Healthcare consultation and sick leave before and after neck injury: a cohort study with matched population-based references

作者：Joud Anna; Stjerna Johanna; Malmstrom Eva Maj; Westergren Hans; Petersson Ingemar F; Englund Martin^*

来源：BMJ Open, 2013, 3(8): e003172.

DOI：10.1136/bmjopen-2013-003172

Objectives: Recent studies based on self-assessed data on exposure and outcome suggest a negative association between poor health before neck injury and recovery. Our aim was to study actual healthcare consultation and work disability before and after neck injury (whiplash). %26lt;br%26gt;Design: Cohort study with matched references studied prospectively and retrospectively via regional and national held registers. %26lt;br%26gt;Setting: Population-based study in Region Skane, Sweden (population=1.21 million) including all levels of healthcare. %26lt;br%26gt;Participants: 1443 participants aged %26gt;= 18 (54% women) with acute neck injury, Whiplash, (International Classification of Diseases-10-SE code S13.4*) in 2007 or 2008 and no such diagnosis since 1998. Each patient with a neck injury was assigned four randomly selected population references matched for age, sex and area of residence (97% of the patients and 94% of the references were followed during the whole study period). %26lt;br%26gt;Primary and secondary outcome measures: We studied changes in healthcare consultations 3 years before to 3 years after diagnosis as well as sick leave episodes. Analyses were also stratified by preinjury frequency of consultation. %26lt;br%26gt;Results: Before the injury, the mean number of total consultations over 36 months among the neck injured (n=1443) and references (n=5772) was 9.3 vs 7.2 (p%26lt;0.0001) and postneck injury 12.7 vs 7.8 (p%26lt;0.0001). In the group of high-frequent consulters, there were more women compared with frequent and low-frequent consulters (70.6% vs 32.8%; p%26lt;0.0001). Among low-frequent and frequent consulters preinjury (n=967, 67% of the cohort), 16% became high-frequent consulters attributable to the injury. The number of days of sick leave preinjury was correlated with the number of preinjury and postinjury consultations (r=0.47 (99% CI 0.38 to 0.49), r=0.32 (99% CI 0.25 to 0.37)). %26lt;br%26gt;Conclusions: People with a neck injury constitute a heterogeneous group. The preinjury level of healthcare consultation is associated with the postinjury level of consultation.

• 出版日期2013