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Whiplash: facts at your fingertips

Whiplash image from Medical Observer article

This article first appeared in Medical Observer, 10 July 2015.

Professor Simon Willcock is a General Practitioner and is the Director of Primary Care Services, Macquarie University Hospital. He was a subject matter expert appointed by the MAA to the whiplash Guidelines working group.

As GPs we are statistically likely to see a diabetic or hypertensive patient on any busy day in practice.

But according to the 2014 General Practice Activity in Australia report we will only see a patient with a “neck symptom or complaint” in 0.8% of consultations, with a history of whiplash representing only a small fraction of these already infrequent encounters.

When I first entered general practice in the 1980s this was one of the biggest current issues for the medical profession — the need to have mastery over an impossibly diverse range of health issues at a time of exponential increases in health information. ‘Specialists’ had evolved in an attempt to address this herculean task, but by 1980 even the specialists were finding it hard to keep up to date.

However, the advent of the digital age has largely resolved this issue.

We now have instant access to the latest clinical information, fundamentally changing the consultation paradigm.

For an uncommon condition such as whiplash, the GP can now implement a two-step approach: the first being to recognise the possibility of the diagnosis, and the second to implement an appropriate diagnostic and management protocol that can be accessed online if it isn’t already downloaded onto our personal cerebral hard drive.

Fortunately the first step is an easy one for the clinical syndrome of whiplash. Any sudden flexion/extension event involving the neck (often but not exclusively associated with a motor vehicle accident) meets the diagnostic criteria.

The second step can be simplified by reference to the web-based evidence-based guidelines that have just been updated by the Motor Accidents Authority (MAA).

New third edition guidelines are an update of the previous (2007) guidelines.

As well as academics familiar with the current literature, the review process included clinicians who encounter and treat patients with whiplash in clinical practice.

The result is a detailed and considered document housed on the MAA website and easily searchable on the internet. The following whiplash resources to accompany the guidelines are available:

Whiplash is a generic term that covers a multitude of potential underlying pathologies.

However, the WAD (whiplash associated disorder) scale for categorising patients provides clear guidance for assessment and diagnostic imaging. (Diagnostic imaging is usually not indicated in the WAD 1 and 2 categories of patients that will constitute most of the patients that attend their GP).

Electronic links to assessment tools such as the Canadian C-Spine Rule and the Neck Disability Index (NDI) will allow GPs to undertake more formal and standardised assessments within the constraints of a standard consultation, and will also allow them to objectively monitor a patient’s progress over time.

The guidelines also provide simple assessment tools for determining the risk of a poor outcome for an individual patient.

They include and acknowledge the psychosocial ‘yellow’ flags that we clinicians know can be key determinants of a patient’s recovery trajectory. Finally, the guidelines provide clear and concise advice as to the evidence that supports a range of possible treatments for the patient who experiences a whiplash injury.

We are all likely to encounter whiplash periodically in general practice.

The updated MAA guidelines provide an essential and accessible resource that has been developed for use in our local Australian context.


Disclaimer:

Professor Willcock is a GP member of the 2014 guideline reference group.

He is Professor of General Practice at the University of Sydney.

References:

  1. General Practice Activity in Australia (2013-2014), a publication of the Family Medicine Research Unit; General Practice Series Number 36; November 2014
  2. Search this website under Acute Whiplash