Article Text

A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study
  1. Helge Kasch1,
  2. Alice Kongsted2,
  3. Erisela Qerama3,
  4. Flemming W Bach4,
  5. Tom Bendix5,
  6. Troels Staehelin Jensen1
  1. 1Department of Neurology, The Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
  2. 2Department of Research, Spine Center of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
  3. 3Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
  4. 4Department of Neurology, Aarhus University Hospital, Aalborg Hospital, Aalborg, Denmark
  5. 5Department of Rheumatology, Copenhagen Spine Center, Glostrup Hospital, Glostrup, Denmark
  1. Correspondence to Dr Helge Kasch; helge.kasch{at}


Objectives An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented.

Design The design was an observational prospective study of risk factors embedded in a randomised controlled study.

Setting Acute whiplash patients from units, general practitioners in four Danish counties were referred to two research centres.

Participants During a 2-year inclusion period, acute consecutive whiplash-injured (age 18–70 years, rear-end or frontal-end car accident and WAD (whiplash-associated disorders) grades I–III, symptoms within 72 h, examination prior to 10 days postinjury, capable of written/spoken Danish, without other injuries/fractures, pre-existing significant somatic/psychiatric disorder, drug/alcohol abuse and previous significant pain/headache). 688 (438 women and 250 men) participants were interviewed and examined by a study nurse after 5 days; 605 were completed after 1 year. A risk score which included items of initial neck pain/headache intensity, a number of non-painful complaints and active neck mobility was applied. The primary outcome parameter was 1-year work disability.

Results The risk score and number of sick-listing days were related (Kruskal-Wallis, p<0.0001). In stratum 1, less than 4%, but in stratum 7, 68% were work-disabled after 1 year. Early work assessment (p<0.0001), impact of the event questionnaire (p<0.0006), psychophysical pain measures being McGill pain questionnaire parameters (p<0.0001), pressure pain algometry (p<0.0001) and palpation (p<0.0001) showed a significant relationship with risk stratification.

Analysis Findings confirm previous studies reporting intense neck pain/headache and distress as predictors for work disability after whiplash. Neck-mobility was a strong predictor in this study; however, it was a more inconsistent predictor in other studies.

Conclusions Application of the risk assessment score and use of the risk strata system may be beneficial in future studies and may be considered as a valuable tool to assess return-to-work following injuries; however, further studies are needed.

  • Trauma Management
  • Accident & Emergency Medicine

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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