Functional outcome in trauma patients with spinal injury.
METHODS
A retrospective data analysis of all trauma patients admitted the Helicopter Emergency Medical Service was performed.


OBJECTIVE
To assess the long-term outcome of trauma patients with spinal injuries using Functional Independence Measure scores.


BACKGROUND
Mortality after severe multiple trauma is well documented. However, evaluating morbidity in survivors of multiple trauma is complex, and less information is available regarding functional outcome. There are very few systems that can effectively predict the outcome for patients sustaining multiple trauma with spinal injuries. The Functional Independence Measure scoring system, which is easy to use, can be used to assess disability after hospital discharge, and may also be used to predict the long-term outcome for patients after spinal injuries.


METHODS
The records of 1500 trauma patients admitted over a 6-year period by the Helicopter Emergency Medical Service were examined. All patients with documented injuries to the spinal column were selected for study. The distribution and pattern of spinal injury, the injury severity score, and the radiologic findings were determined for each patient, along with clinical outcome measures at 1 year using Functional Independence Measure scores.


RESULTS
Among the 1500 trauma patients, 263 patients (17.5%) (195 men and 68 women; mean age, 37 years; range, 3-92 years) had sustained an injury to the spinal column. Mortality (70/263; 27%) was significantly higher (P < 0.02) in these patients than in those without spinal injury (247/1237; 20%). Injury severity scores higher than 16 were found in 96 patients (55%). The median Functional Independence Measure score was 40 on admission, 86 at discharge from the hospital, 113 at 3 months, 119 at 6 months, and 124 at 12 months. There was significant correlation between discharge Functional Independence Measure (FIM) scores (FIM = 86) and 12-month FIM scores (FIM = 124) (P < 0.01).


CONCLUSIONS
Most of the patients had poor initial Functional Independence Measure scores, but there was significant improvement by 12 months. Discharge FIM scores were a good indicator for functional outcome at one year.
Akmal
Mohammed
M
Department of Surgery, The Royal London Hospital, Whitechapel, London. M.Akmal@orthopaedics.com
Trivedi
Rikin
R
Sutcliffe
John
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances / Q000706:statistics & numerical data; D006259:Craniocerebral Trauma / Q000401:mortality / Q000534:rehabilitation; D004185:Disability Evaluation; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005121:Extremities / Q000293:injuries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000534:rehabilitation; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000401:mortality / Q000534:rehabilitation*; D017741:Survivors / Q000706:statistics & numerical data*; D013995:Time; D015599:Trauma Severity Indices