Validity of self-reported history in patients with acute back or neck pain after motor vehicle accidents.
BACKGROUND
Determining the presence of comorbid conditions in patients with persistent axial pain after motor vehicle accident (MVA) is important to direct appropriate care and as a public health measure against future traffic injuries. In the clinical care of patients after MVA, they are usually asked about previous axial pain problems and relevant comorbid conditions (psychological distress and drug and alcohol abuse). The accuracy of self-reported previous axial pain history and comorbid conditions after MVA has not been systematically evaluated but has been assumed to be high.


OBJECTIVE
To establish the validity of certain elements of the self-reported history in patients with back or neck pain attributed to an MVA.


METHODS
A validation study of crucial elements of the patient history obtained after MVA using internal (chart audit) and external (age- and sex-matched population data) as gold standard references.


METHODS
Medium-sized (n>400) clinical cohort of patients without fracture or dislocation seen within 3 months after an MVA in a university spine clinic.


METHODS
Responses to standardized questionnaires included previous back or neck pain, previous psychological distress, previous illicit drug usage, previous alcohol abuse, other chronic pain conditions, perceived fault of the MVA, and whether a compensation claim has been filed.


METHODS
A consecutive cohort of patients seen from 1998 to 2004 for evaluation of back or neck/shoulder pain reportedly caused by an MVA was enrolled. All clinic patients completed standardized questionnaires. The prevalence of self-reported pre-MVA axial pain and at-risk conditions (drug, alcohol, and psychological problems) and control conditions (hypertension and diabetes) were compared against the age- and sex-matched prevalence determined by the 2005 US Department of Health and Human Services National Surveys on Drug Use and Health (external gold standard). Randomly selected previous medical records were also audited (internal gold standard) and compared with post-MVA description of preaccident health.


RESULTS
Four hundred twenty-two subjects were enrolled, and random audits of 100 subjects were completed. In 68% of the random audits, comorbid conditions denied in the postaccident history (previous axial pain, drug or alcohol abuse, and psychological diagnoses) were documented. In subjects perceiving the MVA to be another's fault (but not their own), the reported prevalence of previous axial pain was markedly below matched data for population prevalence and audited data. Similar findings were observed for psychological problems, illicit drug use, and alcohol abuse. In subjects pursuing compensation claims and retaining an attorney, 80% had significant past axial pain history or serious comorbidities in their records not disclosed in the spine clinic evaluation. In subjects reporting that the MVA was either one's "own fault" or "no one's fault," this effect was seen but was smaller in all dimensions.


CONCLUSIONS
In patients being seen for continued pain related to an MVA, the validity of self-reported previous axial pain and comorbid conditions appeared poor. The self-reported prevalence of previous axial pain and drug, alcohol, and psychological problems is much less than the documented prevalence in prior medical records. These rates were also markedly below the expected prevalence in age- and sex-matched populations. This effect was seen most prominently in patients perceiving the accident to be another party's fault and in those filing compensation claims. The failure to appreciate previous axial pain problems and drug, alcohol, and psychological problems may compromise patient care and public health opportunities.
Stanford University School of Medicine, 800 Pasteur Drive, #R171, Stanford, California 94305, USA. caragee@stanford.edu
Eugene J
EJ
Carragee
D000063:Accidents, Traffic; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D001416:Back Pain / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D019547:Neck Pain / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D015995:Prevalence; D012647:Self-Assessment; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires