After a car accident, it’s common for patients to ask “How Bad is My Car Accident Injury?”
You might be surprised how the “severity” of or “how bad” your injury is determined. Most people believe it has to do with:
- How much vehicle damage there is
- How fast the vehicles were traveling
- How much pain you are in
- Whether or not you take an ambulance ride to a hospital
- Whether or not you miss any work
- Many other incorrect reasons
How to Determine Car Accident Injury Severity:
Rather than subjective information like the above or from a doctor merely giving an educated guess, true car accident injury specialists such as myself use “professional practice guidelines” or “guides.” Guides are a set of rules for doctors that have been established through scientific research to tell them how to practice. Guides tell a doctor objectively, what the items are that lead to a specific diagnosis. Guides can also give doctors direction on what types of treatment are most beneficial for certain conditions.
To determine the severity of specifically a car accident injury, the most well known and scientifically proven set of guidelines are the “Croft Guidelines.”
The guidelines were published by Arthur Croft, D.C., M.S., M.P.H., F.A.C.O., F.A.C.F.E an internationally known doctor and researcher in the spinal trauma field in 1993. These guides were published in his book, “Whiplash Injuries: The Cervical Acceleration/Deceleration Syndrome,” second edition and have been adopted by many state boards of Chiropractic in the US and Canada. There are other guides used in the profession, but most of them borrow heavily form Croft, therefore the original source is best to use.
Within the Croft Guidelines injury severities are determined by objective findings at the time of the initial examination. It is crucial your treating doctor understand how to do a proper and thorough examination of a car accident whiplash injury since failure to recognize some features of an injury could result in the improper severity, which you will see later, leads to incorrect frequency and duration of treatment and overall prognosis. This is just one among many reasons why auto accident victims need to be evaluated by a true car accident injury specialist and not just any doctor.
Looking at the Croft Guidelines we can see there are five injury grades (severities): Grade I through V. The examination findings are clearly stated on what constitutes a given grade or severity. The most common Grades are II and III. Many Grade I’s do not feel enough pain to see a doctor. This is why using guidelines rather than subjective pain is a better method. Grade V’s are rarely seen in private practices in the initial onset, because they are usually triaged at a hospital and undergo surgery. Chiropractors and other therapists may work with them post-surgically. Grade IV’s are not uncommon in a chiropractor’s or other private practitioner’s office, but not as commonly as II and III. It is imperative the treating doctor can recognize a Grade IV and team treat with orthopedists and/or neurosurgeons since these patients usually suffer from disc herniations, nerve injury or ligament instability that may require surgery.
Common Mistakes in Applying the Croft Guides for Injury Severity
Because most doctors treating car accident injuries are not actual specialists in the field, they do not know how to tell which grade to apply because they do not know how to document things like ligament injury and/or ligament instability so they may not be able to decide between a Grade II and Grade III. When your doctor takes a look at your x-rays (ALL accident cases require x-rays of the spine, period) and you see your neck curve is decreased, flat or reversed, that is a sign of ligament injury. The ligaments running up and down the inside of your spine keeps the proper tension that makes your neck curve properly. This is just one example of how a specialist can do a proper exam and apply the findings to the guides for a well documented severity of injury.
Injury Severity Grading is Important in Car Accident Whiplash Cases
Everything in a personal injury whiplash case flows from the severity grading. Once your doctor knows the severity, he or she will know what treatment types are best, what imaging studies to refer you for, what other specialists need to be consulted, etc. The Croft Guides also tells the doctor what frequency and duration of treatment is typical. Your long-term outlook for recovery (prognosis) is also determined by the grade of your injury.
Remember, these are guides and some patient’s heal faster or slower than others and there are complicating factors that can extend care, but in general, the guides give you, your doctor, your lawyer and the insurance company some notice of what to expect treatment wise.
Of course that is only IF your doctor is aware of these guidelines and knows how to use them. My guess is about 25-30% of chiropractors are aware of the Croft Guides and about 10% actually use them regularly. I would estimate that less than 10% of any medical specialists know of or use these guides. And sadly, maybe 20% of lawyers know of them and less than 10% of the doctors they work with use them. The numbers of doctors who are actually true whiplash specialists are very few. Many doctors treat car collision injuries, but very, very few have actual post-graduate specialty training in this field.
Objective Evidence of Injuries to Prove Your Case and Improve Your Treatment
Rather than just guessing or putting all patients through the same old cookie cutter process, specialists in car accident injuries use professional guidelines to make key decisions about your injuries and treatment. Injury severity is an important first step in the process of documenting your injury that leads to decisions on what type of treatments are needed and the frequency and duration of care.