Keith Porter says that he has never seen a significant neck injury from a rear impact. I have seen several but all except
one from high energy transfer crashes. This 'pain like a stiff neck' however in someone who previously had no pain after
the crash would appear to be a relatively benign manifestation of musculoskeletal pain. I suspect immobilisation is the
last thing needed, as I have used the term relatively for a reason; these are the people who are likely to go on to severe
symptoms of neck pain and stiffness; by and large the earlier it starts the worse it will be. If the pain goes on for 3
months it has an 86% chance of lasting for at least 2 years. (The oft-quoted Gargan and Bannister paper).
> What would you have done with this patient I encountered recently - in
> view
> of current guidelines already discussed?
>
> Stationary car hit from behind at less than 20mph. Driver has
> preexisting
> back condition, exacerbation of symptoms (leg pain/paraesthesia worsened
> post RTA), no other injuries, walked unaided from vehicle, conveyed to
> A&E.
> Passenger has no previous history, no injuries at time of impact,
> walking
> around on our arrival. Ten minutes later develops neck pain "like a
> stiff
> neck". No neurological symptoms, on examination has bony midline
> tenderness
> approx C7/T1, no obvious paravertebral spasm. I thought best option
> would be
> to fully immobilise - patient adamantly refused despite full
> explanation of
> potential risks. Fully documented decision, patient advised attend
> A&E etc
> but as far as I know had no intention.
>
> Thanks,
>
> Peter Johnson.
>
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>
Best wishes,
Rowley Cottingham
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http://www.emergencyunit.com
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