Comparing 2 Whiplash Grading Systems To Predict Clinical Outcomes

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SOURCE:   J Chiropractic Medicine 2016 (Jun); 15 (2): 81–86

Arthur C. Croft, PhD, DC, MSc, MPH, Alireza Bagherian, DC, Patrick K. Mickelsen, DC, Stephen Wagner, DC

Spine Research Institute of San Diego,
San Diego, CA.

OBJECTIVE:   Two whiplash severity grading systems have been developed: Quebec Task Force on Whiplash-Associated Disorders (QTF-WAD) and the Croft grading system. The majority of clinical studies to date have used the modified grading system published by the QTF-WAD in 1995 and have demonstrated some ability to predict outcome. But most studies include only injuries of lower severity (grades 1 and 2), preventing a broader interpretation. The purpose of this study was assess the ability of these grading systems to predict clinical outcome within the context of a broader injury spectrum.

METHODS:   This study evaluated both grading systems for their ability to predict the bivalent outcome, recovery, within a sample of 118 whiplash patients who were part of a previous case-control designed study. Of these, 36% (controls) had recovered, and 64% (cases) had not recovered. The discrete bivariate distribution between recovery status and whiplash grade was analyzed using the 2-tailed cross-tabulation statistics.

RESULTS:   Applying the criteria of the original 1993 Croft grading system, the subset comprised 1 grade 1 injury, 32 grade 2 injuries, 53 grade 3 injuries, and 32 grade 4 injuries. Applying the criteria of the modified (QTF-WAD) grading system, there were 1 grade 1 injury, 89 grade 2 injuries, and 28 grade 3 injuries. Both whiplash grading systems correlated negatively with recovery; that is, higher severity grades predicted a lower probability of recovery, and statistically significant correlations were observed in both, but the Croft grading system substantially outperformed the QTF-WAD system on this measure.

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CONCLUSIONS:   The Croft grading system for whiplash injury severity showed a better predictive measure for recovery status from whiplash injuries as compared with the QTF-WAD grading system.

KEYWORDS:   Disability evaluation; Surveys and questionnaires; Whiplash injuries


From the FULL TEXT Article:


Whiplash injuries impose a substantial public health burden. There are approximately 3 million whiplash injuries in the United States each year. [1, 2] The economic burden in the United States has been estimated to be as high as $25 billion, and the comprehensive cost (which includes the costs of Emergency Medical Services, litigation, etc) may be as high as $43 billion annually. [3]

Researchers and clinicians alike are benefited by grading schemes which foster better communication by providing a coherent common language. In 1983, Norris and Watt [4] segmented whiplash patients into 3 groups based upon the type of symptoms or findings with which they presented. Group 1 patients had symptoms only; group 2 patients had symptoms and physical findings; group 3 patients had “objective neurological loss.” Recovery was found to be inversely related to increasing severity grade.

In 1993, a formal whiplash grading system was introduced by Croft, [5, 6] and in 1995, a modified version was published by the Quebec Task Force on Whiplash-Associated Disorders (QTF-WAD). [7] These grading systems are compared in Table 1. Subsequent reports have indicated some correlation between outcome and grade of severity, [8-15] but most authors have studied only grade 1 and 2 injuries.

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