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Early Predictors of Functional Disability After Spine Trauma: A Level 1 Trauma Center Study

Tee, Jin W. MBBS*,†,‡; Chan, Patrick C. H. MD, FRACS*,‡; Fitzgerald, Mark C. B. MD, FACEM†,‡,§; Liew, Susan M. MD, FRACS‡,¶; Rosenfeld, Jeffrey V. MD, MS, FRACS, FRCS (Edin), FACS*,‡,‖

Spine:
doi: 10.1097/BRS.0b013e31828432a3
Clinical Case Series
Abstract

Study Design. Retrospective review on prospective cohort and explicit chart review.

Objective. To identify early spine trauma predictors of functional disability and to assess management compliance to established spine trauma treatment algorithms.

Summary of Background Data. Identification of early (within 48 hours) spine trauma predictors of functional disability is novel and may assist in the management of patients with trauma. Also, with significant global variation, spine trauma treatment algorithms are essential.

Methods. Analysis was performed on patients with spine trauma from May 1, 2009, to January 1, 2011. Functional outcomes were determined using the Glasgow Outcome Scale (GOS) at 1 year. Univariate and multivariate regressions were applied to investigate the effects of the injury severity score, age, blood sugar level, vital signs, traumatic brain injury, comorbidities, coagulation profile, neurology, and spine injury characteristics. A compliance study was performed using the SLIC and TLICS spine trauma algorithms.

Results. The completion rate for the GOS was 58.8%. The completed GOS cohort was 4.2 years younger in terms of mean age, had more number of patients with severe polytrauma, but less number of patients with severe spinal cord injuries (ASIA [American Spinal Injury Association] A, B, and C) in comparison with the uncompleted GOS cohort. Multivariate logistic regression revealed 3 independent early spine trauma predictors of functional disability with statistical significance (P < 0.05). They were (1) hypotension (OR [odds ratio] = 1.98; CI [confidence interval] = 1.13–3.49), (2) hyperglycemia (OR = 1.67; CI = 1.09–2.56), and (3) moderate/severe traumatic brain injury (OR = 5.88; CI = 1.71–20.16). There were 305 patients with subaxial cervical spine injuries and 653 patients with thoracolumbar spine injuries. The subaxial cervical spine injury classification and thoracolumbar injury classification and severity score compliance studies returned agreements of 96.1% and 98.9%, respectively.

Conclusion. Early independent spine trauma predictors of functional disability identified in a level 1 trauma center with high compliance to the subaxial cervical spine injury classification and thoracolumbar injury classification and severity score algorithms were hypotension, hyperglycemia, and moderate or severe traumatic brain injury. Spine trauma injury variables alone were shown not to be predictive of functional disability.

Level of Evidence: 3

In Brief

A prospective cohort study was performed. Multivariate regression identified hypotension, hyperglycaemia and moderate or severe traumatic brain injury as early spine trauma functional disability predictors. The compliance study showed excellent agreement between the spine trauma service and SLIC and TLICS algorithms.

Author Information

*Department of Neurosurgery, The Alfred, Melbourne, Australia

Trauma Service, The Alfred, Melbourne, Australia

Department of Surgery, Monash University, Melbourne, Australia

§Department of Emergency Medicine, The Alfred, Melbourne, Australia

Department of Orthopaedics, The Alfred, Melbourne, Australia; and

National Trauma Research Institute, Melbourne, Australia.

Address correspondence and reprint requests to Jin W. Tee, MBBS, Level 1, Old Baker Building, The Alfred, Commercial Road, Melbourne, 3004 Victoria, Australia; E-mail: Jin_Wee@hotmail.com

Acknowledgment date: November 29, 2012. Acceptance date: December 19, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No relevant financial activities outside the submitted work.

© 2013 Lippincott Williams & Wilkins, Inc.