Personal Injury Claims for Children Suffering Back and Neck Pain following Minor to Moderate Road Traffic Accidents: a Personal View

Over the course of 25 years' experience of providing medico­ legal reports for personal injury claims, I have experienced varying trends of soft tissue injury following accidents of minor to moderate severity. At first it was simply neck pain following rear impact road traffic accidents (RTA's), then back pain became increasingly prevalent. More recently complaints of wrist and shoulder pain and claims for post-traumatic stress and depression appear to be cropping up more regularly than before.

The concept of low velocity impacts causing injury, and the request by medico-legal firms for experts with an understanding of the mysterious "Delta V"* backed by convoluted equations relating to Newton's second and third laws of motion, brought a moment of light relief to a quasi-orthopaedic specialty not known for its scientific exactness. However, of late, I have experienced a worrying trend of children aged 16 years or under appearing for medico-legal consultations for non-specific back and neck pain after RTA's of minor or moderate severity. 

A detailed audit of my medico­ legal instructions between 2005 and 2013 (Table 1) has indicated an increase in claims for such children from 1.4% of all total requests between 2005-2010, including non RTA claims, to 3.3% between 2011-13. These appear small percentages, but in real numbers this equates to seeing nearly 5 per year from 2005-201O to nearly 10 per year from 2011- 2013. In the year 2014, which is not included in the audit, this increase has been sustained. There has been no change in my practice or association with solicitors or medico-legal firms which might have occasioned such a trend, and the number of total claims I have dealt with has dropped by 10% between these two periods of time. The figures comparing the two time periods does not indicate any change in symptom recovery and the delay from accident to report (not to settlement) has shown a slight fall but remains long at 16.8 months in the last three years.

Of course I accept that my findings may not represent what is happening more generally with other medico-legal experts, and statistically there may be many other explanations for the apparent increase, but I do worry that this may be a damaging trend and that claims are being submitted on behalf of children by their parents or litigation friends without fully appreciating the possible negative consequences of the medico-legal process. Clearly children suffering injury are entitled to compensation under the law as much as adults, but I know that for some of my adult patients, their symptoms are difficult to explain and difficult to refute, and I am often left with a feeling that my opinion and prognosis is as imagined as their injuries. Faced with a child too young to even remember the accident, and with many side-long glances to a parent urging recall on their floundering offspring , these feelings are doubled. Many of the very young children take no part at all, except as bemused and disinterested bystanders, with the entire history being given by the parent or guardian, and the examination can feel very uncomfortable at times being little more than an unnecessary physical intrusion on a normal child.

Like many of my colleagues, I worry that the medico-legal process, for which I appreciate I am fully part of, can be damaging to those who may be psycho­ socially vulnerable. With adults I can accept that they are engaging willingly in this process but with children it is different, they are largely passive hostages to usually a very modest financial fortune, for which in return they undergo a lengthy litigation process, including required appearances in front of a judge to ensure a fair outcome. That of course is only very reasonable in the situation of serious physical or psychological injury but one wonders if it is really necessary for a child with minor spinal pain largely forgotten.

Many of the children I have seen are clearly quite resilient and will sit in bemused boredom during the medical examination, but some, and certainly those seen more recently, have clear and severe psychological disturbance almost certainly unrelated to the minor accident, but in whom the injury is depicted as the instigator of their symptoms. In these children the process is harming, deflecting and delaying the child away from appropriate management. Even in those without psychological issues, a lengthy litigation process fosters an attitude which dwells on pain and disability, and obstructs the normal process of healing. I do not believe that parents and guardians, are kno wingly using children as a source of financial gain but I feel that they can get caught up in the unrelenting slow and rolling process of litigation without fully appreciating the hidden dangers.

I am not certain how this matter could be addressed, or indeed if this is a concern shared by my colleagues. Clearly it is incumbent on solicitors, medico-legal agencies and all involved in the legal process to warn the families and litigation friends of prospective young claimants of the risks involved. Perhaps very early settlement with small sums with minimal medical intervention, or fast tracking children through specific experts such as Paediatricians, or the shortening of limitation time to prevent claims being initiated many years after the incident, might make a difference, but all these possibilities have their pitfalls.

For my own part at the end of a report I simply stress the importance of urgency to avoid the possibility of harm to a child that can come from such a litigation process. But it doesn't seem enough.
 

*Delta \I, in this scenario and put very simply, it is the change in velocity of a vehicle at the time of a collision.

Comment from Ian Nelson

Serious spine injuries following road accidents are fortunately uncommon in paediatric spine practice, even in major trauma centres. The vulnerability of immature cervical spine structures makes this surprising. Injury prevention through child car seat design may contribute. Boyd (2002) reported 47% of 105 children involved in road traffic accidents experienced neck pain in an emergency department setting in Australia. A UK study suggested an incidence of 29.5%. The prognosis was favourable. None of the patients reported residual pain after 62 days on direct questioning. Children seem relatively immune to the chronic disability some adults report.

It may be that Mr Summers' paediatric claimants are finally catching up with the perceived rights of their parents! It has been reported that legislative change , with removal of compensation for 'pain and suffering' (Cameron 2008) is associated with an 'improved health status' in the adult populations with neck injuries after road accidents.

The UK Government seems determined reduce the costs associated 'soft tissue injuries' and it will be interesting to see if the observed trend is reversed with recent and future changes introduced by Ministry of Justice. 

Bruce Summers is a Consultant Orthopaedic and Spinal Surgeon at the Princess Royal Hospital in Telford, Shropshire and a Senior Tutor and Lecturer at the University of Keele Medical School. He has been involved in Medico-Legal reporting for over 25 years.

Author: Bruce Summers, Consultant Orthopaedic and Spinal Surgeon

This article was first published in the June 2015 edition of the JTO.