Development of selective criteria for the verification of whiplash-associated disorders.

Abstract

Whiplash injury (distortion of the cervical spine) is the most commonly diagnosed type of injury sustained in car accidents, and it ranks first in the structure of compensation claims for personal injury resulting from traffic incidents. The verification of whiplash-associated disorders (WADs) continues to be a great problem in the formulation of medico- legal expert opinions, as injuries of this type, cannot, by definition, be captured using available imaging methods ("radiologically negative effects of acceleration/deceleration mechanism with a wide variety of clinical manifestations"). The present study aims to define a set of criteria that might represent threshold conditions for WAD verification, enabling preliminary cohorting (preselection) of evaluated cases and facilitating the adoption of legal decisions. The available scientific literature addressing problems relating to WAD verification was reviewed to identify factors that differentiate an extremely broad spectrum and varying severity of symptoms depending on the circumstances of incidents, the results of physical evaluation of patients and additional instrumental examinations, as well as technical indicators. Based on the literature search, a range of criteria with the highest potential significance for application in routine medical and forensic expert practice were selected (with a focus on aspects related to verification, quantification and outcomes). The primary prerequisite for recognising the presence of moderate impairment to health (according to the Polish penal code) due to distortion of the cervical spine should involve confirmation of grade 3 WAD according to the Quebec Task Force (QTF) classification, and exceeding the threshold values of Δv (> 15 km/h), acceleration of the victim's vehicle centre of gravity (> 4 g), and NIC criterion (> 15 m2/s2). Additional criteria used by experts should include the verification of the correct head restraint position as well as results of biomechanical examinations evaluating the level of safety of a given vehicle, and epidemiological data retrieved from databases including the statistics for claims filed by victims of real-life accidents.