The relationship between clinical and kinematic responses from human subject testing in rear-end automobile collisions

Recent experiments have produced a linked data set of clinical and kinematic responses for human subjects exposed to controlled low-speed rear-end collisions. The purpose of this paper was to examine this paired data set and determine whether the presence or absence of clinical symptoms could be predicted from the peak linear and angular kinematic response of the head and neck. The data were generated using 42 male and female human subjects seated normally in the front passenger seat of a stationary vehicle struck from behind to produce vehicle speed changes of 4 and 8 km/h. Pre- and post-test clinical examinations documented the presence, severity and duration of whiplash-associated disorders (WAD). Logistic regression and backward elimination of independent variables were used to develop the prediction model. The analysis yielded a 16 parameter model that was significantly related (odds ratio = 21.2; P = 0.0069) to the presence or absence of transient whiplash symptoms. The model correctly predicted symptom presence in 13 of 23 tests (sensitivity 57%) and symptom absence in 49 of 52 tests (specificity 94%) in a population of 75 with a symptom prevalence of 31%. The model's positive predictive value was 81% and its negative predictive value was 83%. Despite statistical significance, the model did not discriminate between the presence and absence of symptoms in all tests, and indicated that factors other than the selected peak kinematic responses influenced symptom production. (C) 2000 Elsevier Science Ltd. All rights reserved.