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PubMed2003

Classification, staging and prognosis of lung cancer.

Lung cancer has increased in incidence throughout the twentieth century and is now the most common cancer in the Western World. It has a poor prognosis, only 10-15% of patients survive 5 years or longer. Outcome is dependent on clinical stage and cancer cell type. Lung cancer is broadly subclassified on the basis of histological features into squamous cell carcinoma, adenocarcinoma, large cell carcinoma and small cell carcinoma. The histopathological type of lung cancer correlates with tumour behaviour and prognosis. Staging based on prognosis is essential in clinical trials comparing different management strategies, and enables universal communication regarding the efficacy of different treatments in specific patient groups. The anatomic extent of disease determined either preoperatively using imaging supplemented by invasive procedures such as mediastinoscopy, and anterior mediastinotomy or following resection are described according to the T-primary tumour, N-regional lymph nodes, M-distant metastasis classification. The International System for Staging Lung Cancer attempts to group together patients with similar prognosis and treatment options. Various combinations of T, N, and M define different clinical or surgical-pathological stages (IA-IV) characterised by different survival characteristics. Refinements in staging based on imaging findings have enabled clinical staging to more accurately reflect the surgical-pathological stage and therefore more accurately predict prognosis. Recent advances including the use of positron emission tomography in combination with conventional staging promises to increase the accuracy of staging and therefore to reduce the number of invasive staging procedures and inappropriate thoracotomies.

Humans↗
PubMed2001

Long-term prognosis of breast cancer patients with 10 or more positive lymph nodes treated with CMF.

The purpose of this investigation was to study the long-term prognosis of breast cancer patients with 10 or more positive lymph nodes after conventional chemotherapy treatment with cyclophosphamide, methotrexate and 5-fluorouracil (CMF). Between 1984 and 1989, 1048 node-positive patients were treated with CMF in two separate trials conducted by the German Breast Cancer Study Group (GBSG). Subgroups either received radiotherapy or tamoxifen in addition. In this study, long-term prognosis in the subgroup of 141 patients with 10 or more positive lymph nodes was investigated. Univariate and multivariate Cox models were used to evaluate the effect of prognostic factors on event-free survival (EFS) and overall survival (OS). Both univariate and multivariate analyses revealed the progesterone receptor (PR) status as the dominating prognostic factor for both EFS and OS, resulting in a strongly increased risk of more than 2-fold for receptor-negative patients. A large number of positive lymph nodes also affected the prognosis for EFS. In univariate analysis, the degree of lymph node involvement (i.e. percentage of positive nodes out of all examined nodes), oestrogen status (ER) status, and tumour grade also showed significant effects. To conclude, the prognosis in the subgroup of patients with 10 or more positive lymph nodes is heterogeneous. Some surprisingly high survival rates have been observed in case series of breast cancer patients treated with high-dose chemotherapy which may be explained by patient selection. From the usual factors investigated in this study, the PR status showed the strongest effect, and, at least this factor should be taken into account in the design and analysis of trials for breast cancer patients with a poor prognosis.

Adult↗
PubMed2002

Information society in Czech healthcare 'starting point' to prognosis for the year 2013.

A prognosis of how the information society in health care will look like in 2013 must start from the current state of affairs at the given locality regarding healthcare management by public authorities including legislative, ICT technological levels and accessibility of professional knowledge in individual fields of medicine. It is presumed that after 10 years the influence of this 'starting point' will still persist and knowledge of the current state of affairs will be needed to positively but also negatively differentiates the prognosis [Health Care in the Information Society: A Prognosis for the Year 2013, in this issue] for individual localities, e.g. Germany versus neighbouring the Czech Republic. The present article focuses on aims of Czech health care and the measures that are taken in Czech health care that are carried out and which have been already initiated. Their significance towards the future prognosis according to [Health Care in the Information Society: A Prognosis for the Year 2013, in this issue] is clear. The first measure is legalisation of conditions, which allow health care administration only be carried out with electronic forms and the protection of these sensitive personal data when they are placed in a centralised data depository where they are prepared for physicians who use them while providing health care in health institutions. In the Czech Republic an information system is developed called Internet Access to Health Patient Information (IHPI). The second measure is creating a unified central system of health information together with methodologies for data collection, data standards and protocols. In the Czech Republic there is the National Health Information System (NHIS) governed by the Institute for Health Information and Statistics (IHIS CR). The NHIS enables care providers to get information about the health state of citizens, about health institutions, about their activities and economics, it enables to regulate the provision of health care, to define conceptions of state health politics and to administrate public health. The third measure is legalisation of possibilities to establish centralised health care registers that are designated for recording and following of patients with chosen socially serious diseases. These registers help with diagnosis and therapy and reveal consequences of diseases for the patients. It helps to evaluate accessibility and quality of provided health care in the country. An important goal of the use of health care registers and information systems is for educational purposes and as causal expert systems for physicians. The National Health Registers have been introduced to the whole of the Czech Republic; some of them are accessible on-line in a countrywide data network. The last part of the paper focuses on research and education for developing the information society in Czech health care and on co-operation with EU countries in selected projects and initiatives.

Computer Systems↗
PubMed2006

Attitudes toward disease and prognosis disclosure and decision making for terminally ill patients in Japan, based on a nationwide random sampling survey of the general population and medical practitioners.

OBJECTIVE: Employing a nationwide cross-sectional survey, we investigated the Japanese general population's attitudes toward disease and prognosis disclosure and related factors. Furthermore, we investigated Japanese medical practitioners' attitudes toward disease and prognosis disclosure for patients and decision making. METHODS: A nationwide anonymous questionnaire survey was conducted. A total of 5000 individuals were randomly sampled from the general population and 3104 physicians and 6059 nurses were randomly sampled in Japan. RESULTS: Finally, 2422 people from the general population (response rate, 48%), 1577 physicians (51%), and 3361 nurses (56%) returned questionnaires. Among the general population, 73% of participants answered that they "want to know" about their disease and prognosis when in an incurable disease state. Ninety percent desired direct disclosure and 8% disclosure through their family. However, few medical practitioners answered "patient himself" (physician 3%, nurses 4%) as the person whom they would primarily notify about the disease and prognosis when in charge of a patient with an incurable disease. On the other hand, physicians answered "family" most frequently (59%), whereas nurses most commonly responded, "depends on patient's condition" (63%). SIGNIFICANCE OF RESEARCH: Several detailed analyses of factors associated with prognosis disclosure were conducted. Japanese physicians need to carefully communicate with the patients individually about whether direct disclosure or disclosure primarily to the family is preferred.

Adult↗
PubMed1998

The significance of prognosis for a theory of medical practice.

A typical problem of modern medicine results from the gap between scientific knowledge and its application in individual cases. Whereas scientific knowledge is generalized and impersonal information, medical practice takes place under conditions which are singular, individual and irreversible. The paper examines whether prognosis is able to bridge this gap or "hiatus theoreticus". It is shown that diagnosis of a single case always relies on prognostic considerations. The individual prognosis (as distinguished from the nosologic prognosis of a certain disease) enables doctors to apply scientific knowledge and practice according to the actual situation, the history and personal preferences of the patient. Prognosis--not diagnosis--therefore legitimizes medical interference. A methodology of individual prognosis as the basis for a theory of practice is discussed.

Decision Making↗
PubMed1999

The angiotensin-converting enzyme DD gene is associated with poor prognosis in Finnish sarcoidosis patients.

Angiotensin-converting enzyme (ACE) genotypes may reflect prognosis in sarcoidosis. They were determined in 59 Finnish sarcoidosis patients and 70 healthy control subjects. The prognosis of the sarcoidosis patients was determined after follow-up for 1, 2, 3, 5 and >5 yrs and classified as good (normal chest radiograph and lung function, no signs of extrapulmonary disease activity within 2 yrs from diagnosis), intermediate (neither good nor poor) or poor (persisting unstable pulmonary infiltrates, vital capacity and diffusing capacity of the lung for carbon monoxide <50% predicted and/or extrapulmonary disease activity after >5 yrs follow-up). The DD, ID and II genotypes were found in 31 and 27%, in 54 and 49%, and in 15 and 24% of patients and control subjects respectively. The odds ratio (DD+ID to II) was 1.45 (95% confidence interval 0.60-3.49). The D alelle was found more often in patients (58%) and in control subjects (51%) than the I allele but the difference was not statistically significant. Statistically significantly more patients with the DD genotype had a poor prognosis compared with patients with II homozygotes and ID heterozygotes. Among 11 patients with Löfgren's syndrome (bilateral hilar lymphadenopathy and erythema nodosum), four had the DD genotype. Three of these patients had a prognosis despite presenting a clinical picture usually associated with a good prognosis. The angiotensin-converting enzyme genotype may be a prognostic marker in sarcoidosis and larger studies are warranted to define its clinical utility.

Case-Control Studies↗
PubMed1988

In situ hybridisation and S1 mapping show that the presence of infiltrating plasma cells is associated with poor prognosis in breast cancer.

In order to identify potential markers of prognosis in breast cancer, representative cDNA libraries were constructed using RNA isolated from primary breast tumour tissue associated with good and poor prognosis. Cross-screening of these libraries repeatedly identified cloned mRNA species associated with the immune system, in particular B-cells, in libraries derived from tumours of poor prognosis. We have used one of these a kappa IV light chain cDNA probe, in two complementary studies to investigate the relationship between immunoglobin gene expression and prognosis. The results obtained using a combination of S1 mapping, RNA blotting and in situ hybridisation demonstrate that the presence of plasma cells, as defined by infiltrating cells which express high levels of immunoglobulin kappa-chain mRNA, is associated with a poor prognosis.

Adult↗
PubMed1998

Bcl-2 protein expression: association with p53 and prognosis in colorectal cancer.

Bcl-2 expression in colorectal carcinomas was studied in a series of 224 patients and the relation to p53 expression, stage and survival assessed. Bcl-2 expression was down-regulated compared with normal mucosa in 67% (151) of the cases. In 144 cases staining was positive for p53 (MAB DO7), and 41 of these 144 p53-positive cases were also bcl-2 positive (28%) compared with 32 of the remaining 80 p53-negative cases (40%). Survival was significantly worse (P = 0.01) in the p53-positive cases. Bcl-2-positive cases, including patients in all Dukes' stages, had a slightly better prognosis which was not statistically significant. However, cases at an early stage (Dukes' stages A and B) and with negative p53 status, had a much better prognosis if they showed bcl-2 protein expression, suggesting that the bcl-2 status itself has an effect on prognosis (P = 0.01). Neither bcl-2 nor p53 alone was correlated with stage, but when examined by both p53 and bcl-2 status a group [bcl-2(+)/p53(-)] with better prognosis was defined. The last group was significantly lower Dukes' stage, with 26 out of 32 cases (81%) being A or B compared with 22 (11%) of the 202 remaining cases (P = 0.004). Thus, either loss of bcl-2 expression or gain of abnormal p53 expression is associated with high stage and poor prognosis. The bcl-2(+)/p53(-) phenotype is similar to that of normal mucosa, and these results suggest that such cases represent an indolent group at an early stage in the progression of colorectal cancer.

Adult↗
PubMed2005

Good prognosis cytogenetics in B-cell chronic lymphocytic leukemia is associated in vitro with low susceptibility to apoptosis and enhanced immunogenicity.

Chromosomal abnormalities in B-cell chronic lymphocytic leukemia (B-CLL) have been shown to correlate with prognosis. Little is known about the relationship between chromosomal abnormalities and biological behavior of B-CLL cells in vitro. The present study was designed to explore the impact of chromosomal abnormalities determined by interphase fluorescence in situ hybridization (FISH) on the in vitro survival and immunogenicity of B-CLL. Considerable heterogeneity was noted in the in vitro survival and expression of costimulatory, adhesion, and antigen-presenting molecules by B-CLL cells. Spontaneous apoptosis of B-CLL cells in vitro was significantly lower in samples with good prognosis cytogenetics when compared to samples with poor prognosis cytogenetics. In contrast, B-CLL cells from samples with good prognosis cytogenetics exhibited higher basal expression of molecules involved in costimulation, cellular adhesion, and antigen presentation, and induced significantly more T-cell proliferation in mixed lymphocyte cultures. We conclude that chromosomal aberrations of B-CLL cells correlate with the in vitro biological behavior of B-CLL. Our data indicate that good prognosis cytogenetics correlates with less spontaneous apoptosis but greater in vitro immunogenicity. These findings could have significant implications on the design of future therapeutic approaches in patients with CLL, and the likelihood of response based on cytogenetics.

Aged↗
PubMed2006

[Prognosis after complete surgical resection for non-small cell lung cancer based on the staging classification].

BACKGROUND AND OBJECTIVE: The importance of accurate staging according to the international TNM staging system of non-small cell lung cancer (NSCLC) for patient management and ascertaining individual prognosis cannot be overemphasized. The TNM classification is scheduled to be revised in 2007. In a large single-center collective we investigated the prognosis for patients who had complete resection of a NSCLC. PATIENTS AND METHODS: We retrospectively reviewed hospital records and follow-up data of 2,378 patients operated on between 1996 and 2005 for NSCLC. Complete resection was achieved in 2,083 patients. Systematic hilar and mediastinal lymph node dissection was performed concurrently. Probability of survival was then analysed with the Kaplan-Meier method. The significance of differences between subgroups was calculated using the log-rank test. Odds ratios with 95 % confidence intervals (CI) were calculated for each characteristic. The Cox model was used for multivariate analyses. RESULTS: The 5-year survival for patients after complete resection was 50.7 %. The 5-year survival rates for clinical stages were 72 % for stage IA, 59.8 % for stage IB, not defined for stage IIA, 47,8 % for stage IIB, 45 % for stage IIIA, 38.7 % for stage IIIB, and not defined for stage IV. There were significant differences in survival between stages IIIB and IV (p = 0.013). There was a trend towards significance between patients with IA and IB (p = 0.052). However, there was no significant difference between patients with all the other stages. 5-year survival according to pathological stages was: stage IA 68.5 %; stage IB 66.6 %; stage IIA 55.3 %; stage IIB 49.0 %; stage IIIA 35.8 %; stage IIIB 35.4 %; stage IV not defined. Gender, age and type of histology were found by multivariate analysis to be significant independent prognostic factors for survival. CONCLUSIONS: The TNM and stage grouping classification is valid for defining prognosis and prognosis-related criteria in patients with NSCLC. The difference in prognosis between clinical stages IIIB and IV was significant, but not that between all the other related subgroups. Concordance with histological staging demonstrated the quality of existing clinical staging methods and related strategies. Complete surgical resection, age, gender, histology and stage of the disease significantly influenced long-term survival.

Adult↗
PubMed1993

Blood transfusions and prognosis in colorectal cancer.

BACKGROUND: Blood transfusions may adversely affect the prognosis of patients treated surgically for cancer, although definite proof of this adverse effect has not been reported. METHODS: We carried out a randomized trial to investigate whether the prognosis in patients with colorectal cancer would be improved by a program of autologous blood transfusion as compared with the current practice of allogeneic transfusion. Patients in the autologous-transfusion group were required to donate two units of blood before surgery. RESULTS: A total of 475 patients were evaluated. We found no significant difference in prognosis between the allogeneic-transfusion group (236 patients) and the autologous-transfusion group (239 patients); colorectal cancer-specific survival rates at four years were 67 percent and 62 percent, respectively (P = 0.39). Among the 423 patients who underwent curative surgery, 66 percent of those in the allogeneic-transfusion group and 63 percent of those in the autologous-transfusion group had no recurrence of colorectal cancer at four years (P = 0.93). We also found that the risk of recurrence was significantly increased in patients who received blood transfusions, either allogeneic or autologous, as compared with patients who did not require transfusions; the relative rates of recurrence were 2.1 (P = 0.01) and 1.8 (P = 0.04), respectively; these rates did not differ significantly from each other. CONCLUSIONS: The use of autologous blood as compared with allogeneic blood for transfusion does not improve the prognosis in patients with colorectal cancer. Regardless of their type, transfusions are associated with poor prognosis, probably because of the circumstances that necessitate them.

Adult↗
PubMed2006

Presence of activated T lymphocytes in peripheral blood of head and neck squamous cell carcinoma patients predicts impaired prognosis.

CONCLUSIONS: The results indicate that a high level of peripheral blood (PB) T-lymphocyte activation in vivo predicts impaired prognosis with and without adjustment for TNM stage in head and neck squamous cell carcinoma (HNSCC). OBJECTIVE: To determine if PB T-lymphocyte activation in vivo is associated with the presence of, stage of and prognosis of HNSCC. MATERIALS AND METHODS: Sixty-two patients with newly diagnosed HNSCC and 15 control patients were studied. PB T-lymphocyte activation was assessed by measuring by flow cytometry the percentage of PB T lymphocytes (CD3 + ) showing the early activation-related cell surface epitopes CD69+ or CD71+ (transferrin receptor) or the late activation epitopes CD25+ (IL-2 receptor) or HLA-DR+. RESULTS: There was no significant difference in expression of T-lymphocyte activation markers between HNSCC patients and control patients, or any difference dependent on TNMG stage. In HNSCC patients a high percentage of CD71+ T lymphocytes predicted worse prognosis with a relative risk (RR) of 2.38 (confidence interval (CI): 1.04-5.47). A high mean value of the early (CD69 + /CD71 + ) (RR 2.37; CI: 1.06-5.29) or late (CD25 + /HLA-DR + ) (RR 3.31; CI: 1.39-7.88) activation markers also predicted worse prognosis. Following adjustment for TNM stage, high mean value of the early activation epitopes CD71+ (RR 2.89; CI: 1.22-6.85), the mean value of CD69 + /CD71+ (RR 2.58; CI: 1.12-5.91) and CD25 + /HLA-DR+ (RR 2.75; CI: 1.14-6.62) predicted worse prognosis.

Carcinoma, Squamous Cell↗
PubMed1996

A survey of horses with acute diarrhoea: diagnosis, assessment of the prognosis, and comparison of two antibiotic therapies.

Twenty horses, ponies, and foals referred with acute diarrhoea were divided at random into two treatment groups. One group was treated intravenously with trimethoprim/ sulfadiazine and the other group with ampicillin/gentamicin. Both groups were given the same standardized symptomatic therapy. All animals were evaluated clinically and 5 variables (general impression, heart rate, rectal temperature, appetite, and consistency of the faeces) were estimated on a five point scale (0-4). Jugular blood samples were taken at admittance and at regular intervals for routine screening. Three blood variables (packed cell volume, white blood cell count, and base excess) were also classified in a 5-point scale. The 'diarrhoea prognosis index' was the total sum of the eight variables scaled. Faecal samples were cultured aerobically and examined for worm eggs and larvae. A definite diagnosis was only reached in 11 horses (55%). Salmonellosis and parasitic infections were the most common causes of the diarrhoea. Seven horses (35%), three from the ampicillin/gentamicin group and four from the trimethoprim/sulfadiazine group, died or were euthanized because of a poor prognosis. Only the packed cell volume differed significantly between horses that died and horses that survived. No single clinical or haematological/biochemical variable did forecast the prognosis for the individual patient reliably, nor did the 'diarrhoea prognosis index'. The only reliable indication for the outcome of an individual horse appeared to be the clinical response to treatment within 4 days. The clinical outcome of both treatment groups did not differ significantly. In conclusion, it was difficult to reach a specific diagnosis in these horses with diarrhoea. It was not possible to forecast the prognosis of an individual patient by a single variable or by a combination of variables. No significant differences were found between the two antibiotic treatment groups.

Acute Disease↗
PubMed2005

Disclosure of prognosis to terminally ill patients: attitudes and practices among French physicians.

BACKGROUND: Disclosure of the prognosis to terminally ill patients is a strong prerequisite for integrating the physical, psychological, spiritual, and social aspects of end-of-life care. OBJECTIVE: This study aimed to assess French physicians' general attitudes and effective practices (with patients followed up to death recently) toward such disclosure. DESIGN/SUBJECTS: We used data from a cross-sectional survey conducted among a national sample of 917 French general practitioners, oncologists, and neurologists. RESULTS: A majority of respondents opted for prognosis disclosure only at patients' request, very few opted for systematic disclosure without patient's request, and a significant minority opted for systematic concealment. Concerning deceased patients described by respondents, 44.5% of competent patients were informed of prognosis by their physician, 27.3% were informed by someone else, 9.0% refused to be informed, and 19.2% were simply not informed. Concealment was more frequent for older patients, and physicians involved in a nongovernmental organization (NGO) for patients' support were more likely to disclose the prognosis, even without patient's request. CONCLUSIONS: Disclosure of the prognosis to terminally ill patients is still far from systematic in France. Further research is needed to better understand the motivations of French physicians' disclosure practices, which are probably culturally shaped.

Adult↗
PubMed2006

Prognosis assessment in stroke patients at discharge from hospital.

BACKGROUND: accurate prognostic assessments of need of help, health and dwelling situation in stroke patients are important for patient management, rehabilitation, discharge planning, and for providing reliable information to patients and their relatives. OBJECTIVE: to analyse factors affecting the accuracy of discharge prognosis assessments. DESIGN: prospective study of stroke patients discharged from hospital. SETTING: two cities in central Sweden. SUBJECTS: three hundred and ninety stroke patients, 65 years or older, living in their own homes and having no dementia diagnosis prior to hospital admission. METHODS: at discharge, physicians, nurses, occupational therapists and physiotherapists in the Departments of Internal Medicine and Geriatrics were asked to make an individual prognosis assessment regarding patients' need for help, health and dwelling situation at 3 and 12 months after admission to hospital. RESULTS: the prognosis assessments were on average accurate in 68.4% (3 months) and 61.5% (12 months), far better than chance (33.3%). There were no significant differences between staff categories. The accuracy was influenced by a number of patient linked factors, such as activity degree, household situation before admission, and Mini Mental State Examination level and need of help measured 1 week after discharge, and ranged from 22 to 89%, depending on factor combinations. CONCLUSIONS: prognosis assessments based on clinical judgement were on average quite accurate but the accuracy varied markedly with patient linked factors. Feedback of outcome might be one way to further improve the accuracy of prognosis assessment.

Activities of Daily Living↗
PubMed2006

Systematic review: prognosis of angina in primary care.

BACKGROUND: Angina is a common chronic condition, largely managed in primary care in the UK. Mortality data are predominately from population or hospital studies with little known about the prognosis of angina in general practice settings. OBJECTIVE: To describe the prognosis of angina in patients identified in primary care. METHODS DESIGN: Systematic review of cohort studies of angina in primary care. Data sources. Medline, PsycINFO, EMBASE, CINAHL, HMIC, WOS, IBSS, UK National Research Register, notification via JISC, CHAIN. REVIEW METHODS SELECTION CRITERIA: Cohort studies of patients with angina, with >12 months of follow-up, recruited within primary care. VALIDITY ASSESSMENT: Database searches and abstracts were reviewed independently by two authors. Papers were assessed according to criteria derived from the cohort methodological literature. DATA ABSTRACTION: Data were abstracted by two reviewers. DATA SYNTHESIS: Narrative summary. A quantitative synthesis was planned. MAIN OUTCOME MEASURES: Total and cardiovascular death; non-fatal myocardial infarction (MI). RESULTS: Six studies fulfilled our selection criteria. The annual total mortality rate is 2.8-6.6%, an annual cardiovascular death rate of 1.4-6.5% and an annual non-fatal MI rate of 0.3-5.5%. A quantitative synthesis was not possible, because the studies were clinically heterogeneous. CONCLUSIONS: The primary studies have value in determining the prognosis of patients with angina recruited in general practice; however, the studies are old, have small numbers of events and are clinically heterogeneous. The contemporary prognosis of angina in primary care remains a key question, and further research is, therefore, required to estimate the prognosis of angina in this setting and its determinants.

Angina Pectoris↗
PubMed1986

Stratification of prognosis in granulocytopenic patients with hematologic malignancies using the APACHE-II severity of illness score.

The APACHE-II (acute physiology and chronic health evaluation) severity of disease classification system was used to stratify prognosis of granulocytopenic patients with hematologic malignancies. A total of 146 admissions were retrospectively reviewed. In 26 ICU admissions, mortality was 69.2%; in 120 admissions to the ward, mortality was 15.8%. The APACHE-II score successfully stratified prognosis in both ward and ICU settings. Respiratory failure and the presence of pneumonia on chest x-ray were identified as poor prognostic factors. ICU patients admitted for monitoring or postoperative care had a better prognosis than those admitted for severe cardiopulmonary compromise. We suggest that the APACHE-II system is useful for stratifying prognosis for clinical research in this group of patients, although it remains to be shown whether it will be useful in predicting the prognosis of individual patients.

Adolescent↗
PubMed2001

A systematic review of the prognosis of acute whiplash and a new conceptual framework to synthesize the literature.

STUDY DESIGN: Systematic review of prognostic studies of acute whiplash. OBJECTIVES: To update the systematic review on the prognosis of acute whiplash published by the Quebec Task Force on Whiplash-Associated Disorders and to propose a new conceptual framework to conduct systematic reviews on prognosis. SUMMARY OF BACKGROUND DATA: In 1995, the Quebec Task Force published a systematic review of the literature on whiplash and concluded that its prognosis is favorable. However, few prognostic factors were identified. Recent studies have added to this knowledge, and there is a need to update the review conducted by the Quebec Task Force. METHODS: A bibliographic search of four electronic databases was performed to identify prognostic studies of acute whiplash published after 1995. The literature was appraised with standard review criteria. The consistency of evidence across studies was assessed. A conceptual framework was designed to classify the literature according to methodologic quality, target population, and phases of investigation. RESULTS: Thirteen cohort studies were included in the review. The framework used in this study demonstrates that most of the recent prognostic studies are descriptive in nature. The prognosis of acute whiplash varies according to the population sampled and the insurance/compensation system under which individuals are allowed to claim benefits. Besides age, gender, baseline neck pain intensity, baseline headache intensity, and baseline radicular signs and symptoms, there is little consistency in the literature about the prognostic factors for the recovery of whiplash. CONCLUSIONS: Scant knowledge about the prognosis of whiplash has been gained since the release of the Quebec Task Force report. However, it is becoming obvious that the insurance and compensation systems have a large impact on recovery from acute whiplash injuries. The conceptual framework used in this study demonstrates that large cohort studies investigating a wide range of prognostic factors are necessary to improve the understanding of this problem.

Concept Formation↗