Is The Self-Reported History Accurate in Patients
With Persistent Axial Pain After a Motor Vehicle Accident?
Don and Carragee
Department of Orthopedic Surgery,
Stanford University School of Medicine;
The Spine Journal January 2009 #1 pages 1-12

The authors report that the validity of the patients self-reported history when presenting with persistent axial pain after a motor vehicle accident appears poor in a large multi clinic random sample.   The self-reported rates of alcohol abuse, illicit drug use and psychological diagnoses as well as prior axial pain were significantly lower than seen in the medical records, especially in those who perceive that the motor vehicle accident was another person’s fault.  The failure to recognize as under-reporting may seriously compromise clinical care, public health efforts that injury prevention, and research protocols dependent on accurate pre-accident morbidity assessment.  The authors state that the self-reported clinical history in patients after trauma has generally been expected to yield valuable and reliable information.  Certain elements of the history can dictate probable diagnoses, need for further investigation, treatment and prognosis.  This is especially true in the case of persistent neck or back pain where a past history of axial pain is a strong predictor of poor outcomes.  Similarly, depression and other comorbidities have also been associated with future axial pain episodes, pain severity and prolonged illness.  They state that the validity of a patient’s history after a motor vehicle accident has in general assumed to be accurate.  They state that nonetheless, serious traffic accidents in the setting of existing emotional distress, depression, or substance abuse, may be critical events following identification of persons at risk for future events and perhaps allow the opportunity for intervention to prevent more serious injury or death.  A previous history of these factors is clearly associated with future serious motor vehicle accident injuries, including an increased risk of future motor vehicle related spinal cord injury or death.   The authors stated that they studied 100 subjects in which there was a limited audit of medical records to establish the validity of their self-reported prior history of axial back and neck pain after a motor vehicle accident, as well as certain at-risk comorbidities associated with axial pain (depression, drug abuse, alcoholism and psychological distress).  In that study, approximately 70% of the patients denied comorbid conditions in their post-accident history that were found to be previously documented in their records.