The potential and perils of prognosticating persistent post-traumatic problems from a postpositivist perspective.

BACKGROUND CONTEXT: Predicting recovery after traumatic neck pain has become an active area of research but is moving in several different directions with currently little consensus on the important outcomes to predict or relevant variables to predict them.

PURPOSE: This editorial explores the current state of prognostic (risk)-based tools or algorithms for predicting the likelihood of chronic problems after acute axial trauma, with a focus on traumatic neck pain (ie, whiplash-associated disorder).

STUDY DESIGN/

SETTING

This paper has an editorial study design.

METHOD: This is a narrative commentary.

RESULTS

Prognostic efforts have value in guiding clinical decision-making and optimizing resource allocation to those at highest risk while minimizing iatrogenic disability for those at lower risk, but there are also several important caveats that should be observed when applying and interpreting the results of such tools. These include the biases associated with predicting outcomes based on findings from a single administration of a tool, inappropriate assumptions of causality, assumptions of linear relationships, and inability to consider the unique individual traits and contexts of patients that likely interact with clinical variables to influence the actual degree of risk they impart.

CONCLUSIONS

The paper concludes with a brief overview of trends that are likely to dramatically change the field, including creation of large clinical databases and big data analytics.