The increasing problem of whiplash-injury in The Netherlands. Paper presented at the Global Strategies Meeting of the Physical Medicine Research Foundation, Vancouver, 9-10 February 1999.

Dutch (police based) accident data show a tremendous increase over the years of the number of rear-end collisions with cars, while the total number of injury accidents has remained more or less at the same level. The increase of traffic, especially regarding cars and vans, without expanding the road network, is thought to be the main contributing factor. Though these accident data imply the existence of an increasing WAD-problem in The Netherlands, they are not sufficient prove, since they contain no injury details, but only some general indication of injury severity. Besides, they are very much incomplete with respect to non-fatal accidents, especially for accidents in the lower injury severity ranges, where the majority of whiplash cases is to be expected. By using existing medical registration systems, such as the national registration system of in-patients, and the registration of casualties treated at emergency departments (A&E) of hospitals, as well as data from periodical national surveys on accidents, WAD related to traffic casualties can be quantified. It is estimated that annually at least 14,000 car occupants suffer from whiplash injury after a car crash. While (police based) accident data lack information about injury, the medical registration systems do not provide sufficient and reliable accident data. The type of collision (for instance: rear-end accident) is not specified, though the mode of transportation of a casualty fortunately is. One could therefore say that the two main registration types (police based accident data, and injury registrations) do still not prove the existence of a causal link between rear-end accidents of cars and whiplash injury of occupants. It is also not clear from the injury data whether the WAD-problem is increasing or not. Preventing the occurrence of whiplash injury could well be the best way to deal with WAD, since both diagnosis and cure of the this type of neck-injury is still a matter of much debate. Head restraint systems are the most obvious means of preventing neck-injury in rear-end accidents, apart of course from preventing rear-end accidents to occur at all, through infrastructural or other means. The proper use of existing head restraints therefore became a matter of concern, especially after periodical surveys indicated that the (vertical) adjustment of the restraint was not good. It was also found that Dutch people are even more at risk than other (European) people since the average height of the Dutch is greater. SWOV calculated that the requirements for vertical height of head restraints in the existing (European) regulations should be upgraded by 10 centimetres (from 75 cm to 85 cm) in order to better protect still only 95% of the Dutch males. This goal is not yet reached, despite considerable efforts of Dutch officials at the international vehicle legislative field. Only limited data on the costs of whiplash injury is available, mainly based on third party vehicle insurance cost data. The annual cost of injury payments only is estimated at about 350 million guilders, which represents about one third of the total injury payments by insurance companies with respect to injury from accidents in The Netherlands. There are many different disciplines involved in research concerning WAD: medical, technical, biomechanical, to mention just a few. Up to now, these research activities in The Netherlands have been mainly uncoordinated isolated efforts to help improve the situation or at least to describe the problem. In view of the great amount of money involved, and in view of the estimated current magnitude of the personal and societal problem of WAD, a more coordinated national effort to counteract WAD seems very appropriate, especially since a further increase of the problem may be expected as road traffic increases. (Author/publisher