An epidemiological survey of acute spinal trauma caused by traffic accidents versus falls in northern Taiwan

Pattern and In-Hospital Mortality of Thoracoabdominal Injuries Associated with Motor Vehicle Accident-Related Spinal Injury: A Retrospective Single-Center Study

BACKGROUND

Motor vehicle accident (MVA) is a global health hazard that results in spinal, thoracic, and abdominal injuries. Detailed studies on the association between MVA-related traumatic spinal injury (TSI) and thoracoabdominal injuries are lacking. This study aims to elucidate the prevalence, pattern of association between these injuries, and related outcomes in terms of in-hospital mortality.

METHODS

This is a retrospective single-center study of MVA-related TSI with thoracoabdominal associated injuries. Descriptive analysis was performed for gender, age, spinal injury level, thoracoabdominal injury region, admission day, hospital stay duration, and discharge category. The association between TSI and thoracoabdominal injury was analyzed, and the chi-square test was used to test the significance of differences. A statistically significant difference was considered at P values less than 0.05.

RESULTS

The cohort had a mean age of 33.6 ± 17.7 years with predominantly more males (85.1%). Thoracoabdominal injuries were present in 10.5% of MVA-related TSIs, and 9.2% of victims died during their hospital stay. There is a significant (P=0.045) association between the level of the spinal and the region of thoracoabdominal injuries. The presence of TSI-associated thoracic injury significantly (P=0.041) correlated with increased in-hospital mortality more than abdominal injury.

CONCLUSION

Thoracoabdominal injuries concomitant with MVA-related TSI cause considerable mortality. A pattern of association exists between the level of spinal and region of thoracoabdominal injury. Knowledge of this pattern is helpful in the routine practice of trauma health partitioners.

Surgical management of patients following traumatic spinal cord injury: Identifying barriers to early surgery in a specialized spinal cord injury center

CONTEXT/OBJECTIVE

Early surgery in individuals with traumatic spinal cord injury (T-SCI) can improve neurological recovery and reduce complications, costs and hospitalization. Patient-related and healthcare-related factors could influence surgical delay. This study aimed at determining factors contributing to surgical delay in individuals with T-SCI.

DESIGN

Prospective cohort study.

SETTING

Single Level I trauma center in Québec, Canada.

PARTICIPANTS

One hundred and forty-four patients who sustained a T-SCI.

INTERVENTIONS

None.

OUTCOME MEASURES

Socio-demographic and clinical administrative data were collected during the pre-operative period. The cohort was stratified in early surgery, or ES (<24 hours post-trauma) and late surgery, or LS (≥ 24 hours post-trauma) groups. A multivariate logistic regression analysis using patient- and healthcare-related factors was carried out to identify the main predictors of LS.

RESULTS

93 patients had ES (15.6 ± 4.7 hours post-trauma), which is 31 hours earlier than the 51 patients in the LS group (46.9 ± 30.9 hours; P < 10^-3). The transfer delay from trauma site to the SCI center was 8 hours shorter (5.0 ± 3.0 hours vs 13.6 ± 17.0; P < 10^-3) for the ES group, and the surgical plan was completed 17 hours faster (6.0 ± 4.0 hours vs 23.3 ± 23.6 hours; P < 10^-3) than for the LS group. The occurrence of LS was predicted by modifiable factors, such as the transfer delay to the SCI center, the delay before surgical plan completion, and the waiting time for the operating room.

CONCLUSIONS

A dedicated team for surgical treatment of individuals with T-SCI, involving direct transfer to the SCI center, faster surgery planning and access to the operating room in hospitals dealing with emergencies from all subspecialties could improve surgical delay and increase the rate of patients undergoing ES.

The effect of various types of motorcycle helmets on cervical spine injury in head injury patients: a multicenter study in Taiwan

Introduction. The relationship between cervical spine injury (CSI) and helmet in head injury (HI) patients following motorcycle crashes is crucial. Controversy still exists; therefore we evaluated the effect of various types of helmets on CSI in HI patients following motorcycle crashes and researched the mechanism of this effect. Patients and Methods. A total of 5225 patients of motorcycle crashes between 2000 and 2009 were extracted from the Head Injury Registry in Taiwan. These patients were divided into case and control groups according to the presence of concomitant CSI. Helmet use and types were separately compared between the two groups and the odds ratio of CSI was obtained by using multiple logistic regression analysis. Results. We observed that 173 (3.3%) of the HI patients were associated with CSI. The HI patients using a helmet (odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.19−0.49), full-coverage helmet (0.19, 0.10−0.36), and partial-coverage helmet (0.35, 0.21−0.56) exhibited a significantly decreased rate of CSI compared with those without a helmet. Conclusion. Wearing full-coverage and partial-coverage helmets significantly reduced the risk of CSI among HI patients following motorcycle crashes. This effect may be due to the smooth surface and hard padding materials of helmet.