Whiplash injuries and rear-end-accidents in Norway

297 NFT 3/1999 This study is mainly based on statistics over casualties recorded at Gjensidige Insurance and rear-end-accidents recorded at Gjensi- dige and at the police. The statistics this study is based on include about 60 000 claims for collisions and single vehicle accidents yearly reported to Gjensi- dige, of which 3000 with injuries, 8500 acci- dents recorded yearly by the police including 12000 injured and 300 killed. Gjensidige has a marked share near to 30% of motor vehicle insurance in Norway. Strong increase in the 80ties Whiplash injuries among road accident vic- tims are described first time in 1927 (Bas- tiaans, J. 1989). The incidences of reported whiplash injuries over time and in different countries vary and are generally increasing. Braunststein & Moore (1959) found that 1.1 % of motor vehicle occupants sustained whip- lash injuries in USA, Bäckstrøm (1963) came to 1.4 % in Sweden and Bø (1972) found that 5.5 % of vehicle occupants injured in the Oslo area in 1968 suffered from whiplash injuries. According to Bø (1972) he found no serious injuries caused by the whiplash-mechanism in his material of totally 4389 casualties. In the seventies it was increasing awareness about the whiplash-injuries in road accidents. First it was recognized by professionals people in the medical field. However, in the eighties the whiplash-syndrome was heavily empha- sised in the media. Consequently the public opinion was more aware of this problem and Whiplash injuries and rear-end-accidents in Norway av Tore Vaaje, Senior Research Officer, Traffic Safety Gjensidige Insurance, Norway Whiplash injury is an injury mechanism, not a diagno- sis. The essential feature of this injury mechanism is thought to be an initial hyperextention of the cervical spine followed by a rapid flexion. In whiplash cases we are generally often dealing with medically non-objectio- nable injuries with only subjective complaints such as neck pains, headaches, difficulties with concentration irritability and sleeping problems. The lack of objective criteria for a whiplash injury makes the recording and registration of this type of casualties very sensitive to various trends in the society. The scope of this article is to give an overview over the whiplash-syndrome over time in Norway. Tore Vaaje 298 we observed a marked increase in the number of reported rear-end-accidents with injuries to the occupants. According to the road act any person involved in an accident with injured had to report the accident to the police, except minor injuries. In the period from 1980 to 1990 the number of reported injured and killed people in road accidents in Norway increased from 10 601 in 1980 to 12 218 in the year 1990 – 15.2% increase in ten years. Injured and killed in rear-end- accidents, however, increased in the same period from 410 victims in 1980 to 1563 in 1990 – 281% increase. (Statistisk Sentral- byrå) The insurance companies in Norway have no reliable statistics over personal injuries for the same period. From the year 1991 the major insurance companies began a systematic and common registration of casualties in road traffic. Statistics from Gjensidige over traffic casualties injured in 1991 shows that 46% of the victims suffer from a whiplash injury. A limited study covering accidents occurred in 1983 and reported to Gjensidige gives indica- tion that only 5% of the victims suffer from a whiplash-injury this year. (Fjeldberg, 1991) Rear-end-accidents The major cause to whiplash injuries is rear- end-accidents (Kremer, T.Th & vd Kwaak, D. 1996). In table 1 rear-end-accidents re- ported to the police and to Gjensidige for the years 1989 to 1997 are presented. The percentage of the accidents that are rear-end-accidents depends of type of source to data – reported to the police or to the insurance company – and the severity of the accident. Of all accidents reported to the insurance company, rear-end-accidents rep- resent about 20 percent. For accidents with casualties, however, rear-end-accidents re- present 40 percent of the reported accidents. For accidents with casualties reported to the police, only 13-14% are rear-end-acci- dents in the nineties. Fatalities in rear-end- accidents are rare and represent only 1-2% of all fatal accidents. Rear-end-accidents with damage All accidents reported to Gjensidige – of which 95% are with propriety damage only – and fatal accidents, are almost independent of the definition of an injury or the public pro- pensity to report injuries to the insurance company and/or to the police. Public aware- ness about the whiplash-syndrome may very well influence the tendency to report the incidence as an accident with injury. From table 1 and figure 1 apparently the proportion of rear-end-accidents with dam- age only, have decreased during the last ten years. It has decreased steadily from 22.8% in 1989 to 17.6% in 1998. Rear-end-accidents with injuries In the same period the problems related to Source and severity 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 Gjensidige - 22.8 22.0 20.3 19.1 18.7 17.4 18.2 18.1 17.9 17.6 all accidents Gjensidige - 35.5 40.0 41.6 42.7 40.3 38.8 42.3 42.2 38.1 with injuries Police reported - 11.0 12.8 13.7 15.0 13.5 13.1 14.0 13.8 13.6 injuries Police reported - 1.8 1.4 1.0 3.0 0.8 0.4 3.7 0.9 1.5 fatal Table 1: Rear-end-accidents in Norway 1989-1998. Percent of all reported accidents. 299 driving too close, rear-end-accidents and whiplash injuries caused by road accidents were heavily emphasized in Norway, as men- tioned above. Public campaigns, increasing police enforcement of driving too close in traffic and publicity in the press obviously have some impact on this type of accident. On the other side this publicity may consequent- ly motivate the public and the police to report minor whiplash injury previously not reported. As stated above the number of injured in rear-end-accidents reported to the police in- creased by 281% from 1980 to 1990. From table1and figure 2, showing rear-end-acci- dents as a share of all accidents, we can see that this share increased year by year to 1992. The same pattern we can see for statistics of rear-end-accidents with injuries reported to Gjensidige with an “all time high” in 1992. Slight improvement from 1993? From the year 1993 we can observe a slight decrease, or at least a stabilized development, in rear-end-accidents with injuries reported to Gjensidige and/or to the Police. This evi- dence appears in table 1 and figure 1 and 2. As pointed out earlier, rear-end-accidents with damage only have decreased at least from the year 1989 and in all following years - with one exemption. A reasonable assumption is that after the year 1992 the rear-end-accidents with injury to people follow the general trend of rear-end-accidents with damage only. Whiplash injuries and neck injuries at Gjensidige The registration of various data about per- sons injured is often delayed until the case is 22,8 22 20,3 19,1 18,7 17,4 18,2 18,1 17,9 17,6 35,5 40 41,6 42,7 40,3 38,8 42,3 42,2 38,1 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 All accidents Injury accidents 11 12,8 13,7 15 13,5 13,1 14 13,8 13,6 1,8 1,4 1 3 0,8 0,4 3,7 0,9 1,5 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 Injury accidents Fatal accidents Figure 1: Rear-end-accidents reported to Gjensidige Figure 2: Rear-end-accidents reported to the police Percent rear-end accidents Percent rear-end accidents 300 settled. From the time the accident occurs to the case is settled often many years elapses. Especially for whiplash injuries this time is very long. An analysis based on data from the last year consequently is not reliable. In table 2 data form 1991 to 1996 is presented. How- ever, in the last years in this period the data is more unreliable than data from the first years. The most reliable data is based on settled cases, and data in table 2 include settled cases only. The claim adjusters register the diagno- sis and injured body region as well. Whiplash injuries normally correspond to neck inju- ries. The quality of code setting of injured body region is considered to be of higher quality than the code setting of the diagnosis. This judgement is based on how many cases are lacking data or indicated as “Unknown”. For this reasons “Neck injuries” are used as a substitute for whiplash injuries in table 2. Minor injuries are generally not included in this statistics du to missing registration of diagnosis and injured body region. Most of the whiplash injuries with major compensations cost occurred in the end of this period are not settled and consequently not included in the data in table 2. This evidence may explain the relative reduction in compensation to victims with neck injuries after 1994. This figure suggests that up to 60% of injured road traffic victims registered at Gjen- sidige in 1992 suffer form neck injuries. There are some indications that the proportion of neck injuries are slightly improving in recent years. Summary Whiplash injuries reported to the insurance companies in Norway increased during the eighties and culminated about 1992. More than 50% of the injured road traffic victims suffer from whiplash injuries in the beginning of the nineties. There are some indications of slight improvement in recent years. Rear-end-accidents with injuries reported to the police and the insurance companies as well display the same pattern. However, rear- end-accidents with injuries are far more fre- quent reported to the insurance companies compared to the records from the police. For rear-end-accidents with damage only we have the reverse pattern. From 1989 to 1998 rear-end-accidents are reduced from 22.8% to only 17.6% of all accidents. References Bastiaans, J (1989). Psykiatriske og psykosomatiske as- pekter ang. whiplash-skader. Norwegian translation of paper presented at Nederlandse Stichting Whiplash Pasienten. 21. sept. 1989. Bø, O. (1972). Road Casualties. An Epidemiological In- vestigation. Universitetsforlaget, Oslo Braunstein, P.W & More, J. O (1959). The Fallacy of the Term “Whiplash” Injury. Amer. Surg. 97: 522-529. Bäckstrøm, C-G. (1963). Traffic Injuries in South Sweden with special reference to Mediocolegal Autopsies of Car Occupants and Value of Safety Belts. Acta Chir. Scand., Suppl.308. Fjeldberg, K. (1991). Private communication. Gjensidige. Kremer, F. Th. & vd Kwaak, D. (1996). The Phenomenon of Whiplash and the Compulsory Third Party Liability Insurance; An Interim Report. Verzekeringsarchief, Nederland. Statistisk Sentralbyrå (Yearly): Road Traffic Accidents 19..., Oslo Table 2: Neck injuries and compensation to victims recorded at Gjensidige 1991-1996. Percent of all injured persons in road traffic, settled by March 1999. 1991 1992 1993 1994 1995 1996 Number of casualties with neck injuries 59.3 60.8 53.4 48.1 50.5 52.4 Compensation to victims with neck injuries 59.9 53.9 52.6 44.9 32.5 31.7