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 .
External validation of a clinical prediction rule to predict full recovery and ongoing moderate/severe disability following acute whiplash injury.
STUDY DESIGN Retrospective secondary analysis of data . OBJECTIVES To investigate the external validity of the whiplash clinical prediction rule ( CPR ) . BACKGROUND We recently derived a whiplash CPR to consoli date previously established prognostic factors for poor recovery from a whiplash injury and predicted 2 recovery pathways . Prognostic factors for full recovery were being less than 35 years of age and having an initial Neck Disability Index ( NDI ) score of 32 % or less . Prognostic factors for ongoing moderate/severe pain and disability were being 35 years of age or older , having an initial NDI score of 40 % or more , and the presence of hyperarousal symptoms . Validation is required to confirm the reproducibility and accuracy of this CPR . Clinician feedback on the usefulness of the CPR is also important to gauge acceptability . METHODS A secondary analysis of data from 101 individuals with acute whiplash-associated disorder who had previously participated in either a r and omized controlled clinical trial or prospect i ve cohort study was performed using accuracy statistics . Full recovery was defined as NDI score at 6 months of 10 % or less , and ongoing moderate/severe pain and disability were defined as an NDI score at 6 months of 30 % or greater . In addition , a small sample of physical therapists completed an anonymous survey on the clinical acceptability and usability of the tool . Results The positive predictive value of ongoing moderate/severe pain and disability was 90.9 % in the validation cohort , and the positive predictive value of full recovery was 80.0 % . Surveyed physical therapists reported that the whiplash CPR was simple , underst and able , would be easy to use , and was an acceptable prognostic tool . CONCLUSION External validation of the whiplash CPR confirmed the reproducibility and accuracy of this dual-pathway tool for individuals with acute whiplash-associated disorder . Further research is needed to assess prospect i ve validation , the impact of inclusion on practice , and to examine the efficacy of linking treatment strategies with predicted prognosis . LEVEL OF EVIDENCE Prognosis , level 1b
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 .