What criteria should I use to determine if a patient with whiplash requires referral to a specialist?

Criteria for referral of a patient with whiplash to a specialist include:

• Presence of high-risk factors for cervical spine injury such as age 65 or over, dangerous mechanism of injury (e.g., high-speed motor vehicle collision, fall from height), focal neurological deficits, or paraesthesia in limbs, which warrant urgent imaging and specialist assessment ¹.
• Inability to safely assess neck range of movement due to pain or other factors, or inability to actively rotate the neck 45 degrees left and right, indicating possible serious injury requiring specialist input ¹.
• Neurological abnormalities such as motor weakness, altered or absent sensation in hands or feet, or signs suggestive of spinal cord injury, which necessitate urgent referral to neurosurgical or spinal specialists ².
• Persistent or worsening neck pain or tenderness beyond the expected recovery period, or delayed onset of symptoms that raise suspicion of cervical spine injury ¹.
• Failure to improve with initial conservative management or presence of complications such as post-concussion syndrome, which may require specialist follow-up ¹.

Referral should be made urgently if any of these criteria are met to ensure timely imaging, diagnosis, and management by appropriate specialists ¹,².