title: Underestimation of severity of previous whiplash injuries.
abstract: BACKGROUND
  We noted a report that more significant symptoms may be expressed after second whiplash injuries by a suggested cumulative effect, including degeneration. We wondered if patients were underestimating the severity of their earlier injury.
  
  
  METHODS
  We studied recent medicolegal reports, to assess subjects with a second whiplash injury. They had been asked whether their earlier injury was worse, the same or lesser in severity.
  
  
  RESULTS
  From the study cohort, 101 patients (87%) felt that they had fully recovered from their first injury and 15 (13%) had not. Seventy-six subjects considered their first injury of lesser severity, 24 worse and 16 the same. Of the 24 that felt the violence of their first accident was worse, only 8 had worse symptoms, and 16 felt their symptoms were mainly the same or less than their symptoms from their second injury. Statistical analysis of the data revealed that the proportion of those claiming a difference who said the previous injury was lesser was 76% (95% CI 66-84%). The observed proportion with a lesser injury was considerably higher than the 50% anticipated.
  
  
  CONCLUSIONS
  We feel that subjects may underestimate the severity of an earlier injury and associated symptoms. Reasons for this may include secondary gain rather than any proposed cumulative effect.
authors.affiliation: Department of Orthopaedic Surgery, South Manchester University Hospital NHS Trust, Wythenshawe, Manchester, UK.
authors.forename: S Z H
authors.initials: SZ
authors.lastname: Naqui
authors.forename: S J
authors.initials: SJ
authors.lastname: Lovell
authors.forename: M E
authors.initials: ME
authors.lastname: Lovell
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D001294:Attitude to Health; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D014911:Whiplash Injuries / Q000209:etiology*