Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures

David Häske,Jan-Philipp Stock,Michael Kreinest,The Traumaregister Dgu ,Rolf Lefering

doi:10.1007/s00068-020-01515-w

Abstract

PurposeThis study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization.MethodsRetrospective cohort study drawing from the multi-center database of the TraumaRegister DGU®, spinal injury patients ≥ 16 years of age who scored ≥ 3 on the Abbreviated Injury Scale (AIS) between 2009 and 2016 were enrolled.ResultsThe mean age of the 145,833 patients enrolled was 52.7 ± 21.1 years. The hospital mortality rate was 13.9%, and the mean injury severity score (ISS) was 21.8 ± 11.8. Seventy percent of patients had no spine injury, 25.9% scored 2–3 on the AIS, and 4.1% scored 4–6 on the AIS. Among patients with isolated traumatic brain injury (TBI), 26.8% had spinal injuries with an AIS score of 4–6. Among patients with multi-system trauma and TBI, 44.7% had spinal injuries that scored 4–6 on the AIS. Regression analysis predicted a serious spine injury (SI; AIS 3–6) with a prevalence of 10.6% and cervical spine injury (CSI; AIS 3–6) with a prevalence of 5.1%. Blunt trauma was a predictor for SI and CSI (OR 4.066 and OR 3.640, respectively; both p < 0.001) and fall > 3 m for SI (OR 2.243; p < 0.001) but not CSI (OR 0.636; p < 0.001). Pre-hospital shock was predictive for SI and CSI (OR 1.87 and OR 2.342, respectively; both p < 0.001), and diminished or absent motor response was also predictive for SI (OR 3.171) and CSI (OR 7.462; both p < 0.001). Patients over 65 years of age were more frequently affected by CSI.ConclusionsIn addition to the clinical symptoms of pain, we identify ‘4S’ [spill (fall) > 3 m, seniority (age > 65 years), seriously injured, skull/traumatic brain injury] as an indication for increased attention for CSIs or indication for spinal motion restriction.

Highlights

According to the literature, only 1–2% of all trauma patients suffer from relevant spinal injuries [1]
These patients are at risk of spinal cord injuries (SCIs) with severe neurological consequences, which occur in approximately 20% of these cases [2]
Immobilization has become a standard procedure in emergency medicine [2]; a recent study found that 20% of patients suffering from a cervical SCI were not immobilized whatsoever by emergency care providers [4]

Summary

Introduction

Only 1–2% of all trauma patients suffer from relevant spinal injuries [1]. These patients are at risk of spinal cord injuries (SCIs) with severe neurological consequences, which occur in approximately 20% of these cases [2]. Immobilization has become a standard procedure in emergency medicine [2]; a recent study found that 20% of patients suffering from a cervical SCI were not immobilized whatsoever by emergency care providers [4]. A possible explanation is the fact that, over the years, no evidence for the benefit of immobilization for patient outcomes has been obtained from rigorous studies (e.g., randomized controlled trials) [5,6,7]. Regardless of the method, immobilization has its disadvantages, such as general patient manipulation, pain, decubitus, and prolonged pre-hospital time [8, 9]

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