Evans R W, Evans R I, Sharp M J
Department of Neurology, University of Texas, Houston Medical School.
Headache. 1994 May;34(5):268-74. doi: 10.1111/j.1526-4610.1994.hed3405268.x.
The post-concussion syndrome (PCS) and whiplash syndrome (WS) have been controversial topics among physicians for many decades. There is little information available on the opinions and practices of physicians.
In June of 1992, we performed a national survey by mail of the four physician groups most commonly treating these problems. The number of respondents and response rates were as follows: family physicians, 118, 16%; neurologists, 100, 21%; neurosurgeons, 97, 23%; orthopedists, 82, 13%. The survey instrument contained items on demographics, definitions, causation, prognosis, medico-legal aspects, testing, and treatment.
Only a minority of respondents believe that PCS and WS are clearly defined syndromes. A substantial minority report that psychogenic and litigation factors are most responsible for the conditions. Most of the physicians believe that PCS and WS have a 3-6 month recovery time. A significant minority concur that symptoms of the two syndromes resolve when litigation is settled. Most of the physicians order tests to rule out pathology although a minority order tests to reassure patients or because of litigation concerns. Only a minority of respondents believe that effective treatments are available. Not surprisingly, a multitude of conventional and unconventional treatments are sometimes recommended.
Many aspects of PCS and WS are controversial among treating physicians. This controversy can have a profound impact on the quality and cost of patient care. Ongoing research is required to discover more effective treatments for mild brain injury and chronic pain.
几十年来，脑震荡后综合征（PCS）和挥鞭样损伤综合征（WS）一直是医生们争论的话题。关于医生的观点和做法，可获取的信息很少。
1992年6月，我们通过邮件对最常治疗这些问题的四个医生群体进行了全国性调查。回复者数量及回复率如下：家庭医生118名，回复率16%；神经科医生100名，回复率21%；神经外科医生97名，回复率23%；骨科医生82名，回复率13%。调查问卷包含有关人口统计学、定义、病因、预后、医学法律方面、检测和治疗的项目。
只有少数回复者认为PCS和WS是明确定义的综合征。相当一部分少数人报告说，心理因素和诉讼因素是导致这些病症的主要原因。大多数医生认为PCS和WS的恢复时间为3至6个月。相当一部分少数人同意，当诉讼解决时，这两种综合征的症状就会消失。大多数医生会安排检查以排除病变，尽管少数医生安排检查是为了让患者安心或出于诉讼方面的考虑。只有少数回复者认为有有效的治疗方法。毫不奇怪，有时会推荐多种传统和非传统的治疗方法。
在治疗医生中，PCS和WS的许多方面都存在争议。这种争议可能会对患者护理的质量和成本产生深远影响。需要进行持续研究，以发现更有效的轻度脑损伤和慢性疼痛治疗方法。
