Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .
Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting
Purpose To construct and vali date a prediction instrument for early identification of patients with a high risk of delayed recovery after whiplash injuries ( PPS-WAD ) in an insurance company setting . Methods Prospect i ve cohort study . On the basis of a historic cohort ( n = 130 ) of patients with a whiplash injury identified in an emergency room ( ER , model-building set ) , we used logistic regression to construct an instrument consisting of two demographic variables ( i.e. questions of educational level and work status ) and the patient-rated physical and mental status during the acute phase to predict self-reported nonrecovery after 6 months . We evaluated the instrument ’s ability to predict nonrecovery in a new cohort ( n = 204 ) of patients originating from an insurance company setting ( IC , validation set ) . Results The prediction instrument had low reproducibility when the setting was changed from the ER cohort to the IC cohort . The overall percentage of correct predictions of nonrecovery in the ER cohort was 78 % compared with 62 % in the IC cohort . The sensitivity and specificity in relation to nonrecovery were both 78 % in the ER cohort . The sensitivity and specificity in the insurance company setting was lower , 67 and 50 % . Conclusion Clinical decision rules need validation before they are used in a new setting . An instrument consisting of four questions with an excellent possibility of identifying patients with a high risk of nonrecovery after a whiplash injury in the emergency room was not as useful in an insurance company setting . The importance and type of the risk factors for not recovering probably differ between the setting s , as well as the individuals
Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .