title: Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study.
abstract: This is a European cohort study on predictors of spinal injury in adult (≥16 years) major trauma patients, using prospectively collected data of the Trauma Audit and Research Network from 1988 to 2009. Predictors for spinal fractures/dislocations or spinal cord injury were determined using univariate and multivariate logistic regression analysis. 250,584 patients were analysed. 24,000 patients (9.6%) sustained spinal fractures/dislocations alone and 4,489 (1.8%) sustained spinal cord injury with or without fractures/dislocations. Spinal injury patients had a median age of 44.5 years (IQR = 28.8-64.0) and Injury Severity Score of 9 (IQR = 4-17). 64.9% were male. 45% of patients suffered associated injuries to other body regions. Age <45 years (≥45 years OR 0.83-0.94), Glasgow Coma Score (GCS) 3-8 (OR 1.10, 95% CI 1.02-1.19), falls >2 m (OR 4.17, 95% CI 3.98-4.37), sports injuries (OR 2.79, 95% CI 2.41-3.23) and road traffic collisions (RTCs) (OR 1.91, 95% CI 1.83-2.00) were predictors for spinal fractures/dislocations. Age <45 years (≥45 years OR 0.78-0.90), male gender (female OR 0.78, 95% CI 0.72-0.85), GCS <15 (OR 1.36-1.93), associated chest injury (OR 1.10, 95% CI 1.01-1.20), sports injuries (OR 3.98, 95% CI 3.04-5.21), falls >2 m (OR 3.60, 95% CI 3.21-4.04), RTCs (OR 2.20, 95% CI 1.96-2.46) and shooting (OR 1.91, 95% CI 1.21-3.00) were predictors for spinal cord injury. Multilevel injury was found in 10.4% of fractures/dislocations and in 1.3% of cord injury patients. As spinal trauma occurred in >10% of major trauma patients, aggressive evaluation of the spine is warranted, especially, in males, patients <45 years, with a GCS <15, concomitant chest injury and/or dangerous injury mechanisms (falls >2 m, sports injuries, RTCs and shooting). Diagnostic imaging of the whole spine and a diligent search for associated injuries are substantial.
authors.affiliation: Trauma Audit and Research Network (TARN), Health Sciences Research Group, School of Community Based Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal Hospital, Stott Lane, Salford M6 8HD, UK. rebecca.hasler@gmail.com
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Hasler
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos
authors.forename: Omar
authors.initials: O
authors.lastname: Bouamra
authors.forename: Lorin M
authors.initials: LM
authors.lastname: Benneker
authors.forename: Mike
authors.initials: M
authors.lastname: Clancy
authors.forename: Robert
authors.initials: R
authors.lastname: Sieber
authors.forename: Heinz
authors.initials: H
authors.lastname: Zimmermann
authors.forename: Fiona
authors.initials: F
authors.lastname: Lecky
mesh_terms: D000058:Accidental Falls; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology*; D013124:Spinal Injuries / Q000453:epidemiology*