The Need for Three Separate Parallel WAD Ratings of Whiplash Injuries to Cervical, Lumbosacral, and Thoracic Spine in Clinical Assessments of Injured Motorists

Background: The prevailing classification of whiplash associated disorder (WAD) focuses solely on neck injuries, thus implying that injuries to other spinal regions are relatively inconsequential. In fact, some whiplash studies exclude patients with injuries to lower spine. We examined whiplash pain locations of injured motorists and their statistical correlates. Method: De-identified archival data of 158 injured motorists (57 men and 101 women; mean age 39.4 years, SD=12.5) were reviewed statistically. Their motor vehicle accidents (MVAs) occurred 7 to 194 weeks previously (mean=50.7 weeks, SD=38.5), but all still experienced active whiplash symptoms requiring therapy. Results: The most frequently reported locations of whiplash pain were the head (89.9%), neck (88.6%), shoulders (80.4%), and lower back (77.8%). WAD studies that exclude patients with lower back pain might exclude about 82.9% of injured motorists: the remaining 17.1% of patients with whiplash injury only to the neck are presumably those less adversely affected by the MVA than patients with pain in multiple locations. No correlations of high or moderate magnitude were detected among the various pain locations. Furthermore, no high or moderate correlations were observed between clinical variables (including 2 neuropsychological symptoms scales) and reports of headache or pain in the neck or in lower back. Discussion and Conclusions: The prevailing WAD classification system needs to be renamed as specific to neck injury only: WAD-C. Parallel WAD classification systems need to be introduced separately for the lumbosacral spine (as WAD-LS) as well as the thoracic spine (as WAD-T) to improve diagnostic descriptive precision of clinical WAD assessments and of their research applications.

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Flawed Studies of SIMS’s Diagnostic Accuracy by Teams of Puente-López and Capilla Ramírez

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.2.730 ◽

2021 ◽

Vol 3 (2) ◽

pp. 16-23

Author(s):

Zack Z. Cernovsky

Keyword(s):

Diagnostic Accuracy ◽

Motor Vehicle ◽

Severely Injured ◽

X Rays ◽

Vehicle Accidents ◽

Post Concussion Syndrome ◽

Lower Back ◽

Physical Examinations ◽

Injured Patients ◽

Medical Symptoms

Background: The teams of Puente-López and Capilla Ramírez evaluated diagnostic accuracy of the Structured Inventory of Malingered Symptomatology (SIMS), a test often used to assess malingering by persons injured in motor vehicle accidents (MVAs). Yet all SIMS items represent legitimate medical symptoms, and more than 50% of them are those experienced by severely injured motorists, but they are fallaciously scored as indicative of malingering. Thus, more injured patients with more symptoms obtain higher SIMS scores for malingering. Method: The studies by Puente-López and by Capilla Ramírez were carried out on SIMS scores of injured motorists. The present article assesses the severity of their injuries, as documented by Puente-López and by Capilla Ramírez. Results and Discussion: The study by Capilla Ramírez’s team excluded patients with pathological results on physical examinations, or on X-Rays, EMG, and MRI: thus, only mildly injured motorists were included. The patients of Puente-López had signs of only a mild cervical whiplash. Almost none reported lower back pain or dizziness. Thus, both studies included patients with only mild symptoms that resulted in very low SIMS scores: they scored within the non-malingering range as defined by the SIMS manual. Their scores were below SIMS scores of healthy persons instructed to feign whiplash symptoms from an MVA. The teams of Capilla Ramírez and of Puente-López erroneously interpreted these results as demonstrating diagnostic accuracy of the SIMS for detection of malingering in injured motorists. Conclusions: The two studies of very mildly injured motorists fail to demonstrate “diagnostic accuracy of the SIMS” because the SIMS is mostly used by insurance contracted psychologists on more severely injured MVA patients (those with whiplash and post-concussion syndrome), i.e., those with more symptoms and thus, with higher SIMS scores that fallaciously classify them as “malingerers.”

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Clinical Correlations of Posttraumatic Nightmares in Survivors of Motor Vehicle Accidents

European Journal of Clinical Medicine ◽

10.24018/clinicmed.2021.2.3.38 ◽

2021 ◽

Vol 2 (3) ◽

pp. 19-21

Author(s):

Zack Z. Cernovsky ◽

Varadaraj R. Velamoor ◽

Stephan C. Mann ◽

Larry C. Litman

Keyword(s):

Motor Vehicle ◽

Brief Pain Inventory ◽

Severity Index ◽

Motor Vehicle Accidents ◽

Stressful Event ◽

Vehicle Accidents ◽

Symptom Pattern ◽

Neuropsychological Symptoms ◽

Disability Questionnaire ◽

Clinical Correlations

Background: We evaluated the severity and clinical correlates of nightmares of persons injured in high impact motor vehicle accidents (MVAs). Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) were available and included scores on Item 2 of the PCL-5 (severity of repeated, disturbing dreams of the stressful event). Scores were also available on the Brief Pain Inventory (BPI), Morin’s Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whiplash Disability Questionnaire, and on three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA; all still experienced active post-MVA symptoms requiring therapy. Results: Clinically relevant levels of MVA nightmares were reported by 62.5% of post-MVA patients. Subjectively more aversive levels of MVA nightmares correlated with higher driving anxiety as measured by the Whetstone questionnaire and DAQ, with higher levels of average post-accident pain and insomnia, with post-accident neuropsychological symptoms as measured by the Rivermead and SNPSS, and with higher post-accident levels of depression, anger, and generalized anxiety. Discussion and Conclusions: Almost two-thirds of our post-MVA patients reported MVA nightmares and their level of subjectively aversive impact correlated with most variables within the typical polytraumatic symptom pattern of these patients.

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Frequency of Formication Symptoms in Injured Motorists and in Normal Controls

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.2.751 ◽

2021 ◽

Vol 3 (2) ◽

pp. 48-52

Author(s):

Zack Z. Cernovsky ◽

Varadaraj R. Velamoor ◽

Stephan C. Mann ◽

L. Kola Oyewumi ◽

James D. Mendonça ◽

...

Keyword(s):

Motor Vehicle ◽

Control Sample ◽

Brief Pain Inventory ◽

Severity Index ◽

Lumbosacral Spine ◽

Whiplash Injuries ◽

Vehicle Accidents ◽

Whiplash Trauma ◽

Normal Controls ◽

As If

Background: Formication is the sensation or feeling as if insects were crawling on or under the skin. It is observed in a variety of clinical situations including drug intoxications, multiple sclerosis, and diabetic neuropathy, among many others. Furthermore, it can be associated with injuries incurred during motor vehicle accidents (MVAs). We examined the frequency of reports of formication in a normal control sample as well as in a sample of motorists who sustained concussive and whiplash injuries following high impact MVAs. We also evaluated the correlations of the formication to measures of pain, insomnia, and of various post-accident neuropsychological symptoms. Method: De-identified data on 23 injured motorists (mean age=38.0 years, SD=12.8) and on 20 normal controls (mean age 42.8 years, SD=19.9) were available. All motorists responded to the following True/False item: “I have pain in my body which seems to feel like bugs crawling under the surface of my skin.” Their data were also available on the Brief Pain Inventory, Post-MVA Neurological Symptoms (PMNS) scale, Insomnia Severity Index, and on the Rivermead Post-Concussion Symptoms Questionnaire. The data of normal controls included responses to the following specific item of the formication questionnaire: “Do you sometimes have an annoying feeling in some of your limbs or in some other part of your body as if insects were crawling on or under your skin?” The participants were to circle one of the following responses: “never, very rarely, sometimes, often, or almost constantly.” Results and Discussion: Almost a third (30.4%) of the motorists who sustained whiplash trauma in their MVA reported the formication. In contrast, only one of the 20 normal controls (i.e., 5%) reported formication (this was an elderly man with MRI documented pathology in lumbosacral spine). Notably, formication correlated significantly with the ratings of “reduced feeling in the limbs” (r=.55, p=.010), but not with ratings of “tingling in the limbs” (r=.21, p>.05). Conclusion: The painful form of formication has been reported by almost a third of motorists who sustained whiplash injuries in their accident.

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Validation of the PTSD Checklist for DSM-5 (PCL-5) on Patients Injured in Car Accidents

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.2.790 ◽

2021 ◽

Vol 3 (2) ◽

pp. 154-159

Author(s):

Zack Z. Cernovsky ◽

Milad Fattahi ◽

Larry C. Litman ◽

David M. Diamond

Keyword(s):

Convergent Validity ◽

Motor Vehicle ◽

Brief Pain Inventory ◽

Severity Index ◽

Criterion Validity ◽

Control Group ◽

Vehicle Accidents ◽

Dsm 5 ◽

Ptsd Checklist ◽

Neuropsychological Symptoms

Background: The PTSD Checklist for DSM-5 (PCL-5), is presently the most widely used psychological measure of PTSD along the criteria of DSM-5. We examined the criterion validity of PCL-5 separately for each of its 20 items by comparing scores of patients injured in high impact motor vehicle accidents (MVAs) to scores of persons in a control group. In addition, we evaluated criterion and convergent validity of the PCL-5 total scores. Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) included their scores on the PCL-5, Brief Pain Inventory (BPI), Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), ratings of depression, anger, and anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire), and three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA, but all still experienced active post-MVA symptoms requiring therapy. The PCL-5 scores were also available from 21 controls (mean age 43.0 years, SD=20.3). Results and Discussion: With respect to criterion validity of the PCL-5, the post-MVA patients differed significantly from the control group not only with respect to their total PCL-5 scores, but also on all 20 individual items of the PCL-5, and also on all 4 subscales of PCL-5 (Intrusion, Avoidance, Altered Cognitions/Mood, and Arousal). The PCL-5 total scores correlated significantly to all three measures of post-MVA driving anxiety, post-MVA pain and insomnia, post-MVA depression, anger, and generalized anxiety, and to post-MVA subjective neuropsychological symptoms in the post-concussion and whiplash spectrum. Conclusions: Both the criterion and convergent validity of the PCL-5 for the use on post-MVA patients are excellent.

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Island Latissimus Dorsi Muscle Flap and a Perforator Flap in Repairing Post-Gunshot Thoracic Spine CSF Fistula: Case Presentation

Case Reports in Surgery ◽

10.1155/2015/219535 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Nangole F. Wanjala ◽

Khainga Ominde Stanley

Keyword(s):

Thoracic Spine ◽

Motor Vehicle ◽

Perforator Flap ◽

Muscle Flap ◽

Gunshot Wounds ◽

Latissimus Dorsi Muscle Flap ◽

Case Presentation ◽

Surgical Interventions ◽

Vehicle Accidents ◽

Dorsi Muscle

Persistent posttraumatic CSF fluid leakage may present a challenge to manage. Failure to address the leakage may result in complications such as meningitis, septicemia, radiculopathy, muscle weakness, and back pains. While the majority of the leakages may be managed conservatively, large dura defects as a result of gunshot wounds or motor vehicle accidents are best managed by surgical interventions. This may range from primary closure of the defect to fascial grafts, adhesive glues, and flaps. We present our experience with the use of flaps in a patient who had sustained such wounds in the thoracic spine. An island latissimus dorsal flap and a perforator fasciocutaneous flap were used to close the defect. Postoperatively the patient recovered well and the wounds healed without any complications.

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Thoracolumbar Injury Classification and Severity Score in children: a reliability study

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.7.peds1720 ◽

2018 ◽

Vol 21 (3) ◽

pp. 284-291 ◽

Cited By ~ 7

Author(s):

Ross L. Dawkins ◽

Joseph H. Miller ◽

Omar I. Ramadan ◽

Michael C. Lysek ◽

Elizabeth N. Kuhn ◽

...

Keyword(s):

Severity Score ◽

Interrater Reliability ◽

Pediatric Patients ◽

Motor Vehicle ◽

Classification Systems ◽

Actual Treatment ◽

Vehicle Accidents ◽

Thoracolumbar Injury ◽

The Mean ◽

Injury Classification

OBJECTIVEThere are many classification systems for injuries of the thoracolumbar spine. The recent Thoracolumbar Injury Classification and Severity Score (TLICS) has been shown to be a reliable tool for adult patients. The aim of this study was to assess the reliability of the TLICS system in pediatric patients. The validity of the TLICS system is assessed in a companion paper.METHODSThe medical records of pediatric patients with acute, traumatic thoracolumbar fractures at a single Level 1 trauma center were retrospectively reviewed. A TLICS was calculated for each patient using CT and MRI, along with the neurological examination recorded in the patient’s medical record. TLICSs were compared with the type of treatment received. Five raters scored all patients separately to assess interrater reliability.RESULTSTLICS calculations were completed for 81 patients. The mean patient age was 10.9 years. Girls represented 51.8% of the study population, and 80% of the study patients were white. The most common mechanisms of injury were motor vehicle accidents (60.5%), falls (17.3%), and all-terrain vehicle accidents (8.6%). The mean TLICS was 3.7 ± 2.8. Surgery was the treatment of choice for 33.3% of patients. The agreement between the TLICS-suggested treatment and the actual treatment received was statistically significant (p < 0.0001). The interrater reliability of the TLICS system ranged from moderate to very good, with a Fleiss’ generalized kappa (κ) value of 0.69 for the TLICS treatment suggestion among all patients; however, interrater reliability decreased when MRI was used to contribute to the TLICS. The κ value decreased from 0.73 to 0.57 for patients with CT only vs patients with CT/MRI or MRI only, respectively (p < 0.0001). Furthermore, the agreement between suggested treatment and actual treatment was worse when MRI was used as part of injury assessment.CONCLUSIONSThe TLICS system demonstrates good interrater reliability among physicians assessing thoracolumbar fracture treatment in pediatric patients. Physicians should be cautious when using MRI to aid in the surgical decision-making process.

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A Reassessment of Suicide Measurement

Crisis ◽

10.1027/0227-5910.30.1.6 ◽

2009 ◽

Vol 30 (1) ◽

pp. 6-12 ◽

Cited By ~ 3

Author(s):

D.P. Doessel ◽

Ruth F.G. Williams ◽

Harvey Whiteford

Keyword(s):

Causes Of Death ◽

Motor Vehicle ◽

Years Of Life Lost ◽

Health Prevention ◽

Prevention Strategies ◽

Vehicle Accidents ◽

The Social ◽

Evaluation Exercise ◽

Two Measures ◽

Circulatory Diseases

Background. Concern with suicide measurement is a positive, albeit relatively recent, development. A concern with the social loss from suicide requires careful attention to appropriately measuring the phenomenon. This paper applies two different methods of measuring suicide data: the conventional age-standardized suicide (count) rate; and the alternative rate, the potential years of life lost (PYLL) rate. Aims. The purpose of applying these two measures is to place suicide in Queensland in a historical and comparative (relative to other causes of death) perspective. Methods. Both measures are applied to suicide data for Queensland since 1920. These measures are applied also to two largish causes of death and two smaller causes of death, i.e., circulatory diseases, cancers, motor vehicle accidents, suicide. Results. The two measures generate quite different pictures of suicide in Queensland: Using the PYLL measure, suicide is a quantitatively larger issue than is indicated by the count measure. Conclusions. The PYLL measure is the more appropriate measure for evaluation exercise of public health prevention strategies. This is because the PYLL measure is weighted by years of life lost and, thus, it incorporates more information than the count measure which implicitly weights each death with a somewhat partial value, viz. unity.

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