Original Communication
No cash no whiplash?: Influence of the legal system on the incidence of whiplash injury

Presented in part at the 17th Meeting of the International Association of Forensic Sciences, Hong Kong, August 21–26, 2005.
https://doi.org/10.1016/j.jflm.2007.12.016Get rights and content

Abstract

Whiplash injury has been a continuous source of controversy due to its association with litigation. We studied the incidence of whiplash associated disorder (WAD) in two similar socioeconomic areas and carried out a retrospective study based on the hypothesis that the Spanish law 30/1995 might have an affect on the incidence and duration of cervical symptoms and the persistence of impairment. More than 10,000 patients injured in traffic accidents were studied over a period three years. Of these, only patients with an initial diagnosis of whiplash injury were included in the study. Patients with other injuries were excluded. The patients were classified into two groups: Galicia-Spain and North-Central Portugal (depending on where the accident took place and the medico-legal evaluation procedure in force). Statistical analysis was made using SPSS 13.0 and Statistix 8.0. We found a statistically significant difference between Spain and Portugal in the incidence of WAD and in the duration of symptoms. The incongruities caused by the compulsory application of Spanish law arise from the fact that evaluation on a points scale of impairment does not always reflect the functional state of the injured person.

Section snippets

1. Introduction

In countries of Roman or French influence the assessment of bodily damage in civil law and the juridical implications form one of the main working areas of the forensic medicine specialist.1 Whiplash injuries, where the diagnosis is largely subjective and the ideal treatment controversial, have provided a continuous source of controversy due to their association with compensatory litigation claims secondary to motor vehicle accidents.2, 3, 4, 5, 6, 7 We have studied the incidence of whiplash

2. Material and methods

Over a three-year period from 2000 to 2002 inclusive, we studied 10,608 patients injured in traffic accidents in the areas within the mandates of the Institute of Legal Medicine of the University of Santiago de Compostela, (G-Spain) and the National Institute of Legal Medicine, Coimbra and Porto delegations, (NC-Portugal).

This enabled us to take into account those accidents in which the judicial and compensatory processes had concluded. Only patients with an initial diagnosis of whiplash injury

3. Results

We studied 8796 patients from NC-Portugal and 1812 from G-Spain. Of these, 162 in G-Spain were patients initially diagnosed with WAD as the sole pathology, whereas in NC-Portugal the corresponding number was only 35. We found a statistically significant difference between Spain and Portugal in the incidence of WAD, which was much greater in Spain (odds ratio: 24.57). Although the mean age differs between the groups (32.17 in G-Spain and 42.6 for NC-Portugal) no significant relationship between

4. Discussion

A significant difference in the recovery time between sexes was noted in both groups and is similar to that reported by Pearce 8 and Evans.9

Despite the socio-economic and road traffic similarities, there is a much greater incidence of WAD in Galicia than in North-Central Portugal. The odds ratio we found is impressive (24.57), and is particularly noticeable in the much longer period of recovery time taken in Spain. In addition, for group G-Spain, in cases with an identical initial diagnosis of

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Partially supported by Grant 2006/CI194 from the University of Santiago de Compostela (USC).

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