Identification of concomitant injuries associated with specific spine level fractures in polytrauma patients

• Published in: Injury 2022-03, Vol.53 (3), p.1068-1072
• Main Authors: Tang, Alex, Gambhir, Neil, Menken, Luke G., Shah, Jay K., D'Ambrosio, Matthew, Ramakrishnan, Vivek, Liporace, Frank A., Yoon, Richard S.
• Format: Article
• Language: English
• Subjects: Aged; Cervical; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - injuries; Glasgow Coma Scale; Humans; Injury; Injury Severity Score; Lumbar; Multiple Trauma - surgery; Polytrauma; Retrospective Studies; Skull Fractures - complications; Spinal Fractures - complications; Spinal Injuries - complications; Spinal Injuries - surgery; Spine; Thoracic
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2021.12.005

•Cervical spine fractures were associated with head trauma and bleeding, facial/skull fractures, cervical cord injuries, falls≤6m, and age≥65.•Thoracic spine fractures were only associated with rib fractures.•Lumbar fractures were associated with rib, pelvis/lower extremity fractures, thoracic/retroperitoneal visceral injuries, and falls>6m.•Inpatient mortality risk increased in patients with cervical spine fractures, higher injury severity scores, and lower Glascow coma scale. Spine fractures are associated with high energy mechanisms and can lead to substantial morbidity and mortality in the trauma setting. Rapid identification and treatment of these fractures and their associated injuries are paramount in preventing adverse outcomes. The purpose of this study is to identify concomitant skeletal and non-skeletal injuries related to cervical, thoracic, and lumbar fractures. A retrospective review of institutional American College of Surgeons (ACS) registry was conducted on 3,399 consecutive trauma patients identifying those with spine fractures from 1/2016–12/2019. Two-hundred ninety patients were included(8.5%) and separated into three groups based on fracture location: eighty-eight cervical(C)-spine, 129thoracic(T)-spine, and 143lumbar(L)-spine. Logistic regression analyses were performed to identify associated injuries, presenting injury severity score(ISS) and Glasgow coma scale(GCS), mechanism of injury, demographic data, substance use, and paralysis for each group. Cox hazard regression was utilized to identify factors associated with inpatient mortality. C-spine fractures were associated with head trauma(OR2.18,p = 0.003),intracranial bleeding (OR2.64,p = 0.001),facial(OR2.25,p = 0.02) and skull fractures(OR3.92,p = 0.001),and cervical cord injuries(OR4.78,p = 0.012). T-spine fractures were associated with rib fractures(OR2.31,p = 0.003). L-spine fractures were associated with rib(OR1.77, p = 0.04), pelvic(OR5.11,p6meters were associated with L-spine fractures(OR4.30,p = 0.001). Inpatient mortality risk increased in patients with C-spine fractures(HR4.41,p = 0.002), higher ISS(HR1.05, p