Hartling L, Brison R J, Ardern C, Pickett W
Departments of Emergency Medicine, and Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada.
Spine (Phila Pa 1976). 2001 Jan 1;26(1):36-41. doi: 10.1097/00007632-200101010-00008.
Retrospective cohort.
In 1995, a task force from Québec, Canada, developed the Québec Classification of Whiplash-Associated Disorders to assist health care workers in making therapeutic decisions. The Classification was applied to an inception cohort of patients presenting for emergency medical care following their involvement in a rear-end motor vehicle collision.
All patients (n = 446) presenting to the only two emergency departments serving Kingston, Ontario, between October 1, 1995 and March 31, 1998 were considered for inclusion in the study. Eligible patients (n = 380) were categorized according to the Classification based on signs and symptoms documented in their emergency medical chart. Attempts were made to interview all patients shortly following and again 6 months after their collision. Patients were contacted at 12, 18, and 24 months postinjury only if sufficient time had elapsed between recruitment into and cessation of the study. Data were gathered regarding symptoms, treatments received, effects on usual activities, crash circumstances, and personal factors. Associations between initial Classification grade and the frequency/intensity of follow-up symptoms were quantified via multivariable analyses.
The Classification was prognostic in that risk for Whiplash-Associated Disorders at 6, 12, 18, and 24 months increased with increasing grade. Analyses supported modification of the Classification to distinguish between Grade II cases of Whiplash-Associated Disorders with normal or limited range of motion. The greatest risk for long-term symptoms was seen among the group of patients with both point tenderness and limited range of motion.
The analyses of this study support the use of the Québec Classification of Whiplash-Associated Disorders as a prognostic tool for emergency department settings, and the authors propose a modification of the Classification using a subdivision of the Grade II category.
回顾性队列研究。
1）评估魁北克挥鞭样损伤相关疾病分类作为初始评估工具的效用；2）评估其预测碰撞后6、12、18和24个月症状持续存在的能力；3）研究对该分类的一项潜在修改。
1995年，加拿大魁北克的一个特别工作组制定了魁北克挥鞭样损伤相关疾病分类，以协助医护人员做出治疗决策。该分类应用于因追尾机动车碰撞而前来接受急诊医疗护理的起始队列患者。
1995年10月1日至1998年3月31日期间，向安大略省金斯顿仅有的两个急诊科就诊的所有患者（n = 446）均被考虑纳入本研究。符合条件的患者（n = 380）根据其急诊病历中记录的体征和症状按照该分类进行分类。在碰撞后不久及6个月后尝试对所有患者进行访谈。仅当从纳入研究到研究结束有足够长的时间间隔时，才在受伤后12、18和24个月联系患者。收集了有关症状、接受的治疗、对日常活动的影响、碰撞情况和个人因素的数据。通过多变量分析对初始分类等级与随访症状的频率/强度之间的关联进行了量化。
该分类具有预后价值，即6、12、18和24个月时挥鞭样损伤相关疾病的风险随等级升高而增加。分析支持对该分类进行修改，以区分活动范围正常或受限的II级挥鞭样损伤相关疾病病例。长期症状风险最高的是既有压痛点又有活动范围受限的患者组。
本研究分析支持将魁北克挥鞭样损伤相关疾病分类用作急诊科环境的预后工具，作者提议对该分类进行修改，对II级类别进行细分。
