Retrospective review on prospective cohort and explicit chart review.
To identify early spine trauma
predictors of functional disability and to assess management compliance to established spine trauma
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.
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
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.
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