188. Adolescent idiopathic scoliosis: categorization of fracture patterns among blunt trauma patients relative to a general trauma population

Abstract

BACKGROUND CONTEXT Adolescent idiopathic scoliosis (AIS) affects up to 4% of adolescents. As of yet, the characterization of traumatic injuries in AIS patients is unknown. PURPOSE To compare the risk of varying fracture locations after blunt trauma between patients with and without AIS. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE The Kid's Inpatient Database (KID) was queried from 2003 to 2009 to identify all patients aged 0-20 with AIS admitted for acute trauma. OUTCOME MEASURES The rates of various spinal fracture patterns as well as risk factors for vertebral fracture. METHODS KID was queried for AIS patients aged 0-20 years, from 2003 through 2009. AIS patients admitted for acute trauma were isolated. Mechanisms of injury (MOI), fracture locations and surgical procedures were assessed. Trauma AIS patients were then propensity-score matched to a general (Gen) trauma population of 323,729 KID patients, using age, sex and MOI. Fracture types were compared utilizing Chi-square and t-tests. Logistic regression analysis predicted relative odds of fracture in AIS patients. RESULTS Of 41,142 AIS cases identified, 442 patients suffered acute blunt trauma (2003: 112; 2006: 139; 2009: 186). Of those, the most prevalent MOIs were MVA (37.1%), pedestrian struck (PS) (22.9%), falls (18.3%) and assault (7.6%). Of the 442 acute blunt trauma patients, 99 (22.3%) sustained vertebral fracture. Of those, 25 patients had cervical fractures (MVA 66.52%, PS 24.14%, fall 6.9%), 23 thoracic (MVA 47.8%, PS 21.7%, fall 26.1%), 35 lumbar (MVA 57.1%, PS 20%, fall 25.7%), and 16 sacral/coccygeal (MVA 68.8%, PS 25%, fall 12.5%). Twenty-eight patients underwent spinal fusion (2-3 levels: 35.7%, 4-8 levels: 25.0%, >9 levels: 14.0%) and 14 had vertebral fracture repairs. After propensity-score matching (AIS: 432, Gen: 432), AIS patients had significantly more vertebral fractures (99 vs 52, p<0.001) and exhibited higher rates of thoracic (5.3% vs 2.5%, p=0.035) and lumbar fractures (8.1% vs 2.8%, p<0.001). Logistic regression showed AIS patients had increased odds of overall fracture (OR: 2.1 95% CI [1.4 - 3.1], p<.001), thoracic (OR: 2.2 95% CI [1.0 - 4.5], p=0.039) and lumbar fractures (OR: 3.1 95% CI [1.6 - 6.1], p<0.001). CONCLUSIONS AIS trauma patients relative to a normative trauma population were more likely to present with a vertebral fracture; specifically, thoracic and lumbar fractures. Authors acknowledge the limitations of the KID database, such as unavailability of radiographic data. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Adolescent idiopathic scoliosis (AIS) affects up to 4% of adolescents. As of yet, the characterization of traumatic injuries in AIS patients is unknown. To compare the risk of varying fracture locations after blunt trauma between patients with and without AIS. Retrospective review. The Kid's Inpatient Database (KID) was queried from 2003 to 2009 to identify all patients aged 0-20 with AIS admitted for acute trauma. The rates of various spinal fracture patterns as well as risk factors for vertebral fracture. KID was queried for AIS patients aged 0-20 years, from 2003 through 2009. AIS patients admitted for acute trauma were isolated. Mechanisms of injury (MOI), fracture locations and surgical procedures were assessed. Trauma AIS patients were then propensity-score matched to a general (Gen) trauma population of 323,729 KID patients, using age, sex and MOI. Fracture types were compared utilizing Chi-square and t-tests. Logistic regression analysis predicted relative odds of fracture in AIS patients. Of 41,142 AIS cases identified, 442 patients suffered acute blunt trauma (2003: 112; 2006: 139; 2009: 186). Of those, the most prevalent MOIs were MVA (37.1%), pedestrian struck (PS) (22.9%), falls (18.3%) and assault (7.6%). Of the 442 acute blunt trauma patients, 99 (22.3%) sustained vertebral fracture. Of those, 25 patients had cervical fractures (MVA 66.52%, PS 24.14%, fall 6.9%), 23 thoracic (MVA 47.8%, PS 21.7%, fall 26.1%), 35 lumbar (MVA 57.1%, PS 20%, fall 25.7%), and 16 sacral/coccygeal (MVA 68.8%, PS 25%, fall 12.5%). Twenty-eight patients underwent spinal fusion (2-3 levels: 35.7%, 4-8 levels: 25.0%, >9 levels: 14.0%) and 14 had vertebral fracture repairs. After propensity-score matching (AIS: 432, Gen: 432), AIS patients had significantly more vertebral fractures (99 vs 52, p<0.001) and exhibited higher rates of thoracic (5.3% vs 2.5%, p=0.035) and lumbar fractures (8.1% vs 2.8%, p<0.001). Logistic regression showed AIS patients had increased odds of overall fracture (OR: 2.1 95% CI [1.4 - 3.1], p<.001), thoracic (OR: 2.2 95% CI [1.0 - 4.5], p=0.039) and lumbar fractures (OR: 3.1 95% CI [1.6 - 6.1], p<0.001). AIS trauma patients relative to a normative trauma population were more likely to present with a vertebral fracture; specifically, thoracic and lumbar fractures. Authors acknowledge the limitations of the KID database, such as unavailability of radiographic data.