Spinal injury in major trauma: Epidemiology of 1104 cases from an Italian first level trauma center. Issue 4 (April 2023)

• Record Type: Journal Article
• Authors: Spota, Andrea; Giorgi, Pietro Domenico; Cioffi, Stefano Piero Bernardo; Altomare, Michele; Schirò, Giuseppe Rosario; Legrenzi, Simona; Villa, Fabio Giuseppe; Chiara, Osvaldo; Cimbanassi, Stefania
• Is Part Of: Injury. Volume 54:Issue 4(2023)
• Page Start: 1144
• Page End: 1150
• Publication Date: 2023-04
• Subjects: Spinal injury -- Trauma -- Major trauma -- Spinal cord injury -- Vertebral fracture -- Spinal injury predictive factors -- Injury severity score -- Abbreviated injury score; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2023.02.039
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: In Italy, spinal injuries are most frequently caused by road accidents (59.9%, mainly cervico-thoracic) than by falls (35.1%, mainly lumbar). Most patients with spinal injuries (70.7%) have a high injury severity score patients, i.e. ISS≥16. Trauma patients have more severe spinal injuries in fall cases (40.1%) compared to RA (21.9% to 26.3%). A spinal cord injury (SCI) complicated 13.7% fractures. SCI decreased with aging and extremities associated injuries but increased at higher ISS. Among upper cervical injuries, the probability of a severe fracture increased by 5.95 times in the presence of facial associated injuries. Abstract: Introduction: Traumatic spinal injuries are frequent and their management is debated, especially in major trauma patients. This study aims to describe a large population of major trauma patients with vertebral fractures to improve prevention measures and fracture management. Patients and methods: Retrospective analysis of 6274 trauma patients prospectively collected between October 2010 and October 2020. Collected data include demographics, mechanism of trauma, type of imaging, fracture morphology, associated injuries, injury severity score (ISS), survival, and death timing. The statistical analysis focused on mechanism of trauma and the search of predictive factors for critical fractures. Results: Patients showed a mean age of 47 years and 72.5% were males. Trauma included 59.9% of road accidents and 35.1% of falls. 30.7% patients had at least a severe fracture, while 17.2% had fractures in multiple spinal regions. 13.7% fractures were complicated by spinal cord injury (SCI). The mean ISS of the total population was 26.4 (SD 16.3), with 70.7% patients having an ISS≥16. There is a higher rate of severe fractures in fall cases (40.1%) compared to RA (21.9% to 26.3%). The probability of a severe fracture increased by 164% in the case of fall and by 77% in presence of AIS≥3 associated injury of head/neck while reduced by 34% in presence of extremities associated injuries. Multiple level injuries increased with ISS rise and in the case of extremities associated injuries. The probability of a severe upper cervical fracture increased by 5.95 times in the presence of facial associated injuries. The mean length of stay was 24.7 days and 9.6% of patients died. Conclusions: In Italy, road accidents are still the most frequent trauma mechanism and cause more cervico-thoracic fractures, while falls cause more lumbar fractures. Spinal cord injuries represent an indicator of more severe trauma. In motorcyclists or fallers/jumpers, there is a higher risk of severe fractures. When a spinal injury is diagnosed, the probability of a second vertebral fracture is consistent. These data could help the decisional workflow in the management of major trauma patients with vertebral injury.