with increasing backset. Results were compared to a previously published head restraint rating system, wherein lower cervical extension magnitudes from this study exceeded mean physiologic limits for restraint positions rated good, acceptable, marginal, and poor. As head restraint contact was the limiting factor in head retraction and segmental angulations, the present study indicates that minimizing whiplash injury may be accomplished by limiting head restraint backset to less than 60mm either passively or actively after impact.

Impact of a TeamSTEPPS Trauma Nurse Academy at a Level 1 Trauma Center.

Science.gov (United States)

Peters, V Kristen; Harvey, Ellen M; Wright, Andi; Bath, Jennifer; Freeman, Dan; Collier, Bryan

2018-01-01

Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired. Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers. With the increased expectations of a well-orchestrated team and larger number of emergency nurses, our program created the Trauma Nurse Academy. This academy provides a core of experienced nurses with an advanced level of training while decreasing the variability of personnel in the trauma bay. Components of the academy include multidisciplinary didactic education, the Essentials of TeamSTEPPS, and interactive trauma bay learning, to include both equipment and drug use. Once completed, academy graduates participate in the orientation and training of General Surgery and Emergency Medicine residents' trauma bay experience and injury prevention activities. Internal and published data have demonstrated growing evidence linking trauma teamwork training to knowledge and self-confidence in clinical judgment to team performance, patient outcomes, and quality of care. Although trauma resuscitations are stressful, high risk, dynamic, and a prime environment for error, new methods of teamwork training and collaboration among trauma team members have become essential. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Modulation of Cervical Facet Joint Nociception and Pain Attenuates Physical and Psychological Features of Chronic Whiplash: A Prospective Study.

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Smith, Ashley Dean; Jull, Gwendolen; Schneider, Geoff M; Frizzell, Bevan; Hooper, Robert A; Sterling, Michele

2015-09-01

To investigate changes in clinical (physical and psychological) features of individuals with chronic whiplash-associated disorder who had previously undergone cervical radiofrequency neurotomy at the time point when the effects of radiofrequency neurotomy had dissipated and pain returned. Prospective cohort observational trial of consecutive patients. Tertiary spinal intervention centre in Calgary, Alberta, Canada. A total of 53 consecutive individuals with chronic whiplash-associated disorder. Individuals underwent radiofrequency neurotomy and were assessed before radiofrequency neurotomy, at 1 and 3 months postprocedure, and then after the return of pain (approximately 10 months postprocedure). Quantitative sensory tests (pressure; thermal pain thresholds; brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement; craniocervical flexion test) were measured. Self-reported disability, psychological distress, pain catastrophization, and posttraumatic stress disorder symptoms also were measured. Upon the return of pain after radiofrequency neurotomy, levels of disability increased (P .22). There were no significant changes in pressure hyperalgesia (P > .054) or craniocervical flexion test performance (P > .07) after the return of pain. Psychological distress and pain catastrophizing increased significantly after the return of pain (P .13). However, there was no difference in number or severity of posttraumatic stress symptoms after the return of pain (P > .30). Physical and psychological features of chronic whiplash-associated disorder are modulated dynamically with cervical radiofrequency neurotomy. These findings indicate that peripheral nociception is involved in the manifestations of chronic whiplash-associated disorder in this cohort of individuals. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

The Evolving Science of Trauma Resuscitation.

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Harris, Tim; Davenport, Ross; Mak, Matthew; Brohi, Karim

2018-02-01

This review summarizes the evolution of trauma resuscitation from a one-size-fits-all approach to one tailored to patient physiology. The most dramatic change is in the management of actively bleeding patients, with a balanced blood product-based resuscitation approach (avoiding crystalloids) and surgery focused on hemorrhage control, not definitive care. When hemostasis has been achieved, definitive resuscitation to restore organ perfusion is initiated. This approach is associated with decreased mortality, reduced duration of stay, improved coagulation profile, and reduced crystalloid/vasopressor use. This article focuses on the tools and methods used for trauma resuscitation in the acute phase of trauma care. Copyright © 2017 Elsevier Inc. All rights reserved.

A Research Synthesis of Therapeutic Interventions for Whiplash-Associated Disorder (WAD: Part 4 – Noninvasive Interventions for Chronic WAD

Directory of Open Access Journals (Sweden)

Robert W Teasell

2010-01-01

Full Text Available Whiplash-associated disorder (WAD represents a significant public health problem, resulting in substantial social and economic costs throughout the industrialized world. While many treatments have been advocated for patients with WAD, scientific evidence supporting their effectiveness is often lacking. A systematic review was conducted to evaluate the strength of evidence for various WAD therapies. Multiple databases (including Web of Science, EMBASE and PubMed were searched to identify all studies published from January 1980 through March 2009 that evaluated the effectiveness of any clearly defined treatment for acute (less than two weeks, subacute (two to 12 weeks or chronic (longer than 12 weeks WAD. The present article, the fourth in a five-part series, evaluates the evidence for noninvasive interventions initiated during the chronic phase of WAD. Twenty-two studies that met the inclusion criteria were identified, 12 of which were randomized controlled trials with ‘good’ overall methodological quality (median Physiotherapy Evidence Database score of 6. For the treatment of chronic WAD, there is evidence to suggest that exercise programs are effective in relieving whiplash-related pain, at least over the short term. While the majority of a subset of nine studies supported the effectiveness of interdisciplinary interventions, the two randomized controlled trials provided conflicting results. Finally, there was limited evidence, consisting of one supportive case series each, that both manual joint manipulation and myofeedback training may provide some benefit. Based on the available research, exercise programs were the most effective noninvasive treatment for patients with chronic WAD, although many questions remain regarding the relative effectiveness of various exercise regimens.

Confirmatory Factor Analysis and Multiple Linear Regression of the Neck Disability Index: Assessment If Subscales Are Equally Relevant in Whiplash and Nonspecific Neck Pain.

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Croft, Arthur C; Milam, Bryce; Meylor, Jade; Manning, Richard

2016-06-01

Because of previously published recommendations to modify the Neck Disability Index (NDI), we evaluated the responsiveness and dimensionality of the NDI within a population of adult whiplash-injured subjects. The purpose of the present study was to evaluate the responsiveness and dimensionality of the NDI within a population of adult whiplash-injured subjects. Subjects who had sustained whiplash injuries of grade 2 or higher completed an NDI questionnaire. There were 123 subjects (55% female, of which 36% had recovered and 64% had chronic symptoms. NDI subscales were analyzed using confirmatory factor analysis, considering only the subscales and, secondly, using sex as an 11th variable. The subscales were also tested with multiple linear regression modeling using the total score as a target variable. When considering only the 10 NDI subscales, only a single factor emerged, with an eigenvalue of 5.4, explaining 53.7% of the total variance. Strong correlation (> .55) (P factor model of the NDI is not justified based on our results, and in this population of whiplash subjects, the NDI was unidimensional, demonstrating high internal consistency and supporting the original validation study of Vernon and Mior.

Neuroimaging of nonaccidental head trauma: pitfalls and controversies

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Fernando, Sujan [University of Missouri-Kansas School of Medicine, Department of Medicine, Kansas City, MO (United States); Obaldo, Ruby E. [The University of Kansas Medical Center, Department of Radiology, Kansas City, MO (United States); Walsh, Irene R. [The University of Missouri-Kansas City, Children' s Mercy Hospitals and Clinics, Department of Emergency Medicine, Kansas City, MO (United States); Lowe, Lisa H. [The University of Missouri-Kansas City, Children' s Mercy Hospitals and Clinics, Department of Radiology, Kansas City, MO (United States)

2008-08-15

Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma. (orig.)

Neuroimaging of nonaccidental head trauma: pitfalls and controversies

International Nuclear Information System (INIS)

Fernando, Sujan; Obaldo, Ruby E.; Walsh, Irene R.; Lowe, Lisa H.

2008-01-01

Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma. (orig.)

MRI in the assessment of the supportive soft tissues of the cervical spine in acute trauma in children

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Keiper, M.D.; Zimmerman, R.A.; Bilaniuk, L.T. [Department of Radiology, Children`s Hospital of Philadelphia, PA (United States)

1998-06-01

We carried out a retrospective analysis of imaging and clinical findings in 52 children with a history of cervical spinal trauma. No patient had evidence of a fracture on plain films or CT. All had MRI at 1.5 T because of persistent or delayed symptoms, unexplained findings of injury or instability, or as further assessment of the extent of soft-tissue injury. Clinical follow-up ranged from 6 months to 3.5 years. MRI was evaluated for its influence on therapy and outcome. MRI was positive in 16 (31 %) of 52 patients. Posterior soft-tissue or ligamentous injury was the most common finding in the 10 patients with mild to moderate trauma, while acute disc bulges and longitudinal ligament disruption, each seen in one case, were uncommon. MRI was superior to CT for assessment of the extent of soft-tissue injury and for identification of spinal cord injuries and intracanalicular hemorrhage in the six patients with more severe trauma. MRI specifically influenced the management of all four patients requiring surgery by extending the level of posterior stabilization. No patients with normal MRI or any of the 10 with radiographically stable soft-tissue injury on MRI, developed delayed clinical or radiographic evidence of instability or deformity. (orig.) With 2 figs., 2 tabs., 24 refs.

Comparative study of potential whiplash injuries for different occupant seated positions during rear end accidents.

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Omerović, Senad; Tomasch, Ernst; Gutsche, Andreas J; Prebil, Ivan

2016-01-01

Whiplash injuries to the cervical spine represent a considerable economic burden on society with medical conditions, in some cases persisting for more than a year. Numerous studies of whiplash injuries have been made for occupant normal seated position, leaving the analysis of neck injuries for out-of-normal positions not well documented. For that purpose, a detailed human cervical spine finite element model was developed. The analysis was made for four most common occupant seated positions, such as: Normal Position with the torso against the seat back and the head looking straight ahead, Torso Lean forward position with the torso away from the seat back for approximately 10°, Head Flexed position with the head flexed forward approximately 20° from the normal position and Head-Flexed with Torso Lean forward position with the head flexed forward approximately 20° and torso 10° from the normal position. The comparative study included the analysis of capsular ligament deformation and the level of S-curvature of the cervical spine. The model developed predicted that Head Flexed seated position and Head-Flexed with Torso Lean forward seated position are most threatening for upper and lower cervical spine capsular ligament, respectively. As for the level of S-curvature, the model predicted that Head-Flexed with Torso Lean forward seated position would be most prone to neck injuries associated with it. This study demonstrated that the occupant seated position has a significant influence on potential whiplash injuries.

Cervical radiofrequency neurotomy reduces central hyperexcitability and improves neck movement in individuals with chronic whiplash.

Science.gov (United States)

Smith, Ashley Dean; Jull, Gwendolen; Schneider, Geoff; Frizzell, Bevan; Hooper, Robert Allen; Sterling, Michele

2014-01-01

This study aims to determine if cervical medial branch radiofrequency neurotomy reduces psychophysical indicators of augmented central pain processing and improves motor function in individuals with chronic whiplash symptoms. Prospective observational study of consecutive patients with healthy control comparison. Tertiary spinal intervention centre in Calgary, Alberta, Canada. Fifty-three individuals with chronic whiplash associated disorder symptoms (Grade 2); 30 healthy controls. Measures were made at four time points: two prior to radiofrequency neurotomy, and 1- and 3-months post-radiofrequency neurotomy. Measures included: comprehensive quantitative sensory testing (including brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement, superficial neck flexor activity during the craniocervical flexion test). Self-report pain and disability measures were also collected. One-way repeated measures analysis of variance and Friedman's tests were performed to investigate the effect of time on the earlier measures. Differences between the whiplash and healthy control groups were investigated with two-tailed independent samples t-test or Mann-Whitney tests. Following cervical radiofrequency neurotomy, there were significant early (within 1 month) and sustained (3 months) improvements in pain, disability, local and widespread hyperalgesia to pressure and thermal stimuli, nociceptive flexor reflex threshold, and brachial plexus provocation test responses as well as increased neck range of motion (all P  0.13) was measured. Attenuation of psychophysical measures of augmented central pain processing and improved cervical movement imply that these processes are maintained by peripheral nociceptive input. Wiley Periodicals, Inc.

Loud preimpact tones reduce the cervical multifidus muscle response during rear-end collisions: a potential method for reducing whiplash injuries.

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Mang, Daniel W H; Siegmund, Gunter P; Brown, Harrison J; Goonetilleke, Samanthi C; Blouin, Jean-Sébastien

2015-01-01

Neck muscle responses after unexpected rear-end collisions consist of a stereotypical combination of postural and startle responses. Prior work using surface electromyography (EMG) has shown that the superficial neck muscle responses can be attenuated when a loud tone (105 dB) is presented 250 milliseconds before impact, but the accompanying response of the deeper multifidus muscles remains unknown. Quantifying this response in multifidus is important because this muscle attaches directly to the cervical facet capsule and can potentially increase the strain in the capsule during an impact and contribute to whiplash injury. To investigate if a loud preimpact tone decreases the cervical multifidus muscle response during rear-end perturbations. After approval by the University Clinical Ethics Review Board, human volunteers experienced a series of three whiplash-like perturbations. Twelve subjects with no history of neurologic disorders or whiplash injury were recruited to participate in this experiment. Bilateral indwelling EMG of multifidus at the C4 and C6 levels, surface EMG of sternocleidomastoid (SCM) and C4 paraspinals (PARAs), and kinematics of the head/neck were measured. Subjects experienced three whiplash-like perturbations (peak acceleration of 19.5 m/s(2)) preceded by either no tone or a loud tone (105 dB) presented 250 milliseconds before sled acceleration onset. The loud tone decreased the muscle activity of C6 multifidus (42%) and C4 PARAs (30%), but did not affect the C4 multifidus or SCM activity. Peak head kinematic responses (extension angle: 6%, retraction: 9%, linear forward acceleration: 9%, and angular acceleration in extension: 13%) were also decreased by the loud preimpact tone. The attenuation of peak C6 multifidus activity and head kinematic responses suggests that a loud preimpact tone may reduce the strain in the cervical facet capsule, which may reduce the risk of whiplash injury during rear-end collisions. Copyright © 2015 Elsevier Inc

Imaging of diaphragmatic rupture after trauma

International Nuclear Information System (INIS)

Eren, S.; Kantarci, M.; Okur, A.

2006-01-01

Traumatic rupture of the diaphragm usually results from blunt or penetrating injuries, or iatrogenic causes. Most cases are initially overlooked in the acute phase because they present with variable clinical and radiological signs. An overlooked diaphragmatic injury presents as a hernia many years later with potentially serious complications, therefore selection of the most appropriate radiological technique and accurate diagnosis of traumatic diaphragmatic hernias (DH) on the first admission is important. Although the diagnosis of diaphragmatic injuries is problematic, various investigations may be used for diagnosis. We describe the imaging findings of 19 traumatic DH cases with various imaging techniques. The patients were acute trauma cases or cases with prior trauma or thoraco-abdominal surgery with clinical suspicion of DH. An evaluation of the imaging techniques used in the diagnosis of DH is presented

Advanced Technologies in Trauma Critical Care Management

Science.gov (United States)

2012-01-01

largely replaced diagnostic peritoneal lavage for identifying intra-abdominal fluid in trauma patients. Furthermore, with the addition of chest windows...authors use chest ultrasound in the following manner: To identify a pneumothorax or hemothorax that needs to be drained acutely To differentiate...these situations, Technologies in the Trauma ICU 913 the authors first insert 2 or 3 chest tubes and position them as usual. A sterile nonad- herent

Can the dissociative PTSD subtype be identified across two distinct trauma samples meeting caseness for PTSD?

Science.gov (United States)

Hansen, Maj; Műllerová, Jana; Elklit, Ask; Armour, Cherie

2016-08-01

For over a century, the occurrence of dissociative symptoms in connection to traumatic exposure has been acknowledged in the scientific literature. Recently, the importance of dissociation has also been recognized in the long-term traumatic response within the DSM-5 nomenclature. Several studies have confirmed the existence of the dissociative posttraumatic stress disorder (PTSD) subtype. However, there is a lack of studies investigating latent profiles of PTSD solely in victims with PTSD. This study investigates the possible presence of PTSD subtypes using latent class analysis (LCA) across two distinct trauma samples meeting caseness for DSM-5 PTSD based on self-reports (N = 787). Moreover, we assessed if a number of risk factors resulted in an increased probability of membership in a dissociative compared with a non-dissociative PTSD class. The results of LCA revealed a two-class solution with two highly symptomatic classes: a dissociative class and a non-dissociative class across both samples. Increased emotion-focused coping increased the probability of individuals being grouped into the dissociative class across both samples. Social support reduced the probability of individuals being grouped into the dissociative class but only in the victims of motor vehicle accidents (MVAs) suffering from whiplash. The results are discussed in light of their clinical implications and suggest that the dissociative subtype can be identified in victims of incest and victims of MVA suffering from whiplash meeting caseness for DSM-5 PTSD.

Minor crashes and 'whiplash' in the United States.

Science.gov (United States)

Bartsch, Adam J; Gilbertson, Lars G; Prakash, Vikas; Morr, Douglas R; Wiechel, John F

2008-10-01

In the United States there is currently a paucity of available real world minor rear crash data with struck vehicle delta-V, or speed change, less than or equal to 15 kilometers per hour. These data are essential as researchers attempt to define 'whiplash' injury risk potential in these minor crashes. This study analyzed a new set of 105 U.S. minor rear aligned crashes between passenger vehicles. Mean struck vehicle delta-V and acceleration were 6.3 km/h (s.d. = 2.1 km/h) and 1.4 g (s.d. = 0.5 g), respectively. A total of 113 struck vehicle occupants were diagnosed within five weeks post-crash with 761 ICD-9-CM complaints and 427 AIS injuries (99.5% AIS1) attributed to the crashes. No striking vehicle occupants reported complaints. The main ICD-9-CM diagnoses were 40.6% cervical, 22.5% lumbar/sacral and 10.2% thoracic and the main AIS1 diagnoses were 29.7% cervical, 23.2% lumbar/sacral and 14.3% thoracic. The diagnosis disparity was mainly due to coding for pre-existing degenerative diagnosis in ICD-9-CM. Degenerative spine conditions were not significant for increased AIS1 injury risk. Surprisingly, many non-'whiplash' diagnoses were found. The AIS injury diagnosis distribution and frequency in these minor delta-V crashes did not correspond with previous minor rear crash studies. A prospectively collected and unbiased minor rear crash databank in the model of CIREN or NASS is highly desirable to verify or refute these results for the U.S. population since the current study cohort may have been influenced by litigation.

Occult Pneumothoraces in Acute Trauma Patients

Directory of Open Access Journals (Sweden)

Chad Berryman

2012-12-01

Full Text Available Introduction: Many traumatic pneumothoraces (PTX are not seen on initial chest radiograph (CR(occult PTX but are detected only on computed tomography (CT. Although CR remains the first toolfor detecting PTX, most trauma patients with significant thoracoabdominal injuries will receive both CTand CR. The primary objective of this study was to retrospectively determine the effectiveness of CR fordetecting PTX in trauma patients. Our hypotheses were that CR is a sensitive indicator of PTX on CT,that chest pain and shortness of breath are good predictors of PTX on CR, and that we could determineother predictors of PTX on CR.Methods: All trauma patients presenting to our Level I trauma center with a CT-diagnosed PTX over a2-year period who had both a CR and a chest CT were included. The CT reading was considered thegold standard for PTX diagnosis. Electronic medical records were searched using key words fordiagnoses, symptoms, demographics, and radiologic results. We recorded the official radiologistreadings for both CR and CT (positive or negative and the size of the PTX on CT (large, moderate,small, or tiny. The outcome variable was dichotomized based on presence or absence of PTXdetected on CR. Descriptive statistics and v2 tests were used for univariate analysis. A regressionanalysis was performed to determine characteristics predictive of a PTX on CR, and 1 variable wasadded to the model for every 10 positive CRs. With equal-size groups, this study has the power of 80%to detect a 10% absolute difference in single predictors of PTX on CR with 45 subjects in each group.Results: There were 134 CT-documented PTXs included in the study. Mean age was 42, and 74%were men. For 66 (49% patients, PTX was detected on CR (sensitivity¼50%. The CR detected 30%of small PTX, 35% of moderate PTX, and 33% of large PTX. Comparing patients with and without PTXon CR, there were no significant differences in shortness of breath or chest pain. There no

Occult pneumothoraces in acute trauma patients.

Science.gov (United States)

Ernst, Amy A; McIntyre, William A; Weiss, Steven J; Berryman, Chad

2012-11-01

Many traumatic pneumothoraces (PTX) are not seen on initial chest radiograph (CR) (occult PTX) but are detected only on computed tomography (CT). Although CR remains the first tool for detecting PTX, most trauma patients with significant thoracoabdominal injuries will receive both CT and CR. The primary objective of this study was to retrospectively determine the effectiveness of CR for detecting PTX in trauma patients. Our hypotheses were that CR is a sensitive indicator of PTX on CT, that chest pain and shortness of breath are good predictors of PTX on CR, and that we could determine other predictors of PTX on CR. All trauma patients presenting to our Level I trauma center with a CT-diagnosed PTX over a 2-year period who had both a CR and a chest CT were included. The CT reading was considered the gold standard for PTX diagnosis. Electronic medical records were searched using key words for diagnoses, symptoms, demographics, and radiologic results. We recorded the official radiologist readings for both CR and CT (positive or negative) and the size of the PTX on CT (large, moderate, small, or tiny). The outcome variable was dichotomized based on presence or absence of PTX detected on CR. Descriptive statistics and χ(2) tests were used for univariate analysis. A regression analysis was performed to determine characteristics predictive of a PTX on CR, and 1 variable was added to the model for every 10 positive CRs. With equal-size groups, this study has the power of 80% to detect a 10% absolute difference in single predictors of PTX on CR with 45 subjects in each group. There were 134 CT-documented PTXs included in the study. Mean age was 42, and 74% were men. For 66 (49%) patients, PTX was detected on CR (sensitivity = 50%). The CR detected 30% of small PTX, 35% of moderate PTX, and 33% of large PTX. Comparing patients with and without PTX on CR, there were no significant differences in shortness of breath or chest pain. There no relationships between PTX detected

Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center.

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Ploumis, A; Kolli, S; Patrick, M; Owens, M; Beris, A; Marino, R J

2011-03-01

Retrospective database review. To compare lengths of stay (LOS), pressure ulcers and readmissions to the acute care hospital of patients admitted to the inpatient rehabilitation facility (IRF) from a model spinal cord injury (SCI) trauma center or from a non-SCI acute hospital. Only sparse data exist comparing the status of patients admitted to IRF from a model SCI trauma center or from a non-SCI acute hospital. Acute care, IRF and total LOS were compared between patients transferred to IRF from the SCI center (n=78) and from non-SCI centers (n=131). The percentages of pressure ulcers on admission to IRF and transfer back to acute care were also compared. Patients admitted to IRF from the SCI trauma center (SCI TC) had significantly shorter (P=0.01) acute care LOS and total LOS compared with patients admitted from non-SCI TCs. By neurological category, acute-care LOS was less for all groups admitted from the SCI center, but statistically significant only for tetraplegia. There was no significant difference in the incidence of readmissions to acute care from IRF. More patients from non-SCI centers (34%) than SCI centers (12%) had pressure ulcers (PSCI TCs before transfer to IRF can significantly lower acute-care LOS or total LOS and incidence of pressure ulcers compared with non-SCI TCs. Patients admitted to IRF from SCI TCs are no more likely to be sent back to an acute hospital than those from non-SCI TCs.

Do Subjects with Whiplash-Associated Disorders Respond Differently in the Short-Term to Manual Therapy and Exercise than Those with Mechanical Neck Pain?

Science.gov (United States)

Castaldo, Matteo; Catena, Antonella; Chiarotto, Alessandro; Fernández-de-Las-Peñas, César; Arendt-Nielsen, Lars

2017-04-01

To compare the short-term effects of manual therapy and exercise on pain, related disability, range of motion, and pressure pain thresholds between subjects with mechanical neck pain and whiplash-associated disorders. Twenty-two subjects with mechanical neck pain and 28 with whiplash-associated disorders participated. Clinical and physical outcomes including neck pain intensity, neck-related disability, and pain area, as well as cervical range of motion and pressure pain thresholds over the upper trapezius and tibialis anterior muscles, were obtained at baseline and after the intervention by a blinded assessor. Each subject received six sessions of manual therapy and specific neck exercises. Mixed-model repeated measures analyses of covariance (ANCOVAs) were used for the analyses. Subjects with whiplash-associated disorders exhibited higher neck-related disability ( P  = 0.021), larger pain area ( P  = 0.003), and lower pressure pain thresholds in the tibialis anterior muscle ( P  = 0.009) than those with mechanical neck pain. The adjusted ANCOVA revealed no between-group differences for any outcome (all P  > 0.15). A significant main effect of time was demonstrated for clinical outcomes and cervical range of motion with both groups experiencing similar improvements (all P   0.222). The current clinical trial found that subjects with mechanical neck pain and whiplash-associated disorders exhibited similar clinical and neurophysiological responses after a multimodal physical therapy intervention, suggesting that although greater signs of central sensitization are present in subjects with whiplash-associated disorders, this does not alter the response in the short term to manual therapy and exercises. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

A scoping review on health economics in neurosurgery for acute spine trauma.

Science.gov (United States)

Chan, Brian C F; Craven, B Catharine; Furlan, Julio C

2018-05-01

OBJECTIVE Acute spine trauma (AST) has a relatively low incidence, but it often results in substantial individual impairments and societal economic burden resulting from the associated disability. Given the key role of neurosurgeons in the decision-making regarding operative management of individuals with AST, the authors performed a systematic search with scoping synthesis of relevant literature to review current knowledge regarding the economic burden of AST. METHODS This systematic review with scoping synthesis included original articles reporting cost-effectiveness, cost-utility, cost-benefit, cost-minimization, cost-comparison, and economic analyses related to surgical management of AST, whereby AST is defined as trauma to the spine that may result in spinal cord injury with motor, sensory, and/or autonomic impairment. The initial literature search was carried out using MEDLINE, EMBASE, CINAHL, CCTR, and PubMed. All original articles captured in the literature search and published from 1946 to September 27, 2017, were included. Search terms used were the following: (cost analysis, cost effectiveness, cost benefit, economic evaluation or economic impact) AND (spine or spinal cord) AND (surgery or surgical). RESULTS The literature search captured 5770 titles, of which 11 original studies met the inclusion/exclusion criteria. These 11 studies included 4 cost-utility analyses, 5 cost analyses that compared the cost of intervention with a comparator, and 2 studies examining direct costs without a comparator. There are a few potentially cost-saving strategies in the neurosurgical management of individuals with AST, including 1) early surgical spinal cord decompression for acute traumatic cervical spinal cord injury (or traumatic thoracolumbar fractures, traumatic cervical fractures); 2) surgical treatment of the elderly with type-II odontoid fractures, which is more costly but more effective than the nonoperative approach among individuals with age at AST between 65

Eye movements in patients with Whiplash Associated Disorders: A systematic review

OpenAIRE

Ischebeck, B.; Vries, Jurryt; Geest, Jos; Janssen, Malou; Wingerden, Jan-Paul; Kleinrensink, Gert Jan; Frens, Maarten

2016-01-01

textabstractBackground: Many people with Whiplash Associated Disorders (WAD) report problems with vision, some of which may be due to impaired eye movements. Better understanding of such impaired eye movements could improve diagnostics and treatment strategies. This systematic review surveys the current evidence on changes in eye movements of patients with WAD and explains how the oculomotor system is tested. Methods: Nine electronic data bases were searched for relevant articles from incepti...

Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report.

Science.gov (United States)

Lee, Thung-Lip; Hsuan, Chin-Feng; Shih, Chen-Hsiang; Liang, Huai-Wen; Tsai, Hsing-Shan; Tseng, Wei-Kung; Hsu, Kwan-Lih