Abstract
Purpose: Although the use of soft cervical collars in the emergency department (ED), for whiplash-associated disorders (WAD), is controversial, it is still widely adopted. The purpose of our study was to investigate the impact of the early use of soft cervical collars on the return to the ED, within three months of a road traffic collision. Methods: We conducted a retrospective observational study on WAD patients from two EDs in Verona (Italy). Patients in the earlier acute phase of WAD (within 48 h from the trauma) were included; those with serious conditions (WAD IV) were excluded. As an end point, we considered patients who returned to the ED complaining of WAD symptoms within three months as positive outcome for WAD persistence. Results: 2162 patients were included; of those, 85.4% (n = 1847/2162) received a soft cervical collar prescription. Further, 8.4% (n = 156/1847) of those with a soft cervical collar prescription, and 2.5% (n = 8/315) of those without a soft cervical collar (p < 0.001) returned to the ED within three months. The use of the soft cervical collar was an independent risk factor for ED return within three months, with an OR, adjusted for possible clinical confounders, equal to 3.418 (95% CI 1.653–7.069; p < 0.001). After the propensity score matching, 25.5% of the patients (n = 25/98) using the soft cervical collar returned to the ED at three months, compared to the 6.1% (n = 6/98) that did not adopt the soft cervical collar. The use of a soft cervical collar was associated with ED return with an OR = 4.314 (95% CI 2.066–11.668; p = 0.001). Conclusions: Our study shows that the positioning of the soft collar in a cohort of patients with acute WAD, following a rear-end car collision, is an independent potential risk factor to the return to the ED. Clinically, the use of the collar is a non-recommended practice and seems to be related to an increased risk of delayed recovery. There is a need to inform healthcare providers involved in the ED of the aim to limit the use of the soft cervical collar. A closer collaboration between clinicians (e.g., physicians, physical therapists, nurses) is suggested in the ED. Future primary studies should determine differences between having used or not having used the collar, and compare early physical therapy in the ED compared with the utilization of the collar.
Highlights
The Quebec Task Force defined whiplash-associated disorders (WAD) as an umbrella term, which includes “a variety of clinical manifestations following an acceleration–deceleration injury commonly resulting from a road traffic collision”, recommending a four-grade classification system based on severity (Table 1) [1]
Despite the fact that patients may have had different options of outpatient care for their symptoms, we considered the return to emergency department (ED) within 3 months as a surrogate of severity, as an emergency visit is the option with the greatest care intensity
The following multivariate analysis, adjusted for WAD grade, showed that the application of a soft cervical collar was an independent risk factor for subsequent admission to the ED in the propensity group as well
Summary
The Quebec Task Force defined whiplash-associated disorders (WAD) as an umbrella term, which includes “a variety of clinical manifestations following an acceleration–. Deceleration injury commonly resulting from a road traffic collision”, recommending a four-grade classification system based on severity (Table 1) [1]. Emergency department (ED) accesses for WAD have been reported to have an annual incidence ranging from 70 per 100,000 inhabitants in Quebec to 325 per 100,000 in the Netherlands, with an average of 235–300/100,000 [4,5,6]. In Italy, the most recent report has estimated the number of WADs to be 12,235 cases per year, with a higher incidence in the northern regions [7]. Neck complaint of pain: Stiffness or tenderness only.
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