Factors that predict poor outcomes in patients with traumatic vertebral body fractures.
METHODS
Prospective cohort study.


OBJECTIVE
To identify factors that predict poor patient-reported outcomes in patients with traumatic vertebral body fracture(s) of the thoracic and/or lumbar spine without neurological deficit.


BACKGROUND
There is a paucity of information on factors that predict poor patient-reported outcomes in patients with traumatic vertebral body fracture(s) of the thoracic and/or lumbar spine without neurological deficit.


METHODS
Patients were identified from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). VOTOR includes all patients with orthopaedic trauma admitted to the two adult Level 1 trauma centres in Victoria, Australia. Patient-reported outcomes and data on possible predictive factors, including demographic details, injury-related and treatment-based factors, were obtained from the VOTOR database. Patient-reported outcomes were measured at 12 months post-injury using the 12-Item Short-Form Health Survey (SF-12), a Numerical Rating Scale (NRS) for pain, global outcome questions and data was collected on return to work or study. For the identification of predictive factors, univariate analyses of outcome vs. each predictor were carried out first, followed by logistic multiple regression.


RESULTS
344 patients were eligible for the study and data were obtained for 264 (76.7%) patients at 12 months follow-up. Patients reported ongoing pain at 12 months post-injury (moderate-severe: 33.5%), disability (70.1%) and inability to return to work or study (23.3%). A number of demographic, injury-related and treatment-based factors were identified as being predictive of poor patient-reported outcomes. Patients who had associated radius fracture(s) were more likely to have moderate to severe disability (odds ratio (OR)=3.85, 95% confidence interval=1.30-11.39), a poorer physical health status (OR=3.73, 1.37-10.12) and moderate to severe pain (OR=3.23, 1.22-8.56) at 12 months post-injury than patients without radius fracture. Patients who did not receive compensation for work-related or road traffic-related injuries were less likely to report moderate to severe pain (OR=0.45, 0.23-0.90) or have a poorer mental health status (OR=0.17, 0.04-0.70) at 12 months post-injury than those who received compensation.


CONCLUSIONS
The prognostic factors identified in this study may assist clinicians in the identification of patients requiring more intensive follow-up or additional rehabilitation to ultimately improve patient care.
Yang
Zi
Z
Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Melbourne, Australia. z.yang2@ugrad.unimelb.edu.au
Lowe
Adrian J
AJ
de la Harpe
David E
DE
Richardson
Martin D
MD
D000293:Adolescent; D000328:Adult; D000368:Aged; D035881:Compensation and Redress; D004185:Disability Evaluation; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D016103:Spinal Fractures / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D013904:Thoracic Vertebrae / Q000293:injuries*; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult