Background
Materials and methods
The ESPARR cohort
Study population
Clinical definition of whiplash
Variables and measurements
Outcome measurements at 5 years
Variable of interest
Exploratory variables
Statistical analysis
Ethics and consent
Availability of data
Results
Representativeness of the study population
Characteristics of the populations
Non-whiplash victims | Whiplash victims | Chi2 test
1
| Whiplash victims by grade | |||
---|---|---|---|---|---|---|
N = 185 |
N = 167 | Grade 1 = 63 | Grade 2 = 104 | |||
n (%) | n (%) |
P-value | n (%) | n (%) | ||
Gender | <0.0001 | |||||
Female | 72 (38.9) | 106 (63.5) | 40 (63.5) | 66 (63.5) | ||
Male | 113 (61.1) | 61 (36.5) | 23 (36.5) | 38 (36.5) | ||
Age at the accident | NS | |||||
16–24 years | 65 (35.1) | 46 (27.5) | 20 (31.7) | 26 (25.0) | ||
25–34 years | 49 (26.5) | 47 (28.1) | 13 (20.6) | 34 (32.7) | ||
35–44 years | 30 (16.2) | 43 (25.7) | 16 (25.4) | 27 (26.0) | ||
45–54 years | 19 (10.3) | 14 (8.4) | 4 (6.3) | 10 (9.6) | ||
≥55 years | 22 (11.9) | 17 (10.2) | 10 (15.9) | 7 (6.7) | ||
Family situation | <0.05 | |||||
Single | 89 (48.1) | 59 (35.3) | 24 (38.1) | 35 (33.7) | ||
In couple | 79 (42.7) | 86 (51.5) | 32 (50.8) | 54 (51.9) | ||
Separated, divorced, widowed | 17 (9.2) | 22 (13.2) | 7 (11.1) | 15 (14.4) | ||
Educational level | NS | |||||
<school-leaving cert. | 92 (49.7) | 76 (45.5) | 30 (47.6) | 46 (44.2) | ||
school-leaving cert. | 38 (20.5) | 36 (21.6) | 16 (25.4) | 20 (19.2) | ||
>school-leaving cert. | 55 (29.7) | 55 (32.9) | 17 (27.0) | 38 (36.5) | ||
Socio-occupational category | NS | |||||
Farming, trade | 13 (7.0) | 5 (3.0) | 4 (6.3) | 1 (1.0) | ||
Exec., sup. intellectual | 22 (11.9) | 23 (13.8) | 8 (12.7) | 15 (14.4) | ||
Intermediate | 21 (11.4) | 17 (10.2) | 5 (7.9) | 12 (11.5) | ||
Office worker | 71 (38.4) | 83 (49.7) | 28 (44.4) | 55 (52.9) | ||
Manual | 20 (10.8) | 11 (6.6) | 3 (4.8) | 8 (7.7) | ||
Student, housewife, other, no reply | 38 (20.5) | 28 (16.8) | 15 (23.8) | 13 (12.5) | ||
Financial difficulties4 before accident | <0.05 | |||||
No | 147 (79.5) | 116 (69.5) | 45 (71.4) | 71 (68.3) | ||
Yes | 38 (20.5) | 51 (30.5) | 18 (28.6) | 33 (31.7) | ||
Reason for travel | NS | |||||
Journey to work/school | 66 (35.7) | 65 (38.9) | 20 (31.7) | 45 (43.3) | ||
Work purposes | 6 (3.2) | 6 (3.6) | 4 (6.3) | 2 (1.9) | ||
Other | 113 (61.1) | 96 (57.5) | 39 (61.9) | 57 (54.8) | ||
Type of road-user | <0.0001 | |||||
4-wheel motor | 76 (41.1) | 145 (86.8) | 52 (82.5) | 93 (89.4) | ||
Other | 109 (58.9) | 22 (13.2) | 11 (17.5) | 11 (10.6) | ||
Place in vehicle | <0.01 | |||||
Driver | 128 (69.2) | 134 (80.2) | 53 (84.1) | 81 (77.9) | ||
Front passenger | 17 (9.2) | 18 (10.8) | 6 (9.5) | 12 (11.5) | ||
Rear seat passenger | 8 (4.3) | 7 (4.2) | 2 (3.2) | 5 (4.8) | ||
Unknown passenger/no reply | 32 (17.3) | 8 (4.8) | 2 (3.2) | 6 (5.8) | ||
Antagonist | <0.01 | |||||
None | 49 (26.5) | 20 (12.0) | 4 (6.3) | 16 (15.4) | ||
Other (pedestrian, fixed obstacle…) | 28 (15.1) | 21 (12.6) | 10 (15.9) | 11 (10.6) | ||
Motor vehicle | 108 (58.4) | 126 (75.4) | 49 (77.8) | 77 (74.0) | ||
Impact direction5
| <0.0001 | |||||
Frontal | 33 (17.8) | 35 (21.0) | 12 (19.0) | 23 (22.1) | ||
Rear | 7 (3.8) | 56 (33.5) | 17 (27.0) | 39 (37.5) | ||
Lateral Right | 18 (9.7) | 19 (11.4) | 6 (9.5) | 13 (12.5) | ||
Lateral Left | 12 (6.5) | 27 (16.2) | 15 (23.8) | 12 (11.5) | ||
Don’t know/no reply | 115 (62.2) | 30 (18.0) | 13 (20.6) | 17 (16.3) | ||
Friend or family member involved6
| NS3
| |||||
No | 142 (76.8) | 115 (69.5) | 45 (71.4) | 70 (67.3) | ||
Yes | 43 (23.2) | 51 (30.5) | 17 (27.0) | 34 (32.7) | ||
Intention to lodge a complaint | NS | |||||
No | 111 (60.0) | 99 (59.3) | 34 (54.0) | 65 (62.5) | ||
Yes | 18 (9.7) | 22 (13.2) | 10 (15.9) | 12 (11.5) | ||
Don’t know/no reply | 56 30.3) | 46 (27.5) | 19 (30.2) | 27 (26.0) | ||
Subjective responsibility in accident | <0.0001 | |||||
No | 52 (28.1) | 92 (55.1) | 39 (61.9) | 53 (51.0) | ||
Yes | 48 (25.9) | 34 (20.4) | 12 (19.0) | 22 (21.2) | ||
Don’t know/no reply | 85 (45.9) | 41 (24.6) | 12 (19.0) | 29 (27.9) | ||
Psychological history7
| NS | |||||
No | 129 (69.7) | 105 (62.9) | 37 (58.7) | 68 (65.4) | ||
Yes | 56 (30.3) | 62 (37.1) | 26 (41.3) | 36 (34.6) | ||
PTSD in the 1st Year | 0.05 | |||||
No | 162 (87.6) | 139 (83.2) | 52 (82.5) | 87 (83.7) | ||
Yes | 23 (12.4) | 28 (16.8) | 11 (17.5) | 17 (16.3) |
Consequences at 5 years
Pain and sequelae
Non-Whiplash victims | Whiplash victims | Chi2 test1
| Whiplash victims by grade | |||
---|---|---|---|---|---|---|
N = 185 | N = 197 | Grade 1 = 63 | Grade 2 = 104 | |||
n (%) | n (%) | p-value | n (%) | n (%) | ||
Presence of pain | <0.001 | |||||
Yes | 41 (22.2) | 68 (40.7) | 22 (34.9) | 46 (44.2) | ||
No/don’t know/no reply | 144 (77.8) | 99 (69.3) | 41 (65.1) | 58 (55.8) | ||
Pain by body region (present vs. absent) | ||||||
Head | 2 (1.1) | 11 (6.6) | <0.01 | 2 (3.2) | 9 (8.7) | |
Face | 2 (1.1) | 0 - | NS2-3
| 0 (0.0) | 0 (0.0) | |
Neck | 8 (4.3) | 49 (29.3) | <0.0001 | 14 (22.2) | 35 (33.7) | |
Spine | 13 (7.0) | 29 (17.4) | <0.01 | 8 (12.7) | 21 (20.2) | |
Thorax | 2 (1.1) | 2 (1.2) | NS3
| 1 (1.6) | 1 (1.0) | |
Abdomen | 0 (0.0) | 2 (1.2) | NS3
| 1 (1.6) | 1 (1.0) | |
Upper limbs | 9 (4.9) | 12 (7.2) | NS | 5 (7.9) | 7 (6.7) | |
Lower limbs | 18 (9.7) | 7 (4.2) | <0.05 | 4 (6.3) | 3 (2.9) | |
Sequelae4 of injuries related to the accident (Yes vs. No/don’t know/no reply) | ||||||
Esthetic (broken nose, scar…) | 41 (22.2) | 13 (7.8) | <0.001 | 7 (11.1) | 6 (5.8) | |
Psychic (feeling bad) | 32 (17.3) | 42 (25.1) | NS | 13 (20.6) | 29 (27.9) | |
Psychocognitive (concentration or memory trouble) | 8 (4.3) | 18 (10.8) | NS | 5 (7.9) | 10 (9.6) | |
Headache | 18 (9.7) | 45 (26.9) | <0.0001 | 15 (23.8) | 30 (28.8) | |
Limbs (joint stiffness, lameness, muscle weakness…) | 18 (9.7) | 18 (10.8) | NS | 6 (9.5) | 12 (11.5) | |
Spine (joint stiffness, frailty…) | 16 (8.6) | 31 (18.6) | <0.01 | 8 (12.7) | 23 (22.1) | |
Neurological (paresthesia…) | 5 (2.7) | 8 (4.8) | NS | 1 (1.6) | 7 (6.7) | |
Sensory disorders (anosmia, …) | 5 (2.7) | 9 (5.4) | NS | 3 (4.8) | 6 (5.8) | |
Internal organs (dysfunction) | 1 (0.5) | 8 (4.8) | <0.023
| 4 (6.3) | 4 (3.8) | |
Other | 3 (1.6) | 0 - | NS3
| 0 (0.0) | 0 (0.0) |
Quality of life – comparison between data at 1 and 5 years after the accident
Non-whiplash (N = 155) | Whiplash grade 1 et 2 (N = 133) | Whiplash grade 1 (N = 50) | Whiplash grade 2 (N = 83) | |||
---|---|---|---|---|---|---|
n (%) | n (%) | n (%) | n (%) | |||
Global Items | ||||||
Good quality of life1
| 1 year | 108 (69.7) | 95 (71.4) | 34 (68.0) | 61 (73.5) | |
5 years | 127 (81.9) | 104 (78.2) | 41 (82.0) | 63 (75.9) | ||
Improvement (%)2
| +12.2
b
| +4.8
| +14.0
| +2.4
| ||
Satisfactory health status3
| 1 year | 108 (69.7) | 88 (66.2) | 34 (68.0) | 54 (65.1) | |
5 years | 117 (75.5) | 90 (67.7) | 38 (76.0) | 52 (62.7) | ||
Improvement (%)2
| +5.8
| +1.5
| +8.0
| −2.4
| ||
Domains | ||||||
m SD4
| m SD4
| m SD4
| m SD4
| |||
Physical | 1 year | 77.1 (15.5) | 72.8 (19.1) | 73.4 (20.9) | 72.4 (18.0) | |
5 years | 81.5 c (13.9) | 76.2 (17.9) | 76.0 (17.6) | 76.2 (18.2) | ||
Improvement5
| +4.4
c
| +3.4
| +2.6
| +3.8
| ||
Psychological | 1 year | 66.6 (15.7) | 64.6 (16.3) | 61.6 (15.8) | 66.5 (16.4) | |
5 years | 71.1 (13.6) | 69.0 (15.3) | 67.2 (17.0) | 70.1 (14.2) | ||
Improvement5
| +4.5
c
| +4.6
b
| +5.6
| +3.7
a
| ||
Social | 1 year | 73.2 (19.5) | 71.6 (19.9) | 68.9 (20.9) | 73.3 (19.3) | |
5 years | 75.5 (17.1) | 74.7 (15.0) | 73.3 (17.4) | 75.5 (13.4) | ||
Improvement5
| +2.3
| +3.3
| +3.4
| +2.3
| ||
Environmental | 1 year | 68.0 (16.5) | 65.0 (16.3) | 65.3 (17.7) | 64.8 (15.5) | |
5 years | 71.1 (15.4) | 69.9 (16.6) | 71.7 (15.9) | 68.8 (17.0) | ||
Improvement5
| +3.1
b
| +4.9
c
| +6.4
a
| +4.0
a
|
Multivariate models: factors for impaired quality of life at 5 years after accident
Perception of overall quality of life and of overall health
Not good overall quality of life | Unsatisfactory health | |||||||
---|---|---|---|---|---|---|---|---|
Adj RR | 95 % CI | Adj RR | 95 % CI | Adj RR | 95 % CI | Adj RR | 95 % CI | |
Model 1 | Model 2 | Model 1 | Model 2 | |||||
Adjustment factors | ||||||||
Age > =35 years | 2.10 | 1.41–3.13 | 1.95 | 1.30–2.92 | 1.23 | 0.89–1.69 | 1.17 | 0.87–1.57 |
Gender: female | 1.29 | 0.85–1.94 | 1.13 | 0.74–1.72 | 1.27 | 0.91–1.76 | 1.00 | 0.73–1.37 |
Other factors | ||||||||
Education level | ||||||||
<school-leaving cert | 1.43 | 0.82–2.47 | 1.10 | 0.61–1.99 | 1.69 | 1.05–2.70 | - | |
>school-leaving cert. | 0.62 | 0.31–1.24 | 0.56 | 0.28–1.11 | 1.12 | 0.65–1.93 | - | |
Intention to lodge a complaint | - | - | 1.64 | 1.11–2.42 | - | |||
Psychological history | 1.63 | 1.11–2.38 | 1.69 | 1.16–2.46 | 1.61 | 1.18–2.20 | 1.76 | 1.30–2.37 |
PTSD | 1.97 | 1.30–2.98 | 1.78 | 1.17–2.70 | 1.61 | 1.16–2.24 | 1.48 | 1.10–1.99 |
Factor of interest | ||||||||
Whiplash grade1 | 0.87 | 0.51–1.51 | 0.80 | 0.47–1.36 | 0.91 | 0.57–1.46 | 0.83 | 0.53–1.30 |
Whiplash grade2 | 1.43 | 0.93–2.17 | 1.24 | 0.81–1.90 | 1.48 | 1.05 –2.08 | 1.19 | 0.85–1.65 |
Suffering from Pain at 5 years | - | - | 1.96 | 1.27–3.03 | - | - | 2.75 | 1.98–3.83 |
Whiplash | No whiplash | |||||||
---|---|---|---|---|---|---|---|---|
Low health status | Good health status | RR(pain if
Whiplash)
| Low health status | Good health status | RR(pain if no Whiplash)
| Adjusted RR | ||
n | n | n | n | |||||
No PTSD | Pain | 28 | 25 | 3.03 (1.79–5.12) | 13 | 20 | 2.31 (1.31–4.08) | 2.67 (1.82–3.93) |
No pain | 15 | 71 | 22 | 107 | ||||
PTSD | Pain | 12 | 3 | 3.47 (1.24–9.65) | 6 | 2 | 2.81 (1.11–7.13) | 3.09 (1.55–6.15) |
No pain | 3 | 10 | 4 | 11 |