title: In-hospital mortality and surgical utilization in severely polytraumatized patients with and without spinal injury.
abstract: BACKGROUND
  Patients who sustain major trauma experience multisystem injuries including those affecting the spine. We hypothesize that recovery after spinal injuries differs from those affecting other systems. The purpose of our study was to compare in-hospital mortality and surgical resource utilization in severely polytraumatized patient with and without spinal injury.
  
  
  METHODS
  We assembled a cohort of patients with severe polytrauma (Injury Severity Score [ISS]>15) and spinal injury and matched them to a cohort without spinal injury for age, gender, ISS, and mechanism of injury. In patients presenting to a Level I trauma center, we compared in-hospital patient mortality, the number of surgical procedures, and duration required for ventilatory support, intensive care unit (ICU) length of stay (LOS), and in-hospital LOS comparing matched groups. We performed a subanalysis of those who sustained severe fracture types and those with neurologic impairment.
  
  
  RESULTS
  From 114 matched pairs, we found no significant differences in mortality rates or numbers of surgical procedures performed between the groups. Patients with spine injury, however, were observed to experience a prolonged duration of ventilation, ICU and in-hospital LOS compared with their matched cohort. Severe fracture patterns and the presence of neurologic involvement amplified the effect on these outcomes.
  
  
  CONCLUSIONS
  In this study, we conclude that the presence of a spinal injury in the setting of severe polytrauma (ISS>15) is associated with a prolonged course of ventilatory support, ICU, and in-hospital LOS. Trauma hospitals treating patients with spinal fracture should be aware of differences in the use of health services for this patient population.
authors.affiliation: Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA 92868, USA. sbederma@uci.edu
authors.forename: S Samuel
authors.initials: SS
authors.lastname: Bederman
authors.forename: Olivia
authors.initials: O
authors.lastname: Murnaghan
authors.forename: Harsha
authors.initials: H
authors.lastname: Malempati
authors.forename: Edward
authors.initials: E
authors.lastname: Lansang
authors.forename: Marc
authors.initials: M
authors.lastname: Wilkinson
authors.forename: Edward
authors.initials: E
authors.lastname: Johnston
authors.forename: Yigal
authors.initials: Y
authors.lastname: Bronstein
authors.forename: Joel A
authors.initials: JA
authors.lastname: Finkelstein
authors.forename: Albert J M
authors.initials: AJ
authors.lastname: Yee
mesh_terms: D000328:Adult; D000367:Age Factors; D016001:Confidence Intervals; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009104:Multiple Trauma / Q000401:mortality* / Q000601:surgery; D016017:Odds Ratio; D016012:Poisson Distribution; D012121:Respiration, Artificial / Q000401:mortality / Q000706:statistics & numerical data; D012737:Sex Factors; D013124:Spinal Injuries / Q000401:mortality* / Q000601:surgery; D016019:Survival Analysis