Effects of litigation on outcome after traumatic injury: A systematic review

There is a widespread belief that litigation procedures may have a negative association with outcome. This systematic review aims to compare outcomes between people going through compensation procedures following traumatic injury vs those who are not going through compensation procedures following traumatic injury. This is the first systematic review on the subject that includes all types of trauma. A PRISMA methodology was used to assess the association between compensation procedures and outcome following personal injury (excluding medical accidents), including articles published in English between 1st January 1980 and 1st September 2023, using the PubMed and Medline databases. We retrieved the data according to outcome measures and divided the data into 5 categories: overall disability and quality of life, cognitive, psychological, somatic, and social. The results were classified into 3 categories: those that showed a significant negative association between compensation procedures and outcome, those that showed a non-significant trend, and those that did not show a significant difference between compensation procedures and outcome. The quality of the studies was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) scale. From 467 articles initially screened, 27 met the inclusion criteria (total of 5,668 participants). Fifteen articles found a negative association between litigation and outcome, 8 found no significant effect, including 2 suggesting a non-significant trend. Four articles had different results according to the outcome measure. While we expected stronger results in favor of the negative association between compensation procedures and outcome, and despite limitations due to methodological heterogeneity and the lack of valid evidence, we nevertheless found a trend towards poorer outcome on psychological, somatic, disability, and quality of life measures. These results suggest that there is a clinical relevance to considering the unconscious and conscious mechanisms of potential secondary benefits in cases of litigation.