Healthcare Use Before and After Whiplash Injury

Up to 50% of whiplash patients report an incomplete recovery, and around 30% of patients continue to be moderately or severely disabled two to three years after the initial injury. With a significant number of patients developing chronic problems, ongoing research has sought to identify what factors put patients at risk for persistent symptoms.

Some research has suggested that those with a prior history of neck pain are more likely to develop chronic symptoms after whiplash, and researchers from Sweden sought to see whether this trend was reflected in rates of healthcare utilization. They wondered whether high healthcare use after the injury was predicted by high healthcare use before the injury.

To answer this question, researchers studied the medical records of 1.2 million people, and identified 1,443 patients with whiplash, along with 5,772 controls matched for age, gender, and regional location. Participants with whiplash were tracked for three years after the neck injury, and researchers also examined their medical data for the three years prior to injury. Whiplash patients were divided into three group based on how often they sought healthcare (i.e., healthcare consultation), including low, frequent, and high rates of healthcare consultation.

Over the course of six years, participants with whiplash were more than twice as likely to have a greater number of healthcare consultations than the control group. Overall, whiplash patients had higher healthcare utilization and more sick leave than the control group, regardless of their pre-injury utilization rates.

However, patients with high pre-injury consultation rates were more likely to have more sick days and greater rates of healthcare consultation compared to patients with lower pre-injury consultation rates. Still, 16% of patients with low or frequent healthcare consultation switched to the higher consultation group after the injury. The risk ratio for switching from a low to a high rate of consultation was 2.27.

Additionally, the low or frequent pre-injury consulters had the greatest increase in the diagnosis of musculoskeletal conditions, headache, dizziness, and tinnitus. They also had the most change in the number of consultations.

Women represented 70% of the high consultation group, confirming earlier findings that women are more likely to suffer from whiplash than men. Educational status did not significantly affect rates of healthcare consultation, although age did. The number of sick days patients took was closely correlated to how frequently they visited a health professional.

The authors also pointed to the link between depression and neck injury, and found that higher levels of healthcare utilization among patients with whiplash may have been attributed to care for psychological distress, both before and after the injury. This corroborates earlier research pointing to an increased risk of chronic symptoms in patients with post-traumatic stress disorder and other psychological symptoms.

"Patients diagnosed with neck injury are thus a heterogeneous group of patients,and it is important to recognize the different subsets within these patients. Some change from low-to-high frequent consulters while others remain low-frequent consulters," the authors pointed out. Still they suggested that it is important to take into account an individual's pre-injury consultation level when determining their post-injury outcomes.


Jöud A, Stjerna J, Malmström EM, Westergren H, Petersson IF, Englund M. Healthcare consultation and sick leave before and after neck injury: a cohort study with matched population-based references. BMJ Open. 2013 Aug 30;3(8):e003172. doi: 10.1136/bmjopen-2013-003172. PubMed PMID: 23996819; PubMed Central PMCID: PMC3758980.