Epidemiology of bicycle injuries and risk factors for serious injury -- Rivara et al. 3 (2): 110 -- Injury Prevention
Epidemiology of bicycle injuries and risk factors for serious injury Epidemiology of bicycle injuries and risk factors for serious injury
F. P. Rivara, D. C. Thompson and R. S. Thompson
Harborview Injury Prevention and Research Center, Department of Pediatrics and Epidemiology, University of Washington, Seattle USA.
OBJECTIVE: To determine the risk factors for serious injury to bicyclists, aside from helmet use. DESIGN: Prospective case-control study. SETTING: Seven Seattle area hospital emergency departments and two county medical examiner's offices. PATIENTS: Individuals treated in the emergency department or dying from bicycle related injuries. MEASUREMENTS: Information collected from injured bicyclists or their parents by questionnaire on circumstances of the crash; abstract of medical records for injury data. Serious injury defined as an injury severity score > 8. ANALYSIS: Odd ratios computed using the maximum likelihood method, and adjusted using unconditional logistic regression. RESULTS: There were 3854 injured cyclists in the three year period; 3390 (88%) completed questionnaires were returned 51% wore helmets at the time of crash. Only 22.3% of patients had head injuries and 34% had facial injuries. Risk of serious injury was increased by collision with a motor vehicle (odds ratio (OR) = 4.6), self reported speed > 15 mph (OR = 1.2), young age (< 6 years), and age > 39 years (OR = 2.1 and 2.2 respectively, compared with adults 20-39 years). Risk for serious injury was not affected by helmet use (OR = 0.9). Risk of neck injury was increased in those struck by motor vehicles (OR = 4.0), hospitalized for any injury (OR = 2.0), and those who died (OR = 15.1), but neck injury was not affected by helmet use. CONCLUSIONS: Prevention of serious bicycle injuries cannot be accomplished through helmet use alone, and may require separation of cyclists from motor vehicles, and delaying cycling until children are developmentally ready.
Cognitive complaints in patients after whiplash injury: the impact of malingering
Cognitive complaints in patients after whiplash injuryCognitive complaints in patients after whiplash injury
Abstract
Top
Abstract
Introduction
Methods
Results
Discussion
References
OBJECTIVESThe validity of memory and concentration complaints that are often reported after a whiplash trauma is controversial. The prevalence of malingering or underperformance in post-whiplash patients, and its impact on their cognitive test results were studied.
METHODSThe Amsterdam short term memory (ASTM) test, a recently developed malingering test, was used as well as a series of conventional memory and concentration tests. The study sample was a highly selected group of patients, who were examined either as part of a litigation procedure (n=36) or in the normal routine of an outpatient clinic (n=72).
RESULTSThe prevalence of underperformance, as defined by a positive score on the malingering test, was 61% (95% CI: 45-77) in the context of litigation, and 29% (95% CI: 18-40) in the outpatient clinic (p=0.003). Furthermore, the scores on the memory and concentration test of malingering post-whiplash patients (n=43) and non-malingering post-whiplash patients (n=65) were compared with the scores of patients with closed head injury (n=20) and normal controls (n=46). The malingering post-whiplash patients scored as low as the patients with closed head injury on most tests.
CONCLUSIONSThe prevalence of malingering or cognitive underperformance in late post-whiplash patients is substantial, particularly in litigation contexts. It is not warranted to explain the mild cognitive disorders of whiplash patients in terms of brain damage, as some authors have done. The cognitive complaints of non-malingering post-whiplash patients are more likely a result of chronic pain, chronic fatigue, or depression.
(J Neurol Neurosurg Psychiatry 1998;64:339-343)
Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms -- Sturzenegger et al. 44 (4): 688 -- Neurology
Presenting symptoms and signs after whiplash injury
Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms
M Sturzenegger, G DiStefano, BP Radanov and A Schnidrig
Department of Neurology, University of Berne, Switzerland.
OBJECTIVE: To assess the relationship between accident mechanisms and initial findings after whiplash injury. DESIGN: Cohort study. SETTING: Outpatient department, Department of Neurology, University of Berne, Switzerland. PATIENTS: A population-based sample of 137 consecutive patients referred by primary care physicians. Fractures or dislocations of the cervical spine, head trauma, and preexisting neurologic disorders were exclusion criteria. MAIN OUTCOME MEASURES: Patients were interviewed and examined within 7.2 days (SD, 3.9 days) after trauma. Analyzed accident features were position in the car, use of seat belt, head restraint and its point of head contact, damage to seat, head position and state of preparedness at the moment of impact, and type of collision. Analyzed symptoms were intensity and onset delay of post- traumatic head and neck pain; pain in the shoulders, back, and anterior neck; symptoms of neurologic dysfunction according to presumed origin-- cranial nerve or brainstem, radicular or myelopathic; and a score of multiple symptoms. Analyzed signs were neck muscle tenderness and restricted neck movement, and signs of cranial nerve, brainstem, or radicular dysfunction. RESULTS: Passenger position in the car, use of seat belt, and the presence of a head restraint showed no significant relationship with findings. Rotated or inclined head position at the moment of impact was associated with a higher frequency of multiple symptoms (p = 0.045 and 0.008) with more severe symptoms and signs of musculoligamental cervical strain (p = 0.048 and 0.038) and of neural, particularly radicular (p = 0.031 and 0.019), damage. Unprepared occupants had a higher frequency of multiple symptoms (p = 0.031) and more severe headache (p = 0.046). Rear-end collision was associated with a higher frequency of multiple symptoms (p = 0.006), especially of cranial nerve or brainstem dysfunction (p = 0.00003). CONCLUSION: Three features of accident mechanisms were associated with more severe symptoms: an unprepared occupant; rear-end collision, with or without subsequent frontal impact; and rotated or inclined head position at the moment of impact.
Epidemiology of whiplash
Epidemiology of whiplash: "Epidemiology of whiplash"
Whiplash associated disorders have become an international medicolegal and social dilemma. Physicians are not sure what the best therapeutic approach should be, and the courts are finding the topic growing ever more controversial. There are many evident paradoxes in the development and presentation of such disorders. We will focus particularly on the remarkable epidemiological findings covering the "natural history" of this problem, and provide a biopsychosocial model to explain these observations.
A model that considers that chronic symptoms reflect some form of chronic, injury related damage cannot account for wide differences in the prevalence of such behaviours between different countries and even different regions of the same country.
SINGAPORE AND AUSTRALIA
The behaviour of reporting chronic symptoms, which once was so commonly observed in whiplash patients in Australia, does not occur in Singapore.1 This is despite there being at least as many collisions in Singapore. According to J L . . . [
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Cervical Zygapophysial Joint Pain
The prevalence of chronic cervical zygapophysial joint pain after whiplash
The prevalence of chronic cervical zygapophysial joint pain after whiplash.
Barnsley L, Lord SM, Wallis BJ, Bogduk N.
Cervical Spine Research Unit, Faculty of Medicine, University of Newcastle, Callaghan, Australia.
STUDY DESIGN. A survey of the prevalence of cervical zygapophysial joint pain was conducted. OBJECTIVES. To determine the prevalence of cervical zygapophysial joint pain in patients with chronic neck pain after whiplash. SUMMARY OF BACKGROUND DATA. In a significant proportion of patients with whiplash, chronic, refractory neck pain develops. Provisional data suggest many of these patients have zygapophysial joint pain, but the diagnosis has been established by single, uncontrolled diagnostic blocks. METHODS. Fifty consecutive, referred patients with chronic neck pain after whiplash injury were studied using double-blind, controlled, diagnostic blocks of the cervical zygapophysial joints. On separate occasions, the joint was blocked with either lignocaine or bupivacaine in random order. RESULTS. A positive diagnosis was made only if both blocks relieved the patient's pain and bupivacaine provided longer relief. Painful joints were identified in 54% of the patients (95% confidence interval, 40% to 68%). CONCLUSION. In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash.
Whiplash produces an S-shaped curvature of the neck
Whiplash produces an S-shaped curvature of the neck Whiplash produces an S-shaped curvature of the neck with hyperextension at lower levels.
Grauer JN, Panjabi MM, Cholewicki J, Nibu K, Dvorak J.
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA.
STUDY DESIGN: A bench-top trauma sled was used to apply four intensities of whiplash trauma to human cadaveric cervical spine specimens and to measure resulting intervertebral rotations using high-speed cinematography. OBJECTIVES: To determine the cervical spine levels most prone to injury from whiplash trauma and to hypothesize a mechanism for such injury. SUMMARY OF BACKGROUND DATA: Whiplash injuries traditionally have been ascribed to hyperextension of the head, but other mechanisms such as hypertranslation also have been suggested. METHODS: Six occiput to T1 (or C7) fresh cadaveric human spines were studied. Physiologic flexion and extension motions were recorded with an Optotrak motion analysis system by loading up to 1.0 Nm. Specimens then were secured in a trauma sled, and a surrogate head was attached. Flags fixed to the head and individual vertebrae were monitored with high-speed cinematography (500 frames/sec). Data were collected for 12 traumas in four classes defined by the maximum sled acceleration. The trauma classes were 2.5 g, 4.5 g, 6.5 g, and 8.5 g. Significance was defined at P < 0.01. RESULTS: In the
whiplash traumas, the peak intervertebral rotations of C6-C7 and C7-T1 significantly exceeded the maximum physiologic extension for all trauma classes studied. The maximum extension of these lower levels occurred significantly before full neck extension. In fact, the upper cervical levels were consistently in flexion at the time of maximum lower level extension. CONCLUSIONS: In whiplash, the neck forms an S-shaped curvature, with lower level hyperextension and upper level flexion. This was identified as the injury stage for the lower cervical levels. A subsequent C-shaped curvature with extension of the entire cervical spine produced less lower level extension.
Generalised muscular hyperalgesia in chronic whiplash syndrome
Muscular hyperalgesia in chronic whiplash syndrome
Koelbaek Johansen M, Graven-Nielsen T, Schou Olesen A, Arendt-Nielsen L.
Department of Rheumatology, Aalborg Hospital, Aalborg, Denmark.
The whiplash syndrome has immense socio-economic impact. Despite extensive studies over the past years, the mechanisms involved in maintaining the pain in chronic whiplash patients are poorly understood. The aim of the present experimental study was to examine the muscular sensibility in areas within and outside the region involved in the whiplash trauma. Eleven chronic whiplash patients and 11 sex and age matched control subjects were included in the study. Before the experiment, the whiplash patients had pain in the neck and shoulder region with radiating pain to the arm. Five patients reported pain that was more widespread. The somatosensory sensibility in the areas over the infraspinatus, brachioradial, and anterior tibial muscles was assessed by pressure stimulation, pin-prick stimulation, and cotton swap stimulation. Infusion of hypertonic saline (5.85%, 0.5 ml) into the infraspinatus and anterior tibial muscles was performed to assess the muscular sensibility and referred pain pattern. The saline-induced muscle pain intensity was assessed on a continuous visual analogue scale (VAS). The distribution of pain was drawn on an anatomical map. The pressure pain thresholds were significantly lower in patients (P<0. 01) compared with controls: infraspinatus (mean 152.2 vs. 172.7 kPa), brachioradial (mean 70.0 vs. 363.8 kPa), and anterior tibial muscle (mean 172.7 vs. 497.8 kPa). The skin sensibility to pin-prick stimulation and cotton swap stimulation was not different between patients and controls. Infusion of hypertonic saline caused significantly higher VAS scores with longer duration in patients compared to control subjects (P<0.01). The area under the VAS-time curve was significantly (P<0.01) increased in patients compared to control subjects after injection into the infraspinatus muscle (mean 4138.1 vs. 780.0 cm s) and anterior tibial muscle (mean 4370.8 vs. 978.7 cm s). The saline infusion caused local pain defined as pain located around the injection site and referred pain areas not included in the local pain area. The area of local and referred pain were significantly larger in patients compared to control subjects (P<0.01). In the control group, the referred pain areas to infusion of hypertonic saline into the anterior tibial muscle were found at the dorsal aspect of the ankle. In contrast, the areas of referred pain were quite widespread in the patient group with both distal and proximal referred pain areas. In the present study, muscular hyperalgesia and large referred pain areas were found in patients with chronic whiplash syndrome compared to control subjects both within and outside the traumatised area. The findings suggest a generalised central hyperexcitability in patients suffering from chronic whiplash syndrome. This indicates that the pain might be considered as a neurogenic type of pain, and new pharmacological treatments should be investigated accordingly.
Cerebral symptoms after whiplash injury of the neck
Cerebral symptoms after whiplash injury of the neck: a prospective clinical and neuropsychological study of whiplash injury Journal of Neurology, Neurosurgery, and PsychiatryTwenty one unselected patients with an acute whiplash injury of the neck had neurological and neuropsychological assessment, cervical x rays, EEG, BAEP, MRI, and an otoneurological examination within two weeks of the injury. Subjectively, 13 patients reported concentration deficits, 18 reported sleep disturbances, 9 had symptoms of depression, and 7 female patients told of menstrual irregularities. Neuropsychological examination revealed significantly lower performance in tests related to attention and concentration compared to sex, age and educational matched control subjects. Otoneurological examination showed abnormalities in 9 of 17
whiplash subjects. EEG showed questionable changes in 8 of 18 recordings. MRI and BAEP were normal in all patients. Repeat neuropsychological testing in 15 patients at three months showed that attention deficits had improved but were still shown in 12 of 14 and the concentration deficits in 8 of 13 patients. At one year all patients had returned to work, 16 to full and 5 to part time employment. In 4, cognitive dysfunction remained the only significant problem. These findings are discussed as being compatible with possible damage to basal frontal and upper brain stem structures after whiplash injury of the neck.
A prospective study of 39 patients with whiplash injury
Study of 39 patients with whiplash injuryA prospective study of 39 patients with whiplash injury.
Karlsborg M, Smed A, Jespersen H, Stephensen S, Cortsen M, Jennum P, Herning M, Korfitsen E, Werdelin L.
Department of Neurology, University Hospital of Hvidovre, Copenhagen, Denmark.
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 were found. RESULTS: The total recovery rate (asymptomatic patients) was 29% after 7 months. MRI was repeated in 6 patients. The correlation between MRI and the clinical findings was poor. Cognitive dysfunction as a symptom of brain injury was not found. Stress at the same time predicted more symptoms at follow-up. All MEP examinations were normal. CONCLUSION: In this study, long-lasting distress and poor outcome were more related to the occurrence of stressful life events than to clinical and paraclinical findings.
Infant whiplash-shake injury syndrome
Whiplash-shake injury syndrome
The infant whiplash-shake injury syndrome: a clinical and pathological study.
Hadley MN, Sonntag VK, Rekate HL, Murphy A.
Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona.
The cases of 13 infants (median age, 3 months) who sustained nonaccidental trauma were reviewed. All presented with profound neurological impairment, seizures, retinal hemorrhages, and intracranial subarachnoid and/or subdural hemorrhages. Of 8 infants who died, autopsy was performed on 6. No patient had a skull fracture, and only one had an extracalvarial contusion. Five of the 6 patients on whom autopsy was performed had injuries at the cervicomedullary junction consisting of sub- or epidural hematomas of the cervical spinal cord with proximal spinal cord contusions. The authors conclude that direct cranial trauma is not an essential element of the injury mechanism in young patients who sustain severe whiplash-shake injuries. In addition to the classic injuries reported to occur with the shaken-baby syndrome, hemorrhages and contusions of the high cervical spinal cord may contribute to morbidity and mortality.
Acute Whiplash
Prognosis of acute whiplash: "STUDY DESIGN: Systematic review of prognostic studies of acute whiplash. OBJECTIVES: To update the systematic review on the prognosis of acute whiplash published by the Quebec Task Force on Whiplash-Associated Disorders and to propose a new conceptual framework to conduct systematic reviews on prognosis. SUMMARY OF BACKGROUND DATA: In 1995, the Quebec Task Force published a systematic review of the literature on whiplash and concluded that its prognosis is favorable. However, few prognostic factors were identified. Recent studies have added to this knowledge, and there is a need to update the review conducted by the Quebec Task Force. METHODS: A bibliographic search of four electronic databases was performed to identify prognostic studies of acute whiplash published after 1995. The literature was appraised with standard review criteria. The consistency of evidence across studies was assessed. A conceptual framework was designed to classify the literature according to methodologic quality, target population, and phases of investigation. RESULTS: Thirteen cohort studies were included in the review. The framework used in this study demonstrates that most of the recent prognostic studies are descriptive in nature. The prognosis of acute whiplash varies according to the population sampled and the insurance/compensation system under which individuals are allowed to claim benefits. Besides age, gender, baseline neck pain intensity, baseline headache intensity, and baseline radicular signs and symptoms, there is little consistency in the literature about the prognostic factors for the recovery of whiplash. CONCLUSIONS: Scant knowledge about the prognosis of whiplash has been gained since the release of the Quebec Task Force report. However, it is becoming obvious that the insurance and compensation sy"
Whiplash and Acute Neck Sprain Injuries
Resources relating to whiplash injuries and other acute neck sprain injuries
This blog is my way of keeping track of the resources I have found which relate to the research I have carried out to attain my Phd.
