Whiplash Grades 0, 1, 2, 3, and 4 – What Does This Mean?

Whiplash is one of the most common car accident injuries, affecting about one million individuals every year in the United States, according to a report from the Insurance Institute for Highway Safety (IIHS).1 While most injuries occur as the result of rear collisions, whiplash can be caused my any type of accident that involves a distortion, or hyperextension, of the neck or upper spine.

Whiplash typically occurs when the head is snapped abruptly in one direction, causing the vertebrae and surrounding tissues to become strained or injured. Many whiplash injuries do not involve physical contact with the neck and therefore result in little to no visibly apparent superficial damage, such as bruising or abrasions. As a result, the pathophysiology of whiplash injuries, as well as diagnosis and management strategies, has been the subject of some controversy among medical practitioners and insurance companies.

In the late 1980s, the Quebec Automobile Insurance Society reported that whiplash-related claims had reached record levels. To help understand whiplash injuries and ensure they were being correctly and effectively evaluated and treated, the Quebec Task Force on Whiplash Associated Disorders was formed. After years spent gathering data from more than 10,000 studies, the 18-member task force issued a report in 1995 (published in the clinical journal Spine) which has since served as the basis for the evaluation and treatment of whiplash injuries.2 One of the most important aspects of the comprehensive report was the establishment of guidelines for “rating” whiplash injuries. These guidelines divided whiplash injuries into five categories or grades, from 0 to 4.

Today, physicians and other healthcare practitioners use the Quebec Task Force (QTF) grading system as the basis for diagnosis, evaluation and treatment of whiplash-associated injuries. Under the QTF system, whiplash injuries are classified according to the presence and severity of specific symptoms as well as the presence and severity of physical signs, including musculoskeletal and neurologic injuries. The grade levels are as follows (some practitioners use the original system of Roman numerals, 0, I, II, III and IV designated by the 1995 report):3

  • Grade 0: Patient has no neck pain or stiffness; no physical signs are noted upon examination
  • Grade 1: Patient complains of neck pain, stiffness or tenderness; no physical signs are noted upon examination
  • Grade 2: Patient has neck complaints and the medical exam reveals decreased range of motion and tenderness
  • Grade 3: Patient has neck complaints as well as neurological symptoms, including but not limited to decreased deep tendon reflexes, weakness and sensory deficits
  • Grade 4: Patient has neck complaints and medical exam reveals fracture or dislocation, or injury to the spinal cord

Even seemingly minor whiplash-associated injuries can cause deep tissue damage and nerve damage which can be long-lasting, sometimes persisting for years after the initial injury. The QTF guidelines have provided a basis by which medical practitioners are better able to classify patients’ injuries and help determine the type and extent of medical care they will likely need to effectively treat the injuries and resolve accompanying pain and discomfort.

If you suffer a grade 1 to 4 whiplash injury from a car accident and you’re not at fault, you’re entitled to pain and suffering compensation as well as perhaps other heads of damages.

References

1. Insurance Institute for Highway Safety. Q&A: Neck Injury. January 2013. http://www.iihs.org/research/qanda/neck_injury.aspx

2. Spitzer WO, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine. 1995 Apr 15;20(8 Suppl):1S-73S. http://www.ncbi.nlm.nih.gov/pubmed/7604354

3. Ibid.
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