Comparing 2 Whiplash Grading Systems To Predict Clinical Outcomes
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.
There are more articles like this @ our:
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. 
Researchers and clinicians alike are benefited by grading schemes which foster better communication by providing a coherent common language. In 1983, Norris and Watt  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).  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.