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Shaw Chiropractic
A Medical-Legal Newsletter for Personal Injury Attorneys
by Dr. Steven W. Shaw

Symptom Onset in MVA Victims

Many patients do not seek immediate medical attention after sustaining injuries. Clinical, automotive and epidemiological studies report frequent delays in patients having initial symptoms, often up to 96 hours. Delay of symptoms from motor vehicle trauma are problematic from a clinical point of view. The delay in treatment may result in anything from acute emergencies resulting from asymptomatic internal bleeding to poor healing from lack of controlled and organized tissue repair.

From an attorneys point of view delayed treatment is particularly problematic. The delay of presentation to the doctors office often equates to no injury from the defense perceive. These gaps in care can be difficult to explain and therefore this newsletter with review this concern.

The Insurance Research Council (1999) reports that 32% of claimants did not report any injury or complaints of pain at the scene of a crash. This is supported by the report from the Quebec Task Force on Whiplash Associated Disorders in 1995 when they found that 21% of victims had a delay in symptom onset.

Local pain such as neck soreness and stiffness should be present within 1-2 weeks to be valid. It is extremely rare to have absolutely no stiffness, ache, soreness or pain early on and then develop it several months later. However, it is common for upper extremity symptoms and headaches to have delayed onset of several months after trauma. A study in the Brittish Journal of Rhumatology by JL Quintner (28:528-33, 1989) found that 65% of the study subjects had onset of radicular symptoms within three months and 35% had onset beyond three months of injury.

Neither doctor or attorney should equate delay in treatment to delay of symptom onset. There is a multitude of reasons why patients do not seek immediate care. Below I have listed common explanations seen in our office:

- Symptoms are discomforting but not debilitating

- Language difficulties regarding care access

- Physician unwillingness to treat patients involved in potential litigation.

- ER physician instructions to remain at rest

- Post-traumatic anxiety or stress

- Delay of symptom onset

- Symptom onset other than pain

- Attempts of OTC medications

- Attempts of home remedies (heat, rest)

- The @ syndrome

- Post trauma transportation difficulties (vehicle damage, non-ambulatory)

- Fear of physician=s intervention (needles, surgery, MRI related claustrophobia))

- Financial constraints (no insurance, unemployed, low salary)

- Fear of lost work time and income

- Fear of job loss

- Primary care provider told to rest

- Cultural influences

- Family or spouse influences

These and many other potential explanations for delay in symptom onset or delayed treatment commencement should be considered. The attending physician should question the patient during initial consultation to understand the reason for gap in care. Often times, the patient has a reasonable and logical explanation. The physician should comment on this in any reporting to avoid future causal relationship issues.

Regardless of your client's actions you may find that they fall into the dammed if you do and dammed if you don''t scenario. If your client doesn't see a doctor and treat immediately they may be perceived as someone who is seeking care only to establish damages. On the other hand, by seeing a doctor the same day they may be perceived as having a litigation consciousness. For this reason, attending physicians should screen patients using questions and examinations which identify inconsistent and unusual symptom presentation. In this manner, the patient, doctor, attorney and carrier interests are best served by treating only those injured parties with validated physical injuries.