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European Spine Journal

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01-04-2017 | Original Article

Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting

Authors: Eric Rydman, Sari Ponzer, Carin Ottosson, Hans Järnbert-Pettersson

Published in: European Spine Journal | Issue 4/2017

Abstract

Purpose

To construct and validate a prediction instrument for early identification of patients with a high risk of delayed recovery after whiplash injuries (PPS-WAD) in an insurance company setting.

Methods

Prospective cohort study. On the basis of a historic cohort (n = 130) of patients with a whiplash injury identified in an emergency room (ER, model-building set), we used logistic regression to construct an instrument consisting of two demographic variables (i.e. questions of educational level and work status) and the patient-rated physical and mental status during the acute phase to predict self-reported nonrecovery after 6 months. We evaluated the instrument’s ability to predict nonrecovery in a new cohort (n = 204) of patients originating from an insurance company setting (IC, validation set).

Results

The prediction instrument had low reproducibility when the setting was changed from the ER cohort to the IC cohort. The overall percentage of correct predictions of nonrecovery in the ER cohort was 78 % compared with 62 % in the IC cohort. The sensitivity and specificity in relation to nonrecovery were both 78 % in the ER cohort. The sensitivity and specificity in the insurance company setting was lower, 67 and 50 %.

Conclusion

Clinical decision rules need validation before they are used in a new setting. An instrument consisting of four questions with an excellent possibility of identifying patients with a high risk of nonrecovery after a whiplash injury in the emergency room was not as useful in an insurance company setting. The importance and type of the risk factors for not recovering probably differ between the settings, as well as the individuals.

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Title: Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting
Authors: Eric Rydman
Sari Ponzer
Carin Ottosson
Hans Järnbert-Pettersson
Publication date: 01-04-2017
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 4/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4652-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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