Teresiński Grzegorz
Katedra i Zakład Medycyny Sądowej, Uniwersytet Medyczny w Lublinie, Polska/ Chair and Department of Forensic Medicine, Medical University of Lublin, Poland.
Arch Med Sadowej Kryminol. 2019;69(4):164-191. doi: 10.5114/amsik.2019.95716.
Whiplash injury (distortion of the cervical spine) is the most commonly diagnosed type of injury sustained in car accidents, and it ranks first in the structure of compensation claims for personal injury resulting from traffic incidents. The verification of whiplash-associated disorders (WADs) continues to be a great problem in the formulation of medico- legal expert opinions, as injuries of this type, cannot, by definition, be captured using available imaging methods ("radiologically negative effects of acceleration/deceleration mechanism with a wide variety of clinical manifestations"). The present study aims to define a set of criteria that might represent threshold conditions for WAD verification, enabling preliminary cohorting (preselection) of evaluated cases and facilitating the adoption of legal decisions. The available scientific literature addressing problems relating to WAD verification was reviewed to identify factors that differentiate an extremely broad spectrum and varying severity of symptoms depending on the circumstances of incidents, the results of physical evaluation of patients and additional instrumental examinations, as well as technical indicators. Based on the literature search, a range of criteria with the highest potential significance for application in routine medical and forensic expert practice were selected (with a focus on aspects related to verification, quantification and outcomes). The primary prerequisite for recognising the presence of moderate impairment to health (according to the Polish penal code) due to distortion of the cervical spine should involve confirmation of grade 3 WAD according to the Quebec Task Force (QTF) classification, and exceeding the threshold values of Δv (> 15 km/h), acceleration of the victim's vehicle centre of gravity (> 4 g), and NIC criterion (> 15 m2/s2). Additional criteria used by experts should include the verification of the correct head restraint position as well as results of biomechanical examinations evaluating the level of safety of a given vehicle, and epidemiological data retrieved from databases including the statistics for claims filed by victims of real-life accidents.
挥鞭伤（颈椎扭曲）是交通事故中最常被诊断出的损伤类型，在交通事故导致人身伤害的赔偿索赔结构中排名第一。在形成法医学专家意见时，挥鞭样相关疾病（WADs）的验证仍然是一个大问题，因为从定义上讲，这种类型的损伤无法通过现有的成像方法检测到（“具有多种临床表现的加速/减速机制的放射学阴性效应”）。本研究旨在定义一组可能代表WAD验证阈值条件的标准，以便对评估病例进行初步分组（预选），并促进法律决策的做出。对涉及WAD验证问题的现有科学文献进行了综述，以确定根据事故情况、患者体格检查结果和其他仪器检查以及技术指标来区分极其广泛和严重程度不同的症状的因素。基于文献检索，选择了一系列在常规医学和法医专家实践中应用具有最高潜在意义的标准（重点关注与验证、量化和结果相关的方面）。根据波兰刑法典，识别因颈椎扭曲导致的中度健康损害的主要前提应包括根据魁北克工作组（QTF）分类确认3级WAD，并超过Δv（>15公里/小时）、受害者车辆重心加速度（>4g）和NIC标准（>15平方米/秒²）的阈值。专家使用的其他标准应包括对头枕正确位置的验证以及评估给定车辆安全水平的生物力学检查结果，以及从数据库中检索的流行病学数据，包括现实生活事故受害者提出索赔的统计数据。
