Acute Traumatic Spinal Injury Research Articles

Characteristics and In-Hospital Outcomes of Pediatric Traumatic Spinal Injuries in A Referral Trauma Center.

Objective:To evaluate the characteristics and in-hospital outcomes of traumatic spinal injuries among children admitted to a local trauma center in Iran. Methods:Patients aged 0-18 years who had been admitted to Shahid Kamyab trauma center for acute traumatic spinal injury (Mashhad, Iran) between 2011 and 2018 were evaluated retrospectively. Various demographic, clinical, radiological, and outcome variables were recorded and analyzed.Results:A total of 127,300 trauma patients were evaluated and amongst them, 61 children had spinal trauma. The mean age was 11.1 and there was no significant sex preponderance (54% males). Most of the injuries were occurred in summer (34.4%) and the most common trauma mechanism was motor vehicle accidents (55.7%) followed by falling (36.1%). Almost all patients (95.1%) had vertebral fractures, which were in the cervical, thoracic, and lumbosacral area in order to decrease incidence. 67.2% of patients were managed non-surgically. The mean hospital stay was 8.9 days and 82.0% of patients had been discharged with normal motor function. Conclusion:Pediatric spinal trauma is less studied entity in the field of traumatology due to the lower prevalence of these injuries in pediatric patients worldwide. But our study shows a higher prevalence of such injuries in the pediatric population. Although controversial, the leading cause of these injuries is motor vehicle accidents. Fortunately, short term in-hospital outcome seems to be good in such injuries.

Pre-Existing Mental Disorder, Clinical Profile, Inpatient Services, And Costs in People Hospitalised Following Traumatic Spinal Injury: A Population Record-Linkage Study

IntroductionRisk of traumatic injury is increased in individuals with mental illness, substance use disorder and dual diagnosis (mental disorders); these conditions will pre-exist among individuals hospitalised with acute traumatic spinal injury (TSI). Although early intervention can improve outcomes for people who experience mental disorders or TSI, the incidence, management, and cost of this often complex comorbid health profile is not sufficiently understood.
 Objectives and ApproachIn a whole-population cohort of patients hospitalised with acute TSI, we aimed to describe the prevalence of pre-existing mental disorders, and compare differences in injury epidemiology, costs and inpatient allied health service access.
 Record-linkage study of all hospitalised cases of TSI between June 2013 and June 2016 in New South Wales, Australia. TSI was defined by specific ICD-10-AM codes. Mental disorder status was considered as pre-existing where specific ICD-10-AM codes were recorded in incident admissions.
 Results13,489 individuals sustained acute TSI during this study. 13.11%, 6.06%, and 1.82% had pre-existing mental illness, substance use disorder, and dual diagnosis, respectively. Individuals with mental disorder were older (p<0.001), more likely to have had a fall or self-harmed (p<0.001), experienced almost twice the length of stay and inpatient complications, and increased injury severity compared to individuals without mental disorder (p<0.001).
 Conclusion / ImplicationsIndividuals hospitalised for TSI with pre-existing mental disorder have greater likelihood of increased injury severity and more complex, costly acute care admissions compared to individuals without mental disorder. Care pathway optimisation including prevention of hospital acquired complications for people with pre-existing mental disorders hospitalised for TSI is warranted.

Pre-existing mental disorder, clinical profile, inpatient services and costs in people hospitalised following traumatic spinal injury: a whole population record linkage study

BackgroundRisk of traumatic injury is increased in individuals with mental illness, substance use disorder and dual diagnosis (mental disorders); these conditions will pre-exist among individuals hospitalised with acute traumatic spinal...

Measuring the burden of mental illness and substance use and the level and impact of health care response in patients with spinal trauma: a record linkage study.

Background with rationale Traumatic spinal injuries (TSI) include column fractures, spinal cord injury, or both. They are among the most severe injuries with potential long-term physical, psychological, and social consequences. Primary causes of TSIs are falls and motor vehicle crashes, however, mental illness and substance use are known to significantly increase all injury risk. Injury is also known to increase risks of mental deterioration and physical complications including self-harm and self-neglect.
 Main Aim We aimed to identify comorbid mental illness and/or substance use at incident TSI, quantifying associated costs and health service management of these inequities.
 Methods NSW record-linkage administrative data analyses (2013-2016) will determine accurate prevalence of mental illness and/or substance use disorder among all patients who sustained acute TSI during the study period. Using recurrent event analyses, we will estimate the contributions of mental illness and/or substance use disorder on the impact on hospital acquired complications (HAC), length of stay and costs; assessing records for social work and/or psychologist consultation.
 Results 13,489 individuals were hospitalised with acute TSI; 21% had either mental health and/or substance use diagnoses; 8.7% had both. These patients were more likely to have experienced falls or intentional self-harm, be male and have multiple comorbidity. Acute care stay and costs were on average twice that of patients with TSI without mental health and/or substance use diagnoses; additionally they were more than twice as likely to experience HACs. Only 56% of TSI patients with these comorbid conditions in the context of TSI, had documented social work or psychologist consultation.
 Conclusion Patients with mental illness and/or substance use disorder, experience significant health disparities that require concerted health system attention that should begin early in acute care.

The Nature and Cost of Readmissions after Work-Related Traumatic Spinal Injuries in New South Wales, Australia.

This study aimed to measure the subsequent health and health service cost burden of a cohort of workers hospitalised after sustaining work-related traumatic spinal injuries (TSI) across New South Wales, Australia. A record-linkage study (June 2013–June 2016) of hospitalised cases of work-related spinal injury (ICD10-AM code U73.0 or workers compensation) was conducted. Of the 824 individuals injured during this time, 740 had sufficient follow-up data to analyse readmissions ≤90 days post-acute hospital discharge. Individuals with TSI were predominantly male (86.2%), mean age 46.6 years. Around 8% (n = 61) experienced 119 unplanned readmission episodes within 28 days from discharge, over half with the primary diagnosis being for care involving rehabilitation. Other readmissions involved device complications/infections (7.5%), genitourinary or respiratory infections (10%) or mental health needs (4.3%). The mean ± SD readmission cost was $6946 ± $14,532 per patient. Unplanned readmissions shortly post-discharge for TSI indicate unresolved issues within acute-care, or poor support services organisation in discharge planning. This study offers evidence of unmet needs after acute TSI and can assist trauma care-coordinators’ comprehensive assessments of these patients prior to discharge. Improved quantification of the ongoing personal and health service after work-related injury is a vital part of the information needed to improve recovery after major work-related trauma.

Epidemiology of Traumatic Spinal Injury: A 15-Year Retrospective Study of 1092 Cases

Background: Spinal trauma is a well‑documented problem in developed countries but literature has been mute on this problem in developing counties. The purpose of this study was to elucidate epidemiological characteristics of spine trauma in our center over a 15-year period. Methods: All consecutive patients with acute spinal trauma who were admitted in our center from March 2003 to March 2018 were included. The analysis was focused on patient-related demographic characteristics, cause and mechanism of injury, level and type of injury, neurological deficit, associated injuries, management and outcome. All of the statistical calculations were performed using the Statistical Package for Social Sciences (SPSS). Statistical analyses were conducted using the Student t-test and nonparametric tests (Mann-Whitney U-test, Kruskal-Wallis test). Values for p<0.05 were regarded as statistically significant and all confidence intervals were expressed at 95%. Results: A total of 1,092 patients with acute traumatic spinal injuries were managed in our trauma center. There were 74.3% males and 25.7% females with mean age 34.5 years. Young adults (age group: 18-39 years) were more affected with 58.9%. The leading mechanism of injury was compression with 39.2%. The most common cause of accident was motor vehicle collision accident (58.5%) followed by high-energy falls (32.6%). Six hundred eighty-seven patients (62.8%) had spinal cord injury, with 14.4% complete tetraplegia and 7.7% complete paraplegia. Overall, the use of operative treatment (64.8%) exceeded that of conservative treatment (35.2%). Conclusion: This study’s unique feature of delineating variables with statistical significance trending toward better management provides useful data to guide future researches, benchmarking, public health policy, and efficient resource allocation for the management of spine trauma.

Health outcomes and costs of acute traumatic spinal injury in New South Wales, Australia

Background ContextTraumatic spinal injuries are often associated with both long-term disability, higher frequency of hospital readmissions, and high medical costs for individuals of all ages. Age differences in terms of injury profile and health outcomes among those who sustain a spinal cord injury have been identified. However, factors that may influence health outcomes among those with a spinal injury have not been extensively examined at a population level. PurposeThe present study aims to describe the characteristics of traumatic spinal injury, identify factors predictive of mortality, and estimate the cost of hospital treatment for younger and older people. Study Design/SettingThis is a population-based retrospective epidemiological study using linked hospitalization and mortality records during January 1, 2010 to June 30, 2014 in New South Wales, Australia. Patient SampleThe present study included 13,429 hospitalizations. Outcome MeasuresMortality within 30 and 90 days of hospitalization, hospital length of stay (LOS), and hospitalization costs were determined. MethodsHospitalizations with a principal diagnosis of spinal cord injury or spinal fractures were used to identify traumatic spinal injuries. Age-standardized incidence rates were calculated and negative binomial regression was used to examine statistical significant changes over time. Cox proportional hazard regression was used to examine the effect of risk factors on survival at 90 days. ResultsThere were 13,429 hospitalizations, with 52.4% of individuals aged ≥65 years. The hospitalization rates for individuals aged ≤64 and ≥65 years were both estimated to significantly increase per year by 3.3% (95% confidence interval [CI] 0.97–5.79, p<.006) and 3.3% (95% CI 1.02–5.71, p=.005), respectively. For individuals aged ≥65 years, there were a higher proportion of women injured, comorbid conditions, injuries after a fall in the home or aged care facility, a longer hospital LOS, unplanned hospital admissions, and deaths than individual aged ≤64 years. The average cost per index hospitalization was AUD$23,808 for individuals aged ≤64 years and AUD$31,187 for individuals aged ≥65 years with a total estimated cost of AUD$371 million. Mortality risk at 90 days was increased for individuals who had one or more comorbidities, a higher injury severity score, and if their injury occurred in the home or an aged care facility. ConclusionsSpinal injury represents a substantial cost and results in debilitating injuries, particularly for older individuals. Spinal injury prevention efforts for older people should focus on the implementation of fall injury prevention, whereas for younger individuals, prevention measures should target road safety.

Risk factors of deep vein thrombosis in patients with acute traumatic spinal cord injury

Objective To investigate the incidence and risk factors of deep vein thrombosis (DVT) in a cohort of Chinese patients with traumatic spinal cord injury (TSCI) , and in addition, to evaluate the effect of injury types and concomitant injuries of other parts of body. Method Records of 143 casualties admitted to our institute for TSCI were analyzed retrospectively. Both lower extremities of all casualties were examined routinely with color Doppler ultrasonography (CDUS) before major surgical treatment. None of these casualties received any thromboprophylaxis before CDUS. Logistic regression was used to analyze risk factors of DVT. Results Of the 143 patients, 32.2% (n=46) suffered from DVT (proximal n=15, distal n=31). All casualties were diagnosed within one week after injury (mean 3.35±1.65 days). Risk factors associated with DVT induced complete motor paralysis (odds ratio [OR]5.05, 95% CI 1.70-14.90) , concomitant fracture of lower extremities (OR 4.30, 95% CI 1.34-17.64) , and lumbar vertebra injury (OR 4.29. 95% CI 1.50-10.83). Conclusions Clinically detectable DVT in TSCI are not uncommon in the Chinese population. Casualties with multiple risk factors may be benefited from early administration of thromboprophylaxis. Key words: Trauma; Spinal cord injury; Deep vein thrombosis; Risk factors

Nonoperative treatment of acute traumatic spinal injuries: A prospective study

Traumatic spinal injury is a major cause of morbidity and mortality worldwide. There is no agreed method of care. Neurological recovery in complete injury has been dismal. Aims and Objectives : The aim of this study is to determine the neurological recovery at discharge in traumatic spinal injury patients managed nonoperatively in our center. This was a prospective descriptive study carried out on traumatic spinal injury patients managed by neurosurgical unit in our center from August 2010 to July 2013. The unit started in July 2010 with virtually no available facilities for surgical care for these patients. All patients were managed nonoperatively. The unit recorded data of the patients in accident and emergency, intensive care unit, and wards using structured proforma. Data were analyzed using Epi Info 7 software. There were 76 patients studied of which 57 were males and 25 were females. Fifty three were caused by road traffic accident. Nineteen were complete injury. Patients with incomplete injuries did well at discharge. Completeness of injury significantly affected the outcome. The neurological recovery in incomplete spinal injuries in our study was good, but poor in complete injury. Conservative treatment should be adopted in developing countries in patients with poor resources and in centers where facilities are not available for adequate imaging and surgical care. Trauma system is imperative in our country.

Profile of acute traumatic spine injuries in Bobo-Dioulasso, Burkina Faso

Background Spinal injuries are common and have a devastating impact on quality of life. African literature on the subject is sparse and there is no data on these injuries from Burkina Faso. Objectives: This study was carried out to describe the various traits of acute traumatic spinal injuries in Bobo-Dioulasso, Burkina Faso to propose solutions for improving their management in our country. Methods: Age, sex, occupation, mode of injury, diagnosis, treatment and outcome of patients admitted for acute traumatic spinal injuries in the University Teaching Hospital of Bobo-Dioulasso from January 2008 to June 2009 were retrospectively studied. Results: Seventy-five patients, mean age 31.3years, 63 men and 12 women were identified. Farming (20%) and trading (17.3%) were the most common occupations. The most common cause of injury was road traffic accident (41.4%) followed by Fall from height (36%). Most of the patients (65,3%) had neurological deficit on admission. The most common injured vertebra was the first lumbar followed by the fifth cervical. The majority of patients (92.3%) were treated conservatively, only 5 patients (6.7%) underwent surgery. Pressure sores and urinary tract infection were the complications. Eleven (14.7%) patients died in hospital; they all had cervical spine injury. The follow-up was poor. Conclusion: Young men in the productive stage of their lives are those most affected. The causes are preventable. A control strategy based on prevention and on creating a spine center could reduce the incidence of such injuries and improve their management. Key words: Burkina Faso, epidemiology, spine, spinal injuries, trauma.

Reappraisal of Methylprednisolone Treatment for Acute Traumatic Cord Injury

Objective: The value of methylprednisolone (MP) treatment in acute traumatic spinal cord injury (SCI) remains controversial. We attempted to evaluate the utilization of resources, motor function recovery and adverse effect after the use of MP. Methods: We compared 13 demographic and clinical characteristics between MP and non-MP treatment groups in 110 patients with acute traumatic SCI treated in hospitals between June 1st, 2000 and May 31st, 2001, and analyzed 10 short-term outcome variables. These demographic and clinical characteristics included age, cause of injury, number of associated injuries, Revised Trauma Score, Glasgow Coma Scale, mean blood pressure, level/completeness and pattern of SCI, number and types of spinal surgeries, frequency of rehabilitation therapy and the time interval between trauma and admission. Results: The MP (64.5%) and non-MP (35.5%) treatment groups showed no significant differences in all characteristics except the time interval between trauma and admission (P=0.024). MP treatment was associated with a higher frequency of infectious complications (P=0.038), but there was no difference between the two treatment groups in other outcome parameters. The results of analysis stratified by dosage of MP showed that the length of ICU stay (P=0.021) and the number of tracheostomies (P=0.005) and pneumonia cases (P=0.004) were increased significantly in the standard dose group. Conclusions: Although the rate of infection had risen in patients receiving MP, the steroid treatment did not significantly increase utilization of resources during hospitalization and appeared safe in terms of mortality. However, it had not been proven to improve motor function recovery.

Thoracic Myelopathy Secondary to Ligamentum Flavum Ossification

Introduction: Focal ossification of the ligamentum flavum (OLF) is a rare cause of thoracic myelopathy. The lower thoracic spine is most frequently affected and the patients present initially with posterior column disturbances followed by progressively increasing spastic paraparesis. The pathogenesis of OLF has not been conclusively established. Materials and Methods: Five patients with thoracic myelopathy due to OLF underwent decompressive laminectomy and excision of the ligamentum flavum. Magnetic resonance (MR) images consistently revealed a linear or beak-like excrescence, uniformly hypodense on T1- and T2-weighted images, situated posterior to the thecal sac. A comparison of the preoperative neurological status and at follow-up was done using the Japanese Orthopaedic Association and Nurick scores modified for thoracic myelopathy. Results: Decompressive laminectomy with excision of the OLF resulted in significant improvement in motor weakness and gait in 4 (1 excellent, 2 good, and 1 fair) patients who had slow-onset, but progressive compression, OLF. The patient who had acute traumatic spinal injury did not recover despite decompression and rehabilitation. All improved in their gait and spasticity, but 4 patients had persistent sensory deficit. Conclusion: OLF can significantly contribute to a spatial reduction of the thoracic spinal canal, resulting in slowly progressive paraparesis or acute paraplegia after trauma to the back. The T2-weighted sagittal image of MR imaging is the modality of choice for screening the longitudinal extent of OLF, with increased diagnostic accuracy when combined with computed tomographic myelogram. Neurological improvement usually occurs following decompression laminectomy with or without excision of the OLF. However, the persistence of residual numbness or weakness at follow-up may be due to irreversible changes within the cord as a result of severe thecal compression and the delay between the onset of initial symptoms/signs and surgical decompression. Prognosis remains poor for acute myelopathy with pre-existing OLF, despite surgery.

Risk factors for surgical site infection in the patient with spinal injury.

A retrospective chart review of 1561 patients with spinal injury was conducted over a 4-year period. To determine the rate of surgical site infection in the spinal trauma population, to compare infection rates after spinal operations for elective and traumatic indications, and to identify risk factors for postoperative wound infections in the traumatic subpopulation. Surgical site infection after spinal operations is a dreaded complication. Risk factors have been investigated previously, but the subset of patients with acute traumatic spinal injury may be distinct. The hospital's infection control program was used to identify surgical site infections after spinal operations, and infection rates were calculated. Data including patient characteristics, severity of injury indicators, surgical factors, and perioperative management factors were collected for the patients presenting with acute spinal injury over a 4-year period. Postoperative wound infections developed in 24 of 256 patients. This infection rate of 9.4% was significantly (P < 0.001) higher than for elective spinal operations during the same period (3.7%). Risk factors found to be independently significant included delay until operation, increased postoperative intensive care unit stay, single (neurosurgical or orthopedic) versus combined operative team. Risk factors for surgical site infection in the acute trauma setting are identified. Two surgical teams may be involved without causing a higher rate of infection.

Prophylactic low dose heparin anticoagulant therapy in patients with spinal cord injuries: a retrospective study.

A retrospective study was performed of 100 consecutive acute traumatic spinal injury patients with neurological deficit admitted to the Yorkshire regional spinal injuries centre prior to May 1990. Ninety-seven of these patients received prophylactic low dose subcutaneous heparin and 3 patients were excluded because of noted complications. Twenty-six patients developed thromboembolic complications. Apart from the fact that acute spinal cord injury patients are considered to be in an hypercoaguable state, the occurrence of deep vein thrombosis/pulmonary embolism (DVT/PE) in our study, even though these patients were on prophylactic low dose subcutaneous heparin, was related to delay in transfers, operative intervention, level of spinal cord injury and was possibly due to loss of some amount of heparin solution from the prefilled syringe during removal of air bubbles prior to the subcutaneous heparin injection.

Magnetic Resonance Imaging of Posttraumatic Spinal Ligament Injury

We evaluated the role of magnetic resonance imaging (MRI) in the detection of ligament injury in 37 patients after acute traumatic spinal injury. Thirty-five patients had fractures, one had neurologic deficit with normal x-rays, and one had evidence of cervical instability on flexion/extension plain films. MRI examinations were performed acutely (average 10.8 d after injury) using T1- and T2-weighted multiplanar imaging. Two radiologists blindly evaluated all MRI examinations. Subsequently, 35 plain films, 16 tomograms, and 30 computed tomography (CT) scans were also evaluated. Nineteen patients were considered to have torn posterior ligaments on the basis of their clinical, radiographic and surgical findings. MRI detected ligament damage in 17. All patients considered to have intact posterior ligament complexes clinically and radiographically had no evidence of ligament damage on MRI. T2-weighted sequences were essential for detection of ligament injury. We conclude that MRI is an accurate method for assessment of the integrity of spinal ligaments after acute trauma.

Closed head injury in acute traumatic spinal cord injury: incidence and risk factors.

Investigators estimate that 15% to 50% of all patients with spinal cord injury (SCI) also incur a closed head injury (CHI), but studies have been hampered by design flaws, including retrospective assessment and inconsistent definition of CHI. We conducted a prospective study of combined CHI and SCI among 82 SCI patients consecutively admitted at two hospitals within 24 hours of injury. The purpose of the study was to determine the incidence and duration of loss of consciousness and posttraumatic amnesia (PTA), and to establish the risk factors for combined CHI and SCI. The overall incidence of CHI as defined by the presence of PTA of any duration was 49%. There was a significantly increased risk of CHI for patients involved in traffic accidents (risk ratio = 3.7; 95% confidence interval 1.8 to 7.2). There was no increased risk associated with level of injury (quadriplegic vs paraplegic; risk ratio = 1.2; 95% confidence interval = 0.8 to 1.8). All SCI patients, regardless of level of injury, deserve systematic evaluations for CHI in their acute care evaluations.

Prophylactic anticoagulant therapy in patients with spinal cord injury.

One hundred and two consecutive acute traumatic spinal injury patients admitted between 1976 and 1979 to a male ward at Stoke Mandeville Hospital were considered for prophylactic anticoagulant therapy. Sixty-six were anticoagulated. Thirty-six were not due to various contra-indications. Nineteen patients had pulmonary emboli. None of these were effectively anticoagulated. These results are compared with a similar previous series where there was a smaller incidence of emboli. The main reason for this was due to the delay in admitting patients to the Centre so that they could not be anticoagulated early enough to prevent pulmonary embolus occurring. In these patients who had a pulmonary embolus or were considered to be a high risk, anticoagulant therapy was continued for 6 months.