Rating criteria of the causal nexus in Whiplash Associated Disorders: A study of interrater reliability / Criterios para el establecimiento del nexo causal en síndrome de latigazo cervical: un estudio de concordancia interobservadores

Introducción: El diagnóstico del síndrome de latigazo cervical está sujeto a criterios ambiguos, algunos de ellos de naturaleza subjetiva, que impide un alto porcentaje de acuerdo interjueces, y compromete seriamente la replicabilidad de los diagnósticos. El objetivo de este estudio es evaluar la concordancia interjueces de 4 expertos en medicina legal, quienes establecen el nexo causal de los pacientes que han sufrido un accidente de tránsito. Material y método: Trescientos pacientes que sufrieron un accidente de circulación fueron evaluados por 4 expertos en medicina legal. Realizaron 2 valoraciones del nexo causal, una sin estudio de la biomecánica y otra con este estudio. El grado de concordancia de las valoraciones fue calificado con el coeficiente de correlación intraclase (ICC) y el índice de concordancia (IC). Resultados: Los resultados de la valoración previa al estudio biomecánico de la lesión arrojan valores moderados-altos (ICC=0,70; CI=0,60). Asimismo, los valores observados en la valoración con el estudio de la biomecánica también indican un acuerdo moderado-alto (ICC=0,78, CI=0,67). Conclusiones: El estudio de la biomecánica mejora la concordancia de forma leve. A pesar de ello, el citado estudio no ayuda a reducir la proporción de casos dudosos y la mejora no alcanza niveles aceptables. Se observan diferencias significativas entre las clasificaciones, lo que sugiere que la metodología de valoración propuesta no es lo suficientemente uniforme como para alcanzar consenso. (AU)

Introduction: The diagnosis of Whiplash Associated Disorders is subject to various criteria, some of a subjective nature, which impedes a high percentage of agreement among raters of the causal nexus. It is necessary to develop an evidence-based methodology to maximize the uniformity of this diagnosis. Our objective is to assess the interrater reliability of four experts in legal medicine who establish the causal nexus of traffic accident patients. Material and method: 300 traffic accident patients evaluated by 4 legal medicine experts. They conducted two ratings, one without and one with a study of the biomechanics of the accident. The degree of concordance of the ratings was studied by the intraclass correlation coefficient (ICC) and the concordance index (CI). Results: The results of both the intraclass correlation coefficient and the concordance index of the rating prior to the biomechanical study of the injury yield moderate-high values (ICC=.70; CI=.60). Likewise, the values observed in the rating with the study of biomechanics also indicate moderate-high agreement (ICC=.78, CI=.67). Conclusions: The study of biomechanics slightly improves concordance. However, the aforementioned study does not help to reduce the proportion of doubtful cases and the levels of improvement are not acceptable. There are significant differences between the classifications, suggesting that the proposed valuation methodology is not uniform enough to reach a consensus. (AU)

Predictive models for the assessment of bodily harm.

The Spanish scale to quantify or qualify bodily harm resulting from any unintentional traffic accident prior to 1 January 2016 is established by Royal Legislative Decree (RDL) 8/2004. This scale assigns points to the sequelae, which are converted into Euros using a table that is updated annually. The objective of this study is to develop a predictive model of sequelae points that will enable the estimation of compensation a short time after the accident. This will facilitate the calculation of the money reserve and rapid access to compensation for the injured party. To conduct this study, we developed a database with information from 999 individuals who had suffered car crash injuries which were evaluated according to the scale contained in RDL 8/2004 for medical experts. Predictive models based on logistic regression models were designed on this database. To choose the best model, we calculated Mallow's Cp. The use of hurdle models made it possible to predict the points received by an injured party within a relatively short period of time after the accident. Once these points are known, it is a simple matter to calculate the corresponding compensation. The prediction models developed provide an easy way to predict the compensation to be awarded to the injured party. These models use days of hospitalization, sex, age and the results of international scales based on the Abbreviated Injury Scale. These variables can be used soon after the occurrence of the crash.

Importancia de la biomecánica del impacto en la valoración pericial del síndrome del latigazo cervical / The importance of the impact biomechanics on the assessment of whiplash injury

Argumentos de diferente naturaleza (impacto epidemiológico, indefinición diagnóstica, ausencia de pruebas objetivas de daño) justifican la necesidad de la biomecánica del impacto en el diagnóstico médico-legal de causalidad del síndrome postraumático cervical (whiplash associated dissorders) en terminología anglosajona. Su investigación biomecánica tiene dos etapas bien definidas de interés médico-legal: la investigación en laboratorio (animales, cadáveres, y fundamentalmente voluntarios) y el estudio de colisiones reales, a lo que ha contribuido el desarrollo de dispositivos de recogida de datos. Esta investigación ha permitido identificar parámetros físicos de la colisión (cambio de velocidad, aceleración) relacionados con el riesgo de lesiones cervicales, así como otros factores de riesgo. Aunque la utilización médico-legal de los umbrales que delimitan el riesgo de lesión poblacional no es pacífica en la literatura, existen suficientes evidencias que permiten individualizar estos umbrales de riesgo de lesión en el diagnóstico médico-legal de la causalidad, si bien exige un profundo conocimiento (AU)

Arguments of a diverse nature ranging from epidemiological to diagnostic justify the need to include the biomechanics of impact as part of the medico legal diagnosis of the cause of cervical post-traumatic syndrome (whiplash associated disorders). Biomechanical research comprises two distinct stages of forensic interest: firstly, laboratory research, using animals, corpses, and volunteers and, secondly, the study of actual collisions. This has contributed to the development of data collection devices which have helped to identify the physical parameters of an impact such as changes in velocity and acceleration in relation to the risk of whiplash injuries as well as other risk factors. Although the literature regarding the forensic use of thresholds that define the risk of injury is not population specific, there is sufficient evidence to individualise these thresholds of risk of injury in the medico legal diagnosis of causality, although this requires further research (AU)