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Lee HD, Jung K, Kang B, Chung NS, Jeon CH, Chung HW. Impact of spinal injury on mortality in patients with major trauma: A propensity-matched cohort study. Medicine (Baltimore) 2023; 102:e34090. [PMID: 37352041 PMCID: PMC10289597 DOI: 10.1097/md.0000000000034090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/15/2023] [Accepted: 06/02/2023] [Indexed: 06/25/2023] Open
Abstract
Major trauma is defined as a significant injury or injury that has the potential to be life-threatening and is quantitatively identified as an injury severity score (ISS) >15. Spinal injuries are common in patients with major trauma; however, because spinal injury is not independently included in the ISS calculation, the impact of spinal injury on mortality in patients with major trauma has not been fully elucidated. The purpose of this study is to identify the association between spinal injury and mortality in patients with major trauma. From January 1, 2016, to December 31, 2020, retrospective analysis was conducted on 2893 major trauma adult patients admitted to a level 1 trauma center. There were 781 patients in the spinal injury group and 2112 patients in the group without spinal injury. After matching the 2 groups 1:1, we compared injury mechanism, mortality, cause of death, intensive care unit length of stay (ICU LOS), and duration of ventilator use between spinal injury group and matched cohorts. Falls and traffic accidents were the most common injury mechanisms in the spinal injury group and the matched cohort, respectively. The mortality was significantly lower in the spinal injury group compared with the matched cohort (4.0% vs 7.9%, P = .001), and the ICU LOS was longer than the matched cohort (8.8 ± 17.4 days vs 7.2 ± 11.7 days, P = .028). In the spinal injury group, multiple organ failure (MOF) was the most common cause of death (41.9%), while that in the matched cohort was central nervous system (CNS) damage (61.3%). In patients with major trauma, spinal injury may act as a shock absorber for internal organs, which is thought to lower the mortality rate.
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Affiliation(s)
- Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - KyoungWon Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - ByungHee Kang
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chang-Hoon Jeon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hee-Woong Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
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van Wessem KJP, Niemeyer MJS, Leenen LPH. Polytrauma patients with severe cervical spine injuries are different than with severe TBI despite similar AIS scores. Sci Rep 2022; 12:21538. [PMID: 36513675 PMCID: PMC9747955 DOI: 10.1038/s41598-022-25809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
Traumatic cervical spine injuries (TCSI) are rare injuries. With increasing age the incidence of TCSI is on the rise. TCSI and traumatic brain injury (TBI) are often associated. Both TCSI and TBI are allocated to the Abbreviated Injury Scale (AIS) head region. However, the nature and outcome of these injuries are potentially different. Therefore, the aim of this study was to investigate the epidemiology, demographics and outcome of severely injured patients with severe TCSI, and compare them with polytrauma patients with severe TBI in the strict sense. Consecutive polytrauma patients aged ≥ 15 years with AIShead ≥ 3 who were admitted to a level-1 trauma center Intensive Care Unit (ICU) from 2013 to 2021 were included. Demographics, treatment, and outcome parameters were analyzed for patients who had AIShead ≥ 3 based on TCSI and compared to patients with AIShead ≥ 3 based on proper TBI. Data on follow-up were collected for TCSI patients. Two hundred eighty-four polytrauma patients (68% male, Injury Severity Score (ISS) 33) with AIShead ≥ 3 were included; Thirty-one patients (11%) had AIShead ≥ 3 based on TCSI whereas 253 (89%) had AIShead ≥ 3 based on TBI. TCSI patients had lower systolic blood pressure in the Emergency Department (ED) and stayed longer in ICU than TBI patients. There was no difference in morbidity and mortality rates. TCSI patients died due to high cervical spine injuries or respiratory insufficiency, whereas TBI patients died primarily due to TBI. TCSI was mainly located at C2, and 58% had associated spinal cord injury. Median follow-up time was 22 months. Twenty-two percent had improvement of the spinal cord injury, and 10% died during follow-up. In this study the incidence of severe TCSI in polytrauma was much lower than TBI. Cause of death in TCSI was different compared to TBI demonstrating that AIShead based on TCSI is a different entity than based on TBI. In order to avoid data misinterpretation injuries to the cervical spine should be distinguished from TBI in morbidity and mortality analysis.
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Affiliation(s)
- Karlijn J. P. van Wessem
- grid.7692.a0000000090126352Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands ,grid.7692.a0000000090126352Department of Trauma Surgery, University Medical Center Utrecht, Suite G04.232, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Menco J. S. Niemeyer
- grid.7692.a0000000090126352Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luke P. H. Leenen
- grid.7692.a0000000090126352Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Spine trauma: Radiological approach and new concepts. Skeletal Radiol 2021; 50:1065-1079. [PMID: 33165712 DOI: 10.1007/s00256-020-03668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
The spine is the main stabilizer and load bearer of the axial skeleton. It is also important for the protection of neural structures, such as the spinal cord, nerve roots, and cauda equina. In the healthy skeleton, most injuries are a consequence of high-energy trauma and can lead to severe dysfunction, such as tetraplegia or paraplegia. In order to avoid such disabilities, it is important to recognize details that will guide treatment, and that will determine the necessity or not to have surgery. Familiarity with radiography, CT, and MRI in evaluating spine trauma is necessary, as, in some cases, all three methods will be useful in determining management and surgical planning. The most important factor in determining management in the thoracolumbar spine is the posterior ligamentous complex (PLC). Therefore, familiarity with its anatomy, primary and secondary signs of its injuries, is essential for radiologists in the emergency setting. Spine fractures are a very heterogeneous group of disorders. Management can be both conservative and surgical. It is important for radiologists to be aware of classifications and patterns for these injuries.
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Mugesh Kanna R, Prasad Shetty A, Rajasekaran S. Timing of intervention for spinal injury in patients with polytrauma. J Clin Orthop Trauma 2021; 12:96-100. [PMID: 33716434 PMCID: PMC7920207 DOI: 10.1016/j.jcot.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The optimal timing of surgical intervention of spinal fractures in patients with polytrauma is still controversial. In the setting of trauma to multiple organ systems, an inappropriately timed definitive spine surgery can lead to increased incidence of pulmonary complications, hemodynamic instability and potentially death, while delayed surgical stabilisation has its attendant problems of prolonged recumbency including deep vein thrombosis, organ-sp ecific infection and pressure sores. METHODS A narrative review focussed at the epidemiology, demographics and principles of surgery for spinal trauma in poly-traumatised patients was performed. Pubmed search (1995-2020) based on the keywords - polytrauma OR multiple trauma AND spine fracture AND timing, present in "All the fields" of the search tab, was performed. Among 48 articles retrieved, 23 articles specific to the management of spinal fracture in polytrauma patients were reviewed. RESULTS Spine trauma is noted in up to 30% of polytrauma patients. Unstable spinal fractures with or without spinal cord injury in polytrauma require surgical intervention and are treated based on the following principles - stabilizing the injured spine during resuscitation, acute management of life-and limb-threatening organ injuries, "damage control" internal stabilisation of unstable spinal injuries during the early acute phase and, definitive surgery at an appropriate window of opportunity. Early spine fracture fixation, especially in the setting of chest injury, reduces morbidity of pulmonary complications and duration of hospital stay. CONCLUSION Recognition and stabilisation of spinal fractures during resuscitation of polytrauma is important. Early posterior spinal fixation of unstable fractures, described as damage control spine surgery, is preferred while a delayed definitive 360° decompression is performed once the systemic milieu is optimal, if mandated for biomechanical and neurological indications.
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Affiliation(s)
- Rishi Mugesh Kanna
- Corresponding author. Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
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Chang SW, Choi KK, Kim OH, Kim M, Lee GJ. Part 4. Clinical Practice Guideline for Surveillance and Imaging Studies of Trauma Patients in the Trauma Bay from the Korean Society of Traumatology. JOURNAL OF TRAUMA AND INJURY 2020. [DOI: 10.20408/jti.2020.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Sandean D. Management of acute spinal cord injury: A summary of the evidence pertaining to the acute management, operative and non-operative management. World J Orthop 2020; 11:573-583. [PMID: 33362993 PMCID: PMC7745491 DOI: 10.5312/wjo.v11.i12.573] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity. Over half a million people suffer from traumatic spinal cord injury annually with the majority resulting from road traffic accidents or falls. The Individual, societal and economic costs are enormous. Initial recognition and treatment of acute traumatic spinal cord injury are crucial to limit secondary injury to the spinal cord and to provide patients with the best chance of some functional recovery. This article is an overview of the management of the acute traumatic spinal cord injury patient presenting to the emergency department. We review the initial assessment, criteria for imaging and clearing the spine, and evaluate the literature to determine the optimum timing of surgery and the role of non-surgical treatment in patients presenting with acute spinal cord injury.
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Affiliation(s)
- Darren Sandean
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, United Kingdom
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Penetrating Spinal Cord Injury in civilians: analysis of a national database. World Neurosurg 2020; 146:e985-e992. [PMID: 33220486 DOI: 10.1016/j.wneu.2020.11.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spinal trauma is common in polytrauma; spinal cord injury (SCI) is present in a subset of these patients. Penetrating SCI has been studied in the military; however, civilian SCI is less studied. Civilian injury pathophysiology varies given the generally lower velocity of the projectiles. We sought to investigate civilian penetrating SCI in the United States. METHODS We queried the National Inpatient Sample for data regarding penetrating spinal cord injury from the past 10 years (2006-2015). The National Inpatient Sample includes data of 20% of discharged patients from U.S. hospitals. We analyzed trends of penetrating SCI regarding its diagnosis, demographics, surgical management, length of stay, and hospital costs. RESULTS In the past 10 years the incidence of penetrating SCI in all SCI patients has remained stable with a mean of 5.5% (range 4.3%-6.6%). Of the patients with penetrating SCI, only 17% of them underwent a surgical procedure, compared with 55% for nonpenetrating SCI. Patients with penetrating SCI had a longer length of stay (average 23 days) compared with nonpenetrating SCI (15 days). Hospital charges were higher for penetrating SCI: $230,186 compared with $192,022 for closed SCI. Males patients were more affected by penetrating SCI, as well as black and Hispanic populations compared with whites. CONCLUSIONS Penetrating SCI represents 5.5% of all SCI patients. Men, blacks, and Hispanics are disproportionally more affected by penetrating SCI. Patients with penetrating SCI have fewer surgical interventions, but their overall length of stay and hospital costs are greater compared with nonpenetrating SCI.
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Prevalence of concomitant traumatic cranio-spinal injury: a systematic review and meta-analysis. Neurosurg Rev 2018; 43:69-77. [PMID: 29882173 PMCID: PMC7010651 DOI: 10.1007/s10143-018-0988-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/12/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022]
Abstract
The biomechanical relationship between cranial and spinal structures makes concomitant injury likely. Concomitant cranio-spinal injuries are important to consider following trauma due to the serious consequences of a missed injury. The objective of this review was to estimate the prevalence of concomitant cranio-spinal injury in the adult trauma population. A systematic search of MEDLINE and EMBASE databases to identify observational studies reporting the prevalence of concomitant cranio-spinal injury in the general adult trauma population was conducted on 21 March 2017. The prevalence of concomitant cervical spinal injury in patients with a traumatic brain injury (TBI); the prevalence of concomitant spinal injury in patients with a TBI; the prevalence of concomitant TBI in patients with a cervical spinal injury; and the prevalence of concomitant TBI in patients with a spinal injury were calculated by meta-analysis. Twenty-one studies met the inclusion criteria and were included in this review. The prevalence of concomitant cervical spinal injury in patients with a TBI was found to be 6.5% (95% CI 6.0-7.1%); the prevalence of concomitant spinal injury in patients with a TBI to be 12.4-12.5%; the prevalence of concomitant TBI in patients with a cervical spinal injury to be 40.4% (95% CI 33.0-48.0%); and the prevalence of concomitant TBI in patients with a spinal injury to be 32.5% (95% CI 10.8-59.3%). This review reports the prevalence of concomitant cranio-spinal injury and highlights the importance of considering concomitant injury in patients with a cranial or spinal traumatic injury.
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Castillejos MÁC, Cadena JLR, Romero RMSV, Rodriguez EB, Luna LM, Zetina CC. FREQUENCY OF VERTEBRAL FRACTURES IN HIGH-ENERGY TRAUMA. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181702189443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
ABSTRACT Objective: Traumatic injuries due to accidents are the leading causes of death and disability in the population of young adults in many countries. Spinal fractures are among the multiple injuries by traumatic mechanisms. The incidence of these injuries is estimated between 8,000 and 16,000 new cases per year and are associated with high-energy trauma. Methods: Retrospective, cross-sectional, descriptive study conducted at the Hospital Central Cruz Roja Mexicana. We reviewed 68 medical records of patients admitted to the emergency department of that hospital and were diagnosed with some type of traumatic vertebral fracture associated with high-energy trauma. Results: The sample consisted of 53 men and 15 women, of whom 11 patients with cervical spine injury, 2 with cervicothoracic injury, 16 with thoracic injury, five with thoracolumbar fracture and 34 with lumbar injury. Conclusions: The lumbar spine is more prone to suffer injuries by high-energy mechanism, followed by the thoracic and cervical spine, respectively. The thoracolumbar junction is more frequently affected than the cervicothoracic junction in a ratio of 2:1. Level of Evidence II; Retrospective studyf.
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Abstract
ABSTRACT Objective: To determine the epidemiology of spine trauma in patients with polytrauma. Methods: The database of the service of polyfractured patients was reviewed from January to December 2015, 334 patients in total. Among them, 56 had spinal injury, of which 38 patients were included in the study. Results: Of the patients with polytraumatism, 16.77% had spinal cord injury. Mechanism of injury: fall 63.16%, traffic accidents 21.05%, running over 10.53%. Injury conditions: occupational 36.84%, at home 23.68%, traffic accident 15.79%, public road 13.16%, motorcycle accident 5.26%, of which 13.16% had consumed alcoholic beverages. Total with neurological injury 23.68%, incomplete lesion 18.42%. Injured vertebral segment: lumbar 76.32%, thoracic 31.58%, and cervical 7.89%. Associated injuries: upper limbs 47.37%, lower limbs 42.11%, pelvis 36.84%, thorax 34.21%, craniofacial 31.58%, abdomen 21.05%. Treatment: instrumentation 71.05%, orthoses 26.32%. Infection rate of 22.22%. Conclusions: The most common mechanism of injury was falls in the working environment, almost one fourth presented neurological damage, the most affected segment was the lumbar associated with injury of the lower limbs in 50%, with one fourth of patients that undergone intervention presenting infection. It is in the workplace, at home and in the transit where preventive measures must be reinforced to reduce the incidence of injuries in working age patients.
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Fujii T, Faul M, Sasser S. Risk factors for cervical spine injury among patients with traumatic brain injury. J Emerg Trauma Shock 2013; 6:252-8. [PMID: 24339657 PMCID: PMC3841531 DOI: 10.4103/0974-2700.120365] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 03/24/2013] [Indexed: 12/16/2022] Open
Abstract
Background: Diagnosis of cervical spine injury (CSI) is difficult in patients with an altered level of consciousness as a result of a traumatic brain injury (TBI). Patients with TBI and older adults are at increased risk for CSI. This study examined the various risk factors for CSI among trauma patients with TBI and whether adults who were older (≥55 years) were at higher risk for CSI when they sustained a fall-related TBI. Materials and Methods: Data used was the 2007 National Trauma Data Bank (NTDB), National Sample Project (NSP) for adults who sustained a TBI. This dataset contains 2007 admission records from 82 level I and II trauma centers. Logistic regression was used to identify potential risk factors for CSI and to test for interaction between age and injury mechanism. Additional model variables included gender, race, Glasgow Coma Score, multiple severe injuries, hypotension and respiratory distress. Results: An analysis of the NTDB NSP identified 187,709 adults with TBI, of which 16,078 were diagnosed with a concomitant CSI. In motor vehicle traffic injuries, the older age group had significantly higher odds of CSI (odds ratio [OR] = 1.26 [1.15-1.39]). In fall-related injuries the older age group did not have a higher odds of CSI compared to the younger age group. Skull/face fracture, other spine fracture/dislocation, upper limb injury, thorax injury, and hypotension were significantly associated with CSI. Pelvic injuries had an inverse association with CSI (OR = 0.60 [0.54-0.67]). Black had significantly higher odds of CSI compared to Whites (OR = 1.25 [1.07-1.46]). Conclusion: The identification of associated injuries and factors may assist physicians in evaluating CSI in patients with TBI.
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Affiliation(s)
- Tomoko Fujii
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
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Mezue WC, Onyia E, Illoabachie IC, Chikani MC, Ohaegbulam SC. Care related and transit neuronal injuries after cervical spine trauma: state of care and practice in Nigeria. J Neurotrauma 2013; 30:1602-7. [PMID: 23758277 DOI: 10.1089/neu.2012.2795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Suboptimal care during extraction and transfer after spinal trauma predisposes patients to additional spinal cord injury. This study examines the factors that contribute to care related and transit injuries and suggests steps to improve standard of care in spinal trauma patients in Nigeria. It is a questionnaire-based prospective study of patients admitted with cervical cord injury to two neurosurgical centers in Enugu, Nigeria, between March 2008 and October 2010. Demography, mechanism of injury, mode of extraction from the scene and transportation to first visited hospital, precautions taken during transportation, and treatment received before arriving at the neurosurgical unit were analyzed. There were 53 (77.9%) males, the mean age was 33.9 years, and 23.5% had concomitant head injury. Average delay was 3.5 h between trauma and presentation to initial care and 10.4 days before presentation to definitive care. Only 26.5% presented primarily to tertiary centers with trauma services. About 94.1% were extracted by passersby. None of the patients received cervical spine protection either during extrication or in the course of transportation to initial care, and 35.3% were sitting in a motor vehicle or supported on a motorbike during transport. Of the 43 patients transported lying down, 41.9% were in the back seat of a sedan, and only 11.8% were transported in an ambulance. Neurological dysfunction was first noticed after removal from the scene by 41.2% of patients, while 7.4% noticed it on the way to or during initial care. During subsequent transfer to definitive centers, only 36% had cervical support, although 78% were transported in ambulances. Ignorance of pre-hospital management of cervically injured patients exists in the general population and even among medical personnel and results in preventable injuries. There is need for urgent training, provision of paramedical services, and public enlightenment.
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Affiliation(s)
- Wilfred C Mezue
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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Patzkowski JC, Blair JA, Schoenfeld AJ, Lehman RA, Hsu JR. Multiple associated injuries are common with spine fractures during war. Spine J 2012; 12:791-7. [PMID: 22054909 DOI: 10.1016/j.spinee.2011.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 09/20/2011] [Accepted: 10/05/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The nature of concomitant injuries associated with spine fractures in American military personnel engaged in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) has been poorly documented in the literature. PURPOSE To characterize the incidence and epidemiology of associated injuries (AIs) in American military personnel with spine fractures sustained during OEF and OIF from 2001 to 2009. STUDY DESIGN Retrospective study. PATIENT SAMPLE American military personnel who were injured in a combat zone and whose medical data were abstracted in the Joint Theater Trauma Registry (JTTR). OUTCOME MEASURES Not applicable. METHODS The JTTR was queried using International Statistical Classification of Disease, Ninth Revision codes to identify all individuals who sustained spine injuries in OEF or OIF from October 2001 to December 2009. Medical records of all identified service members were abstracted to ensure accuracy and avoid duplication. Demographic information, including sex, age, and military rank, were obtained for all patients. Information regarding fracture type, spine region, mechanism of injury, and the presence of AIs was collected for all patients. RESULTS Seventy-eight percent of patients with a spine fracture sustained at least one AI, with an average of 3.4 AIs per patient. Musculoskeletal injuries were most common, followed by chest, abdomen, and traumatic brain injuries. Most patients were injured by an explosive mechanism (62%). Head and face traumas were more common with cervical fractures, chest with thoracic injuries, and abdominopelvic injuries with lumbosacral fractures. Pelvis and acetabulum fractures were common after helicopter crashes, tibia/fibula injuries after explosions, thoracoabdominal injuries after gunshot wounds, and traumatic brain injuries after falls. Most patients (76%) sustained multiple spine fractures. CONCLUSION Spine fractures sustained in OEF and OIF have high rates of AIs. Musculoskeletal AIs are the most common, but visceral injuries adjacent to the spine fracture frequently occur. Multiple spine injuries are more prevalent after military trauma.
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Affiliation(s)
- Jeanne C Patzkowski
- Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA.
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Nau C, Jakob H, Lehnert M, Schneidmüller D, Marzi I, Laurer H. Epidemiology and Management of Injuries to the Spinal Cord and Column in Pediatric Multiple-Trauma Patients. Eur J Trauma Emerg Surg 2010; 36:339-45. [PMID: 26816038 DOI: 10.1007/s00068-010-1136-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 06/30/2010] [Indexed: 12/18/2022]
Abstract
Injuries to the spinal column and cord in children are a rare condition. Epidemiological data could help to establish an evidence-based assessment and therapy of these patients. We present a retrospective chart analysis of children with spinal injuries who were admitted to the emergency room. The patients were analyzed regarding age, mechanism, and distribution of their injuries to all spinal regions and treatment strategies. Thirty-five children met the inclusion criteria with severe spinal injuries (Abbreviated Injury Scale [AIS] for Region 6 [spine]; AIS region 6) in a period from January 2003 to December 2009. The incidence was extremely low in younger children, with increasing numbers during adolescence. Neurological deficit without fracture accounted for almost 25% of all patients. The majority of patients were treated conservatively; operative treatment was performed in 25% of patients with unstable fractures, particularly in adolescents. Treatment strategies differ according to the type and degree of injury, age, and level of spine maturation.
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Affiliation(s)
- Christoph Nau
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe University, Frankfurt/Main, Germany. .,Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Heike Jakob
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Mark Lehnert
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Dorien Schneidmüller
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Helmut Laurer
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe University, Frankfurt/Main, Germany
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Chu D, Lee YH, Lin CH, Chou P, Yang NP. Prevalence of associated injuries of spinal trauma and their effect on medical utilization among hospitalized adult subjects--a nationwide data-based study. BMC Health Serv Res 2009; 9:137. [PMID: 19650923 PMCID: PMC2729309 DOI: 10.1186/1472-6963-9-137] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 08/03/2009] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study was wanted to investigate the prevalence of concomitant injuries among hospitalized acute spinal trauma patients aged 20 and over and the effects of those injuries on medical utilization in Taiwan. METHODS Nationwide inpatient datasets of Taiwan's National Health Insurance (NHI) database from between 2000 and 2003 were used. The major inclusion criteria used to select cases admitted due to acute spinal trauma were based on three diagnostic International Classification of Disease, 9th Version (ICD-9) codes items: (1) fracture of vertebral column without mention of spinal cord injury; (2) fracture of vertebral column with spinal cord injury; or (3) spinal cord lesion without evidence of spinal bone injury. To investigate the associated injuries among the eligible subjects, the concomitant ICD-9 diagnosis codes were evaluated and classified into six co-injury categories: (1) head trauma; (2) chest trauma; (3) abdominal trauma; (4) pelvic trauma; (5) upper extremities trauma; (6) lower extremities trauma. RESULTS There were 51,641 cases studied; 27.6% of these subjects suffered from neurological deficit, but only 17.3% underwent a surgical procedure for spinal injury. Among them, the prevalence of associated injuries were as follows: head trauma, 17.2%; chest injury, 2.9%; abdominal trauma, 1.5%; pelvic injury or fracture, 2.5%; upper limb fracture, 4.4%; lower limb fracture, 5.9%. The three major locations of acute spinal injury (cervical, thoracic, or lumbar spine) were found to be combined with unequal distributions of associated injuries. By stepwise multiple linear regression, gender, age, location of spinal injury, neurological deficit, surgical intervention and the six combined injuries were identified significantly as associated factors of the two kinds of medical utilization, length of stay (LOS) and direct medical cost. The combinations of acute spinal trauma with lower extremity injury, pelvic injury, chest injury, abdominal injury and upper extremity injury resulted in of the highest utilization of medical resources, the estimated additional LOS being between 4.3 and 1.2 days, and the extra medical cost calculated as being between $1,230 and $320. CONCLUSION The occurrence of associated Injuries among hospitalized acute spinal trauma patients in Taiwan is not uncommon, and results in an obvious effect on medical utilization.
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Affiliation(s)
- Dachen Chu
- Community Medicine Research Center & Department and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, Republic of China.
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Schmidt OI, Gahr RH, Gosse A, Heyde CE. ATLS(R) and damage control in spine trauma. World J Emerg Surg 2009; 4:9. [PMID: 19257904 PMCID: PMC2660300 DOI: 10.1186/1749-7922-4-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 03/03/2009] [Indexed: 02/07/2023] Open
Abstract
Substantial inflammatory disturbances following major trauma have been found throughout the posttraumatic course of polytraumatized patients, which was confirmed in experimental models of trauma and in vitro settings. As a consequence, the principle of damage control surgery (DCS) has developed over the last two decades and has been successfully introduced in the treatment of severely injured patients. The aim of damage control surgery and orthopaedics (DCO) is to limit additional iatrogenic trauma in the vulnerable phase following major injury. Considering traumatic brain and acute lung injury, implants for quick stabilization like external fixators as well as decided surgical approaches with minimized potential for additional surgery-related impairment of the patient's immunologic state have been developed and used widely. It is obvious, that a similar approach should be undertaken in the case of spinal trauma in the polytraumatized patient. Yet, few data on damage control spine surgery are published to so far, controlled trials are missing and spinal injury is addressed only secondarily in the broadly used ATLS(R) polytrauma algorithm. This article reviews the literature on spine trauma assessment and treatment in the polytrauma setting, gives hints on how to assess the spine trauma patient regarding to the ATLS(R) protocol and recommendations on therapeutic strategies in spinal injury in the polytraumatized patient.
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Affiliation(s)
- Oliver I Schmidt
- Klinikum St. Georg gGmbH, Trauma Centre, Dept. of Trauma and Orthopaedic Surgery, Delitzscher Strasse 141, 04129 Leipzig, Germany
| | - Ralf H Gahr
- Klinikum St. Georg gGmbH, Trauma Centre, Dept. of Trauma and Orthopaedic Surgery, Delitzscher Strasse 141, 04129 Leipzig, Germany
| | - Andreas Gosse
- Klinikum St. Georg gGmbH, Trauma Centre, Dept. of Trauma and Orthopaedic Surgery, Delitzscher Strasse 141, 04129 Leipzig, Germany
| | - Christoph E Heyde
- Leipzig University, Department of Orthopaedic Surgery, Spine Unit, Liebigstrasse 20, 04103 Leipzig, Germany
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Chance Fracture of the Upper Thoracic Spine in a Child. Eur J Trauma Emerg Surg 2008; 35:318. [DOI: 10.1007/s00068-008-8088-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 09/22/2008] [Indexed: 10/21/2022]
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Bühren V, Marzi I. Focus on Spinal Injuries in Multiple Trauma Patients. Eur J Trauma Emerg Surg 2007; 33:475. [PMID: 26814931 DOI: 10.1007/s00068-007-2006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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