A national survey of clinical practice for the management of whiplash-associated disorders in UK emergency departments

Abstract

Objective: To undertake a national survey to determine current practice for the management of whiplash injuries in UK emergency departments (ED). Methods: Postal questionnaire survey. 316 lead consultants from all UK ED with annual new attendances of over 50 000 people were asked to indicate the use of a range of treatments and the frequency with which these treatments were used. Samples of written advice were requested and content analysis was conducted and compared with survey responses. Results: The response rate was 79% (251/316). The intervention most frequently used was verbal advice to exercise, reported by 84% of respondents for most or all cases, and advice against the use of a collar (83%). Other treatments reported as being used frequently were written advice and anti-inflammatory medication. 106 consultants (42%) provided a sample of written materials. Reference to expected recovery and encouragement for early return to activities were included in less than 6%. Nearly 50% of written materials contained information on how to use a soft collar and 61% contained information on solicitors and pursuing a personal injury claim. There were important differences between reported verbal behaviours and written advice. Conclusion: Verbal advice is the primary method for managing whiplash injuries in ED and is usually supplemented by written advice. Within individual hospitals there is a lack of consistency between verbal and written advice. The promotion of personal injury claims is a common feature of written advice. Research is required to develop effective and consistent models of advice.

Managing Injuries of the Neck Trial (MINT): a randomised controlled trial of treatments for whiplash injuries

“…23 Over 90% of departments suggest using analgesics and gradually increasing movement of the neck. Some departments use soft collars as well, suggesting that they should be removed and the neck exercised on a regular basis.…”

Clinical Pressure Pain Threshold Testing in Neck Pain: Comparing Protocols, Responsiveness, and Association With Psychological Variables

“…A recent survey 8 suggests that although rehabilitation professionals appear to be aware of the biopsychosocial influences on neck pain and disability, relatively few are actively capturing multidomain variables in routine practice. In order to facilitate adoption of multisystem assessment, tools need to be clinically accessible, valid, and reliable and provide rich data with minimum burden.…”

Review article: Best practice management of neck pain in the emergency department (part 6 of the musculoskeletal injuries rapid review series)

“…There was a large focus in the included literature on the assessment and management of patients with WAD, which is likely due to the chronicity risks and subsequent financial implications associated with these injuries. Despite existing evidence‐based strategies to manage these patients early in their presentation, actual practice within the ED is discordant with these recommendations . A national survey of ED consultants in the UK showed that there is a lack of consistency between verbal and written advice, and that the promotion of personal injury claims was a common feature of written advice .…”

“…Despite existing evidence‐based strategies to manage these patients early in their presentation, actual practice within the ED is discordant with these recommendations . A national survey of ED consultants in the UK showed that there is a lack of consistency between verbal and written advice, and that the promotion of personal injury claims was a common feature of written advice . Up to 50% of patients with WAD report ongoing pain and disability, and as such it is imperative that WAD is not treated as a homogenous diagnosis and that treatment is targeted to those who need it most …”