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

Poor Outcome From Second Injury

The journal Injury published a scientific article in their May issue titled APrognosis Following a Second Whiplash Injury@. The article was written by four authors, two of which (Gargan and Bannister) are considered leaders in the whiplash literature. The article examined victims who sustained injuries in 2 motor vehicle collisions. The results are interesting, particularly to those attorneys who represent clients who have had prior injuries with worsening of their symptoms.

The authors examined seventy-nine patients who had suffered two whiplash injuries. The severity of each patient=s symptoms were assessed after the first and second injuries using the Gargan and Bannister classification. Eighty-four percent of the patients reported increased symptoms after the second injury. Ninety seven percent of patients who had been symptom free before the second injury reported persistent symptoms.

The authors note that AWhiplash injuries occur as a result of indirect injury to the cervical spine. Symptoms persist in 43% of patients, are disabling in 8%, with 4% unable to work again@

In this study there were fifty women and 29 men with a mean age of 42.3 years. The mean time between injuries was 6.1 years (range of 0.4-25). Before the second injury 47% were asymptomatic, 31% had nuisance symptoms, 13% had intrusive symptoms and 1% was disabled. The authors state that AAfter the second injury symptoms deteriorated in eighty-four percent, particularly in patients with mild residual disability after the first injury@.

Some interesting observations from these researchers include that AThe increased severity of residual symptoms following a second whiplash injury may result from an increased vulnerability to trauma caused by the first injury@. Furthermore, that AThese are all injuries, that in joints, are associated with long-term, degenerative changes. The authors state that AThis suggests that whiplash injuries appear to cause structural damage to the neck, rendering it more vulnerable to subsequent trauma, which results in more severe symptoms and poorer prognosis@.

The authors conclude by noting that the differences in neck pain shown in this study, as compared to studies reporting neck pain in the general population Aare greater by many multiples suggesting that our observations are not confounded by age related neck pain@

Quality research, such as this paper, should become part of your medical legal library. The argument that a patient=s prior injuries eliminate the likelihood of worsened outcome has been proven to be in error. This research shows that the prior injury, if anything, worsens prognosis and leads towards greater disability. The fact that a patient has had a prior injury is not in question. The issue is whether the new trauma substantially worsened the patient=s physical condition and the answer is clearly yes. Not only has it worsed the condition but the quantity and quality of traumatic insult does not need to be as great as in a patient who has no history of prior trauma.

These patient=s should be treated in the same manner as a patient with pre-existing medical conditions such as osteoarthritis, diabetes or Lupus. While these conditions will adversely affect outcome they are not the primary cause of the patients disability. They are contributing factors which may have had no debilitating affect in the absence of the trauma (or in this case, the second trauma).