Dr. Christopher Quigley – Crash Course On Documenting Your Case With The Right Injury Objective Evidence
Dr. Christopher Quigley Presents: Crash Course On Documenting Your Case With The Right Injury Objective Evidence
- Get practical and reliable information to understand which car safety mechanisms affect injury outcomes to help you win more cases.
- Learn what documentation you need to avoid low ball settlement offers.
- Discover valuable information about which accident types result in the most damage to your client – and the biggest settlements
- Learn critical factors you cannot miss when documenting the accident – beyond the collision itself
- Gain the knowledge needed to properly convey the accident and your client’s injuries to a jury – and win your case!
Dr. Chris Quigley:
All right. Well we have a top 10 article today we’re going to review.
Speaker 2:
Excellent.
Dr. Chris Quigley:
Let me see. How can I share my screen? There we go. There we go. All right. So the title of this article is The Effect of Accident Mechanism and Initial Findings on the Long-term Course of Whiplash Injury. So this is one you probably want to buy and maybe keep in your top 10 binder. This is with Dr. Matthias Sturzenegger who’s a neurologist. He is from the Department of Neurology at University of Bern, Switzerland, and his coauthor is a guy named Radanov. Now both these guys are really strong in the field, top excellent guys. The DiStefano, the third guy, he’s a third wheel in this one. He’s a little step down from the other two. All right. So I’m just going to read the abstract and the results here. And then we’ll get into the details.
Speaker 2:
Alrighty.
Dr. Chris Quigley:
The aim of this study was to assess the relationship between accident mechanisms as well as initial findings in the long-term course of whiplash injury. A representative sample of 117 consecutive patients followed by primary care physicians was followed up over 12 months. So again, these guys are neurologists, so these patients are referred by the primary care physicians. Fractures or dislocations of the cervical spine, head trauma, and pre-existing neurological disorders were exclusion criteria. So these are going to be some of your worst cases, so keep that in mind when thinking about these results. The interval between the accident and baseline examination was 7.4 days. Assessment included accident features such as passenger position in the car, head restraint, head position, type of collision, initial symptoms, intensity and onset of pain, symptoms of neurological dysfunction, multiple symptom score and signs, restricted neck movement, neurological deficits. At the one year examination, patients were divided into an asymptomatic and symptomatic group and were compared with respect to the accident features and baseline findings. 24% of the patients were still symptomatic after one year. Now keep in mind again, they excluded a lot of the worst patients. So still they got 24%.
Dr. Chris Quigley:
Analyzing accident mechanisms separately, rotated or inclined head position was the primary feature related to symptom persistence. All right? Key point. Symptomatic groups also scored higher at baseline on multiple symptom rating, had a higher incidence of initial headache, neurological symptoms together with a higher intensity of headache and neck pain. So they say that the following set of initial variables predicted persistence of symptoms at one year: intensity of neck pain, headache, rotated or inclined head position, unpreparedness at the time of impact, and car stationary when hit. In conclusion, accident mechanisms in initial findings suggest that more severe injury were significantly related to long-term persistence of symptoms after whiplash injury. So a lot of this stuff fits in really well with our previous discussions.
Speaker 2:
Yeah.
Dr. Chris Quigley:
Now the one thing they don’t have here is pre-existing arthritis, so they didn’t go much into the situation of the patient when they got into the accident. So this is mainly the other factors. So I’ll read a couple of notes here. The prognosis of common whiplash injuries without fracture or dislocation of cervical spine is generally good and almost three-quarters of patients recover in six months. Again, that’s not the best number you’ve seen. We’ve seen way over, after a year, even after seven years sometimes it’s not even that good. However, the remaining 26% have symptoms persisting more than six months after injury and represent an important diagnostic and therapeutic problem for and legal medicine. Had these patients had more severe injuries or the injuries which are unrecognized or unresolved or either physiological frail or psychologically frail or even conscious malingerers. And that’s always the question in these cases. So that’s good they brought that up.
Dr. Chris Quigley:
So let’s get into some of the findings here. So assessment included accident features, so passenger position, head restraint, head position, and type of collision were the factors here. And they said that head position was number one. All really good stuff there. Now they said it was number one. They didn’t say it was the only one either, so head position is key. So what do we talk about head position? We say if your head is turned, that is the number one thing that we talk about, and that’s one of the first things I ask when people come into the collision. So, “Were you looking in the rear view mirror? Were you looking in the side view mirror?” I usually ask them the question to try to force an answer. I say, “Were you looking in the rear view mirror or the side view?” I don’t give them the option of straight. A lot of people default to straight. And so I usually get a good answer there because they say, “I was looking straight ahead,” even though it wasn’t one of the options. So I can have pretty good confidence in that answer.
Dr. Chris Quigley:
Initial symptoms, intensity and onset of pain, symptoms of neurological dysfunction and multiple symptom score. So this is something you’ll see in my reports now in the crash factors. I will go into these things. I’ll say that patients came in with a severe headache and severe headache at the beginning of any crashes indicated by report prognosis. Multiple symptom score, so this is people have one, two, three, four, five complaints. Our most recent… That lady, the nurse, she had multiple symptoms where she had four or five areas of complaint. And then signs, restricted neck movement and neurological deficits. So as I was talking about, rotated or inclined head position was the primary feature related to symptom persistence. The symptomatic groups scored higher on baseline and on multiple symptom rating and higher incidence of initial headache and neurological symptoms together with a higher intensity of headache and neck pain. So these are all real good, common sense things, but it’s nice to have an article that you can say, “Dr. Sturzenegger, the neurologist, this is what he says,” now if anybody wants to call you on it.
Dr. Chris Quigley:
Now again, this is one of your ones you’re going to have in your top 10. It’s got a bunch of good nuggets in it. The chart there on page 446 is excellent. They give you all the numbers who was symptomatic at a year. Unpreparedness is one that we’ve talked about several times in the past. All right? That’s another one. And you’ll find the few that are prepared, it’s plain as day most of the time that they have less symptoms. They saw it coming. Even if you consciously are able to protect yourself, there is definitely a bracing effect that…
Dr. Chris Quigley:
If you’ve been hit before, you looked at the car in your rear view mirror like, “Uh oh. Something’s coming here,” which also brings you to… You had a comment about, “There’s those eight or so references that they always cite when they did a crash test with four cars, and now they extrapolate to the whole world about rear-end crashes.” Well the fact is all those people know they were in a car accident study, so they knew they were going to get hit. They might not know when, but they knew they were going to get hit. So that’s one of the ways you can attack those really terrible studies. They usually have eight guys. They’re usually all healthy, athlete types. And then they get hit and they’re like, “They didn’t get hurt.” Well, no kidding. They knew it was coming. They knew it was coming. They were six foot something males, got range of ages 18 to 24. And of course they were going to have a lesser incidence of being hurt.
Speaker 2:
Yeah.
Dr. Chris Quigley:
And then you have your client who’s a 40 year old young lady who’s five foot two and 105 pounds. And they’re like, “They go together.”
Speaker 2:
Yeah.
Dr. Chris Quigley:
It strains credulity. Questions?
Speaker 2:
So far on this, no.
Dr. Chris Quigley:
Yeah. It’s just a real good solid study to have as background, to have as something you can really hang your hat on. And these guys are no slouches. Sturzenegger’s one of the top referenced researcher in the whiplash world. He’s a neurologist. Yeah. [crosstalk 00:09:19] real solid study.
Speaker 2:
How do you spell the name?
Dr. Chris Quigley:
Sturzenegger?
Speaker 2:
Yeah.
Dr. Chris Quigley:
S-T-U-R-Z-E-N-E-G-G-E-R.
Speaker 2:
Okay.
Dr. Chris Quigley:
And the other guy is Radanov: R-A-D-A-N-O-V. And Sturzenegger is Matthias and Radanov is Bogdan: B-O-G-D-A-N.
Speaker 2:
Okay. (Silence).