Effect of Depressive Symptoms at Acute Stage on the Course of Disease Progression in Whiplash Patients

OBJECTIVE: To find out the effect of depressive symptoms at acute stage on the course of disease progression in whiplash patients. METHOD: Thirty-eight patients with neck pain after acute whiplash injury were enrolled. The patients were prospectively surveyed within 7 days after whiplash injury and followed up after discharge by telephone interview. Depressive symptoms, self-perceived disability from neck pain, and pain intensity were measured by Center for Epidemiological Studies-Depression Scale (CES-D), neck disability index (NDI), and visual analog scale (VAS), respectively. Depressive group was defined as CES-D scores more than 21. The correlation between duration of total treatment and CES-D score and other variables was investigated by calculating independent t-test, Pearson's correlation coefficient and linear regression analysis. RESULTS: The mean overall score of CES-D was 20.8+/-11.7 and 20 (52.6%) patients were classified as depressive group. Depressive group showed longer duration of total treatment (55.1+/-35.1 vs 38.9+/-16.4, p>0.05) and higher pain intensity after total treatment (37.0+/-21.3 vs 29.4+/-20.1, p>0.05) than non-depressive group, but statistical significance was not sufficient. Duration of total treatment was correlated with NDI score (gamma=0.454, p<0.01) and initial pain intensity (gamma=0.349, p<0.05), but not related with socio-demographic factors - age, gender, marital status - and CES-D score. CONCLUSION: Duration of total treatment was correlated with physical disability and initial pain intensity. Depressive symptoms at acute stage of whiplash injury was correlated with both of them. Depressive symptoms could affect the outcome of whiplash injury indirectly through pain intensity and physical disability.

The Effect of Hyperglycemia at Admission on Clinical Outcomes after Acute Stroke

OBJECTIVE: To clarify the issues about the importance of hyperglycemia in the acute stage of stroke as a poor predictor of clinical outcome, we analyzed the relationship between the glucose level in admission and clinical outcome in the acute stroke patients. METHOD: Twenty-five patients with sudden onset of acute stroke with focal neurological deficit were included in this study. Clinical assessments consisted of the National Institutes of Health Stroke Scale (NIHSS) for neurological impairment and the Korean modified Bathel index (KMBI) for functional status. NIHSS and K-MBI were assessed at admission and at discharge. Plasma glucose level was measured at admission in all patients. Acute hyperglycemia at admission was defined as fasting plasma glucose level more than 140 mg/dl. Statistical analysis were used to compare variables and clinical outcome scores between the normoglycemic and hyperglycemic groups. RESULTS: For the patient with hyperglycemia at admission, the odds ratio for neurological improvement decreased (beta=-0.604) and the odds ratio for functional improvement decreased (beta=-0.553). However, control of the glucose level during the acute stroke was not significantly related to neurological and functional recovery (p>0.05). CONCLUSION: In patients with acute stroke, hyperglycemia at admission was associated with neurological and functional impairments. Therefore, we expect that strict control of hyperglycemia during the acute stroke would improve clinical outcomes.