Predicting new onset of widespread pain following a motor vehicle collision.
OBJECTIVE
To determine, in a group of persons involved in a motor vehicle collision, the contributions of pre-collision health and psychological factors, the social environment, collision-specific factors, and post-collision symptoms, to the new onset of widespread pain (WP).


METHODS
A prospective cohort study of persons, registered with an insurance company, who had recently experienced a motor vehicle collision. Participants were sent a questionnaire to assess pre-collision health, collision-specific factors, post-collision health, and WP. Those reporting WP prior to the collision were excluded from followup. At 12 months, participants were sent a followup questionnaire to ascertain one-month period prevalence of (new onset) WP.


RESULTS
In total 957 individuals took part in the baseline survey and were eligible for followup. Subsequently, 695 (73%) completed a questionnaire at 12 months, of whom 54 (7.8%) reported new WP. Few collision-specific factors predicted the onset of WP. In contrast, post-collision physical symptoms (rate ratio 2.5, 95% confidence interval 1.2-5.1), pre-collision health-seeking behavior (RR 3.6, 95% CI 1.6-7.9), pre-collision somatization (RR 1.7, 95% CI 0.99-2.8), and perceived initial injury severity (RR 1.7, 95% CI 0.9-3.3), in addition to older age (RR 3.3, 95% CI 1.5-7.1), were all independently predictive of new onset WP. In combination, these factors accounted for about a 20-fold difference in the risk of new onset WP.


CONCLUSIONS
We identified 5 factors that independently predict the onset of WP following a motor vehicle collision. Early identification of this "at-risk" group may allow the targeting of preventive management in those at highest risk of developing future symptoms.
Primary Care Sciences Research Centre, Keele University, Keele, United Kingdom.
Gwenllian
G
Wynne-Jones
Gareth T
GT
Jones
Nicola J
NJ
Wiles
Alan J
AJ
Silman
Gary J
GJ
Macfarlane
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D001334:Automobile Driving; D002908:Chronic Disease; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009141:Musculoskeletal System / Q000293:injuries / Q000503:physiopathology; D019547:Neck Pain / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D010146:Pain / Q000209:etiology* / Q000503:physiopathology* / Q000523:psychology; D010346:Patient Care Management; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires