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01.12.2015 | Research article | Ausgabe 1/2016 Open Access

BMC Public Health 1/2016

Five years after the accident, whiplash casualties still have poorer quality of life in the physical domain than other mildly injured casualties: analysis of the ESPARR cohort

BMC Public Health > Ausgabe 1/2016
Charlène Tournier, Martine Hours, Pierrette Charnay, Laetitia Chossegros, Hélène Tardy
Wichtige Hinweise
Charlène Tournier and Martine Hours contributed equally to this work.

Competing interest

The individual authors have no competing interests, financial or non-financial, to declare.
The current paper and the data have neither been published nor are under review elsewhere.

Authors’ contributions

MH and PC made substantial contributions to conception and design, and data acquisition; CT, LC, HT and MH made substantial contributions to data analysis and interpretation; CT and MH performed the literature search and data analysis and wrote the initial manuscript; LC and HT were involved in revising the manuscript critically for important intellectual content. All authors gave final approval of the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Authors’ information

MH is a senior researcher (MD and PhD in epidemiology)
PC is an epidemiological researcher (MSc).
CT, LC and HT are statisticians (MSc).



This study aims to compare health status and quality of life five years after a road accident between casualties with whiplash versus other mild injuries, to compare evolution of quality of life at 1 and 5 years after the accident, and to explore the relation between initial injury (whiplash vs. other) and quality of life.


The study used data from the ESPARR cohort (a representative cohort of road accident casualties) and included 167 casualties with “pure” whiplash and a population of 185 casualties with other mild injuries (MAIS-1). All subjects with lesions classified as cervical contusion (AIS code 310402) or neck sprain (AIS code 640278) were considered as whiplash casualties. Diagnosis was made by physicians, at the outset of hospital care, based on interview, clinical findings and X-ray. Whiplash injuries were then classified following the Quebec classification (grades 1 and 2). Quality of life was assessed on the WHOQoL-Bref questionnaire. Correlations between explanatory variables and quality of life were explored by Poisson regression and variance analysis.


Between 1 and 5 years, global QoL improved for both whiplash and non-whiplash casualties; but, considering the two whiplash groups separately, improvement in grade 2 was much less than in grade 1. At 5 years, grade-2 whiplash casualties were more dissatisfied with their health (39.4 %; p < 0.05) than non-whiplash (24.3 %) or grade-1 whiplash casualties (27.0 %). Deteriorated quality of life in the mental, social and environmental domains was mainly related to psychological and socioeconomic factors for both whiplash and other mildly injured road-accident casualties. While PTSD was a major factor for the physical domain, whiplash remained a predictive factor after adjustment on PTSD; unsatisfactory health at 5 years, with deteriorated quality of life in the physical domain, was observed specifically in the whiplash group, pain playing a predominant intermediate role.


Deteriorated quality of life in the physical domain remained 5 years after the accident, specifically in the grade-2 whiplash group, pain playing a predominant intermediate role, which may be in line with the hypothesis of neuropathic pain.
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