Poor prognosis of whiplash injuries

As personal injury practitioners we often scoff at the thought of a whiplash injury being a serious injury that warrants our attention any more than as a mere nominal payment for General Damages if at all (MVA’s come to mind)

  

 A Canadian study[1] 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 factor 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. One can assume that a falling lift, a tumble down the stairs or any other relevant injury may have the same consequences.

The study introduced a combined risk score that predicts longer recovery. In the subjects with these signs and symptoms, the median recovery time was 32 days and 12% of subjects had still not recovered after 6 months. The signs and symptoms that were found to be independently associated with a slower recovery from whiplash, besides female gender and older age, were neck pain on palpation; muscle pain; pain or numbness radiating from neck to arms , hands or shoulders; and headache. I would suggest that a predisposition to osteoporosis should also be taken into consideration.

Together, the presence of all these factors in females aged 60 predicted a median recovery time of 262 days, compared with 17 days for younger males aged 20 who do not have any of these factors.

In a different 15 year study of forty patients[2] with a whiplash injury, who had been reviewed previously 2 and 10 years after injury, were assessed again after a mean of 15.5 years by physical examination, pain and psychometric testing. Twenty-eight (70%) continued to complain of symptoms referable to the original accident. Neck pain was the commonest, but low-back pain was present in half. Women and older patients had a worse outcome. Radiating pain was more common in those with severe symptoms. Evidence of psychological disturbance was seen in 52% of patients with symptoms. Between 10 and 15 years after the accident 18% of the patients had improved whereas 28% had deteriorated.

In another study, Frequency, Timing, and Course of Depressive Symptomatology after Whiplash, the assessment of[3] 5,211 subjects reported no pre-injury mental health problems, 42.3% (95% confidence interval, 40.9–43.6) developed depressive symptoms within 6 weeks of the injury, with subsequent onset in 17.8% (95% confidence interval, 16.5–19.2). Depressive symptoms were recurrent or persistent in 37.6% of those with early post-injury onset. Pre-injury mental health problems increased the risk of later onset depressive symptoms and of a recurrent or persistent course of early onset depressive symptoms.

It was concluded from this study that depressive symptomatology after whiplash is common, occurs early after the injury, and is often persistent or recurrent. This suggests that, like neck pain and headache, depressed symptomatology is part of the cluster of acute whiplash symptoms and that clinicians should be aware of both physical and psychological injuries after traffic collisions.

What these studies prove is that we need to ask our experts to be clearer in their reports on patients future prospects, especially in cases where an addendum is prepared and where the only prospect of financial reward would be the application of the narrative test (MVA’s). It is clear from these studies that a whiplash injury cannot simply be ignored when taking into consideration if a client qualifies for general damages or for what amount such general damages should be awarded.

Careful consideration and adequate instructions to our experts will insure that matters are properly considered as they should be.

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[1] McGill University, Montreal, Canada. samy.suissa@clinepi.mcgill.ca

[2] © 1996 British Editorial Society of Bone and Joint Surgery

[3] © 2006 Lippincott Williams & Wilkins, Inc.

Post Traumatic Stress Disorder (PTSD)

A large number of South African suffers from Post Traumatic Stress Syndrome for some reason or another. It is common for Personal Injury victims to have recurring nightmares or unreasonable fear when again placed in the particular event or situation that afflicted them in the first place. Research indicates that 7 to 12 percent of people develop post-traumatic stress disorder (PTSD) at some point in their lives, with women more likely than men to develop it.

PTSD is an anxiety disorder that can occur after a person experiences a traumatic event such as combat or military experience, sexual or physical abuse or assault, a serious accident, or a natural disaster such as a fire, tornado, flood, or earthquake. Some people develop PTSD after seeing someone else experience a traumatic event. The more severe and the greater the number of traumatic events experienced, the more likely someone is to develop the disorder. PTSD often leaves one feeling vulnerable, out of control, and as if one is in constant danger. These feelings are persistent, are strong, and do not disappear over time on their own. Everyday life, work, and relationships can be negatively affected.

In some instances the effects of such PTSD can have a debilitating effect on the work and home environment of the sufferer and can go undiagnosed in such personal injury cases preventing provision being made for proper care and treatment after the fact.

To be diagnosed with PTSD, the person must have persistent trauma-related problems for at least a month after the event. The person must also have specific

symptoms, which are described below.

What Are the Symptoms of PTSD?

PTSD is defined as experiencing three types of persistent symptoms following a traumatic event:

• re-experiencing the event through intrusive memories, dreams, or flashbacks, or feeling distress upon exposure to trauma-related stimuli

• avoidance of people, places, or things that remind the person of the traumatic event; numbing of feelings or detachment from others

• increased arousal, including increased heart rate and muscular tension, restlessness, sleeping, irritability, poor concentration, feeling on guard or hyper vigilant, or having an exaggerated startle response[1]

I find that attorneys for both parties too easily dismiss these diagnoses with a wave of the hand and open themselves up to litigation for under settling. Once again, ensure that you investigate your client’s complaints completely and in totality.

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[1] Co-occurring disorders program: Family program 2008 – Hazelden Foundation

The Correct Expert

My most frustrating moments in settlement negotiations, regularly, is when your opponent does not know the difference between a neurosurgeon and a neuropsychologist and the impact this can have on your ability to settle a matter.

An orthopaedic surgeon who looks at the ex rays and does not test the physical capabilities of a particular body part to perform its functions as an occupational therapist does, can similarly prevent a fair and reasonable settlement discussion taking place.

Whereas the neurosurgeon is just that, a surgeon, the neuropsychologist does a battery of test not limited to cognitive functioning, that will enable him to determine if a minor brain injury has had an impact on a person’s capabilities and have led to any incapacity. Ditto for the Orthopaedic v the OT.

The AMA guidelines as applied by the surgeons are often incorrectly applied as they are not trauma specialist. As such it would be in the client’s best interest to utilize a Trauma Physician to assess the client for completion of the RAF 4 form.

The assessment of General Damages in any personal injury matter can be better determined with a Trauma Specialist so as to more fully appreciate the extend of the pain and suffering the client will be exposed to in future and will further assist in preventing the determination of General Damages being a thumb such stuck in the old ages without taking the subjective pain and suffering of the individual into account.

A short period of unconsciousness can have serious future complications and any lack of oxygen during injury can lead to future cognitive difficulties. Make sure that you investigate all your injuries carefully and peruse the hospital and medical reports in detail. The ambulance records form a vital part of such an investigation as a patient that is found unconscious at the scene of the accident should raise alarm bells. Check the time of accident and the time of arrival of the ambulance and you will have an estimated period of unconsciousness. As such make sure that the specialist completing your RAF 4 form is in possession of these docs and have considered them when applying the AMA Guidelines and the narrative test.