Timing of thoracic spine stabilization in trauma patients: impact on clinical course and outcome.
BACKGROUND
Optimal timing of stabilization for thoracic spine injuries in multiply injured patients is still controversial because additional lung injury occurs frequently. Early operation might benefit clinical course and outcome in these patients.


METHODS
We analyzed the German National Trauma Database (n = 8,057) and compared clinical parameters and outcome of patients with severe thoracic spine injuries (Abbreviated Injury Scale >2; n = 298) who underwent spine stabilization within 72 hours posttrauma (group I) or later (group II).


RESULTS
In all, 95% of all patients had additional severe thoracic injuries such as lung contusion. In spite of comparable demographic data, patients in group I had a significant shorter intensive care unit (ICU) stay (median [range]: group I, 8 [0-237] days; group II, 16 [2-91] days; p = 0.001), shorter dependence on mechanical ventilation (group I: 2 [0-48] days; group II: 5 [0-91] days; p = 0.02), and shorter hospital stay (group I: 22 [1-255] days; group II: 31 [2-274] days; p = 0.048). Expected mortality calculated by Trauma and Injury Severity Score was significantly reduced in group I (calculated: 16%; documented: 6%; p < 0.05) but not in group II (19% versus 17%; p = NS).


CONCLUSIONS
Almost 10% of all patients in the German National Trauma Registry had severe spine injuries. Severe thoracic injuries occurred in 95% of these patients with thoracic spine trauma. We provide further evidence that early stabilization of thoracic spine injuries in trauma patients reduces overall hospital and ICU stay and improves outcome. Thus early stabilization of thoracic spine injuries within 3 days after trauma appears to be favorable.
Schinkel
Christian
C
Berufsgenossenschaftliche Kliniken Bergmannsheil, Department of Surgery, Ruhr University, Bochum, Germany. christian.schinkel@ruhr-uni-bochum.de
Frangen
Thomas M
TM
Kmetic
Andrej
A
Andress
Hans-Joachim
HJ
Muhr
Gert
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005592:Fracture Fixation; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy*; D012121:Respiration, Artificial; D016103:Spinal Fractures / Q000601:surgery*; D016019:Survival Analysis; D013904:Thoracic Vertebrae; D013997:Time Factors; D016896:Treatment Outcome