Whiplash injury – the science of prognosis

Whiplash injury medicolegal

With the Medco now monitoring the medical reporting industry it has become ever so important to understand the science of prognosis, the ‘holy grail’ of Whiplash!

Whilst it is true that prognosis is not an exact science, the medical expert is expected to give a Magic Number for recovery period.

The industry’s obsession with the magic number of 12 to 13 month prognosis is ill-founded. It is easy to succumb to the temptation of giving a ball park figure of 12 months.

Published evidence on the long-term prognosis of whiplash injury

Over the last 46 years there have been over 53 papers published on the long-term prognosis of Whiplash Injury. In the studies that followed up patients for at least 6 months post accident, the average of the proportions of the patient who are still symptomatic was between 35% – 55%. The patients that remained symptomatic at follow-up were in some cases totally disabled with pain, where as others complained of only occasional bothersome pain.

Whilst 45% of cases may recover in 12 weeks, nearly 55% continue to suffer beyond three months and some beyond two years post-accident. More than 50% will have certain level of symptoms beyond the first year and 10% never recover and can be classed as disabled.

What this means in practical terms for the medical expert writing the initial / first report?

Consider the range of opinion giving regard to the fact that recovery can occur at various stages.

Undertake risk factor analysis through careful assessment & recommend re-examination for high risk cases if they fail to recover in the initial six months.

Recognise that a majority of the straightforward low-risk cases would recover in the first three to six months.

Not get dictated by the industry or the constraints of report writing softwares if these do no allow free text to give a detailed opinion.

Remember, the Medco is only interested in the job well done – opinion and prognosis based on evidence, not whether you get paid £30 or £180!