In-hospital mortality rate in subaxial cervical spinal cord injury patients: a systematic review and meta-analysis

Comparison of cervical versus thoracic spinal cord injury outcomes in pediatric trauma patients

PURPOSE

To explore differences based on level of pediatric spinal cord injury (SCI), we compared cervical and thoracic SCI in pediatric trauma patients (PTPs), hypothesizing higher mortality and length of stay (LOS) for cervical SCI.

METHODS

The 2017-2021 Trauma Quality Improvement Program was queried for all PTPs ≤ 17 years-old with cervical or thoracic SCI. Bivariate analyses compared the two groups. The primary outcome was mortality and secondary outcomes included hospital LOS and injury severity scores (ISS). Logistic regression models were used to determine independent risk factors for death and prolonged ventilation.

RESULTS

Of 5280 PTPs, 2538 (65.9%) had cervical SCI and 1316 (34.1%) had thoracic SCI. Motor vehicle collisions were the most common cause of both cervical and thoracic SCI (37.8 and 41.9%). PTPs with thoracic SCI had higher rates of positive drug screen as compared to cervical SCI (39.2 vs 29.8%, p = 0.001). PTPs with thoracic SCI had higher median ISS (25 vs 16, p < 0.001), while cervical SCI had higher mortality (13 vs 6.1%, p < 0.001) but decreased hospital LOS (median 9 vs 5 days, p < 0.001. Cervical SCI were associated with a nearly fourfold increase in the risk of death (95% CI 2.750-5.799, p < 0.001) and a 1.6-fold increase in the risk of prolonged ventilator requirement (95% CI 1.228-2.068, p < 0.001).

CONCLUSIONS

PTPs with cervical SCI have higher mortality while those with thoracic SCI have higher ISS and hospital LOS. Cervical SCI were associated with a fourfold higher risk of death. MVC was the most common cause of injury, and both groups had high rates of positive drug screens. Understanding differing outcomes may assist providers with prognostication and injury prevention.

Impact of patient age on morbidity and mortality in adults with acute traumatic cervical spinal cord injury: An ACS trauma quality programs database study

BACKGROUND

This study aimed to examine associations between age and outcomes in acute cervical SCI (cSCI) patients.

METHODS

We conducted a retrospective cohort study using the American College of Surgeons Trauma Quality Programs database to compare outcomes for acute cSCI patients stratified by age: 18-44, 45-65, and > 65 years. Patient demographics, comorbidities, injury type, treatment modality, AEs, and length of stay (LOS) were assessed. Multivariable logistic regression was used to identify independent predictors of AEs, NRD, and in-hospital mortality.

RESULTS

Of the 71,048 patients identified, 19,838 (27.9 %) were 18-44 years, 26,888 (37.8 %) were 45-65 years, and 24,322 (34.2 %) were > 65 years of age. SCI rates from falls significantly increased with age (18-44: 21.7 % vs. 45-65: 47.1 % vs. >65: 71.9 %, p < 0.001). The > 65 years cohort had significantly greater rates of NRD (18-44: 64.5 % vs. 45-65: 70.4 % vs. >65: 87.0 %, p < 0.001) and in-hospital mortality (18-44: 9.1 % vs. 45-65: 8.3 % vs. >65: 19.4 %, p < 0.001). Conversely, mean LOS decreased significantly with increasing age (18-44: 14.3 ± 19.1 days vs. 45-65: 12.7 ± 16.8 days vs. >65: 10.5 ± 10.9 days, p < 0.001). On multivariable analysis, the 45-65 and > 65 years cohorts, respectively, significantly predicted any AE [1.19[ 1.11-1.27], p < 0.001; 1.18, [1.10-1.28], p < 0.001], NRD [1.41[1.29-1.5] p < 0.001; 3.46[ 3.07-3.90], p < 0.001], and in-hospital mortality [1.90[1.69-2.14] p < 0.001; 5.22[4.59-5.93], p < 0.001]. Regarding treatment modalities, cervical fusion was associated with AEs (p < 0.001), cervicothoracic fusion with AEs (p = 0.024) and NRD (p = 0.005), and excision/release (laminectomy) with NRD (p < 0.001).

CONCLUSION

Our study suggests that older age is associated with increased morbidity and mortality risk in acute cSCI patients.

Traumatic cervical spinal cord injury in southeastern Norway: acute treatment, specialized rehabilitation referral and mortality

Background

Traumatic cervical spinal cord injury (cSCI) is a serious condition that requires a multidisciplinary treatment approach involving care at a neurotrauma center (NTC) and specialized rehabilitation. Contemporary population-based studies of cSCI are important for ensuring the quality and planning of health care approaches for these patients.

Methods

This is a population-based cohort study of patients with traumatic cSCI who were admitted to the NTC in Southeast Norway between 2015 and 2022. The main outcome variables were length of stay (LOS), rate of surgical fixation/stabilization, rate of transfer to specialized rehabilitation, and 90-day mortality. Uni-and multivariate binary logistic regression analyses were used to investigate the effect of different covariates on LOS, transfer to specialized rehabilitation and 90-day mortality.

Results

The median age of the 370 patients admitted to the NTC was 64 years, 75% were males, 40% had severe comorbidities, 45% had multiple injuries, and 67% underwent primary triage at a local hospital (LH). Surgical cervical stabilization/decompression was performed in 78% of the patients. The median LOS at the NTC was 9 days, and increasing LOS was significantly associated with young age, American Spinal Injury Association Impairment Scale (AIS) grade B, surgery and prolonged ventilatory support. Inpatient specialized rehabilitation was provided to 54% of patients. Receiving specialized rehabilitation was associated with younger age, preinjury independent living, more severe cSCI, no need for acute phase tracheostomy, and surgical stabilization/decompression. Only 6% of the octogenarians received specialized rehabilitation. The 90-day mortality rate was 13%, which was associated with older age, preinjury dependent living, more severe cSCI, upper cervical injuries, and days on ventilator and inversely correlated with LOS.

Conclusion

Advanced age, especially among octogenarians, was significantly linked to a lack of specialized rehabilitation. Qualified physicians should assess all patients with cSCI for their need of rehabilitation and their potential to benefit from it. If the number of patients who are likely to respond to rehabilitation outnumbers the capacity of the rehabilitation center, we have two choices. Either guidelines for prioritization of patients for rehabilitation should be developed, or the capacity of the rehabilitation centers should be increased.

Quality of in-hospital care in traumatic spinal column and cord injuries (TSC/SCI) in I.R Iran

PURPOSE

This study aimed to implement the Quality of Care (QoC) Assessment Tool from the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to map the current state of in-hospital QoC of individuals with Traumatic Spinal Column and Cord Injuries (TSCCI).

METHODS

The QoC Assessment Tool, developed from a scoping review of the literature, was implemented in NSCIR-IR. We collected the required data from two primary sources. Questions regarding health system structures and care processes were completed by the registrar nurse reviewing the hospital records. Questions regarding patient outcomes were gathered through patient interviews.

RESULTS

We registered 2812 patients with TSCCI over six years from eight referral hospitals in NSCIR-IR. The median length of stay in the general hospital and intensive care unit was four and five days, respectively. During hospitalization 4.2% of patients developed pressure ulcers, 83.5% of patients reported satisfactory pain control and none had symptomatic urinary tract infections. 100%, 80%, and 90% of SCI registration centers had 24/7 access to CT scans, MRI scans, and operating rooms, respectively. Only 18.8% of patients who needed surgery underwent a surgical operation in the first 24 h after admission. In-hospital mortality rate for patients with SCI was 19.3%.

CONCLUSION

Our study showed that the current in-hospital care of our patients with TSCCI is acceptable in terms of pain control, structure and length of stay and poor regarding in-hospital mortality rate and timeliness. We must continue to work on lowering rates of pressure sores, as well as delays in decompression surgery and fatalities.

Neurological recovery rate and predictive factors of incomplete AIS grade C spinal cord injury in the older aged population

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

To define the prognosis and predictive factors for neurological improvement in older patients with incomplete spinal cord injury (SCI) of American Spinal Injury Association Impairment Scale grade C (AIS-C).

SETTINGS

Multi-institutions in Japan.

METHODS

We included patients aged ≥65 years with traumatic SCI of AIS-C who were treated conservatively or surgically with >3 follow-up months. To identify factors related to neurological improvement, patients were divided into three groups according to their neurological status at the final follow-up, with univariate among-group comparisons of demographics, radiographic, and therapeutic factors. Significant variables were included in the multivariate logistic regression analysis.

RESULTS

Overall, 296 older patients with SCI of AIS-C on admission were identified (average age: 75.2 years, average follow-up: 18.7 months). Among them, 190 (64.2%) patients improved to AIS-D and 21 (7.1%) patients improved to AIS-E at final follow-up. There were significant among-group differences in age (p = 0.026), body mass index (p = 0.007), status of pre-traumatic activities of daily living (ADL) (p = 0.037), and serum albumin concentrations (p = 0.011). Logistic regression analysis showed no significant differences in variables in the stratified group of patients who improved to AIS-D. Meanwhile, serum albumin was a significant variable in patients who improved to AIS-E (p = 0.026; OR: 6.20, pre-traumatic ADL was omitted due to data skewness).

CONCLUSIONS

Most older patients with incomplete AIS-C SCI demonstrated at least 1 grade of neurological improvement. However, <10% of patients achieved complete recovery. Key predictors of complete recovery were high serum albumin levels on admission and independent pre-traumatic ADL.

SPONSORSHIP

No funding was received for this study.

An updated systematic review of neuroprotective agents in the treatment of spinal cord injury

This systematic review aims to summarize the findings from all clinical randomized trials assessing the efficacy of potential neuroprotective agents in influencing the outcomes of acute spinal cord injuries (SCI). Following the PRISMA guidelines, we conducted comprehensive searches in four electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) up to September 5th, 2023. Our analysis included a total of 30 studies. We examined the effects of 15 substances/drugs: methylprednisolone, tirilazad mesylate, erythropoietin, nimodipine, naloxone, Sygen, Rho protein antagonist, granulocyte colony-stimulating factor, autologous macrophages, autologous bone marrow cells, vitamin D, progesterone, riluzole, minocycline, and blood alcohol concentration. Notable improvements in neurological outcomes were observed with progesterone plus vitamin D and granulocyte colony-stimulating factor. In contrast, results for methylprednisolone, erythropoietin, Sygen, Rho Protein, and Riluzole were inconclusive, primarily due to insufficient sample size or outdated evidence. No significant differences were found in the remaining evaluated drugs. Progesterone plus vitamin D, granulocyte colony-stimulating factor, methylprednisolone, Sygen, Rho Protein, and Riluzole may enhance neurological outcomes in acute SCI cases. It is worth noting that different endpoints or additional subgroup analyses may potentially alter the conclusions of individual trials. Therefore, certain SCI grades may benefit more from these treatments than others, while the overall results may remain inconclusive.