Article References & Abstracts

COMPENSATION HAZARDS

1.  AUTHOR Klekamp J; McCarty E; Spengler DM
INSTITUTION Emory Spine Center, Decatur, Georgia 30033, USA.
TITLE Results of elective lumbar discectomy for patients involved in the workers' compensation system.
SOURCE J Spinal Disord 1998 Aug; 11 (4): p277-82
ISSN0895-0385
ABSTRACTWe compared the outcomes from lumbar discectomy for patients who were workers' compensation claimants and/or who were involved in active litigation with patients who underwent elective lumbar discectomy, but who were not involved with either compensation or litigation. Eighty-two consecutive patients who underwent elective lumbar discectomy by the senior author were identified from 1989 through 1994. Those patients who underwent a primary discectomy with a minimum of 6 months' follow-up were studied. Patients were excluded if a spinal fusion was performed or if a multilevel laminectomy procedure was required. Patients were classified as compensation patients if they were involved in either worker's compensation claims or active litigation at the time of the lumbar discectomy. The compensation group was further divided into three subsets of patients: those involved in active litigation without compensation, those involved in both compensation and litigation, and those pursuing workers' compensation claims without litigation. The control group was comprised of patients who were not in any way involved with compensation or litigation. Outcome assessment and ratings were determined independently by the coauthors, not the primary surgeon. Outcome was based on pain, employment status, analgesic use, and level of activity. Fifty-four patients met the inclusion criteria. Average follow-up for the compensation patients was 40 weeks. Follow-up for the noncompensation patients averaged 51 weeks. Eighty-one percent of our patients in the noncompensation group achieved a good result. Only 1 of 27 patients was categorized as having a poor outcome. Conversely, patients who were actively involved in the compensation and/or litigation process had significantly poorer outcomes, with only 29% of the patients receiving a good outcome evaluation (p = < 0.0002). Legal involvement was associated with poorer outcome in compensation patients (p = < 0.001).
2.  AUTHOR  Parmar HV; Raymakers R
INSTITUTION Leicester Royal Infirmary, UK.
TITLE  Neck injuries from rear impact road traffic accidents: prognosis in persons seeking compensation.
SOURCE Injury 1993 Feb; 24 (2): p75-8
ISSN 0020-1383
ABSTRACTWe studied the natural history and prognostic factors in 100 patients who had sustained neck sprains in rear impact road traffic accidents, and who had all originally been seen for medicolegal reports. They were seen for clinical and radiological review at a mean of 8 years after injury. The detailed medicolegal reports from the early years were available on all patients, and were used to supplement the information obtained at review. Of the patients, 50 per cent had significant pain at 8 months, decreasing to 22 per cent at 2 years and 18 per cent at 3 years. At review, 45 per cent were free of pain, and 14 per cent had significant pain. Front seat position, pain within 12 h of injury, past history of neck pain and degenerative changes on radiographs were associated with a longer duration of significant pain (P 0.05). Early onset of pain was also associated with a worse level of pain at review. The timing of compensation was not associated with improvement in symptoms. The injury had not accelerated the development of degenerative changes.
3.  AUTHOR Schrader H; Obelieniene D; Bovim G; Surkiene D; Mickeviciene D; Miseviciene I; Sand T
INSTITUTION Department of Neurology, University Hospital Trondheim, Norway.
TITLE Natural evolution of late whiplash syndrome outside the medicolegal context [see comments]
SOURCE  Lancet 1996 May 4; 347 (9010): p1207-11
ISSN 0140-6736
ABSTRACTBACKGROUND: In Lithuania, few car drivers and passengers are covered by insurance and there is little awareness among the general public about the potentially disabling consequences of a whiplash injury. We took this opportunity to study the natural course of head and neck symptoms after rear-end car collisions. METHODS: In a retrospective questionnaire-based cohort study, 202 individuals (157 men; 45 women) were identified from the records of the traffic police department in Kaunas, Lithuania. These individuals were interviewed 1-3 years after experiencing a rear-end car collision. Neck pain, headache, subjective cognitive dysfunction, psychological disorders, and low back pain in this group were compared with the same complaints in a sex-matched and age-matched control group of uninjured individuals selected randomly from the population register of the same geographic area. FINDINGS: Neck pain was reported by 71 (35% [95% CI 29-42]) accident victims and 67 (33% [27-40]) controls. Headache was reported by 107 (53% [46-60]) accident victims and 100 (50% [42-57]) controls. Chronic neck pain and chronic headache (more than 7 days per month) were also reported in similar proportions (17 [8.4%; 5-13] vs 14 [6.9%; 4-12] and 19 [9.4%; 6-15] vs 12 [5.9%; 3-10]) by the two groups. Of those who reported chronic neck pain or daily headache after the accident, substantial proportions had had similar symptoms before the accident (7/17 for chronic neck pain; 10/12 for daily headache). There was no significant difference found. No one in the study group had disabling or persistent symptoms as a result of the car accident. There was no relation between the impact severity and degree of pain. A family history of neck pain was the most important risk factor for current neck symptoms in logistic regression analyses. INTERPRETATION: Our results suggest that chronic symptoms were not usually caused by the car accident. Expectation of disability, a family history, and attribution of pre-existing symptoms to the trauma may be more important determinants for the evolution of the late whiplash syndrome.
 
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