Early predictors of mortality after spine trauma: a level 1 Australian trauma center study.
METHODS
Retrospective cohort study.


OBJECTIVE
To identify early independent mortality predictors after spine trauma.


BACKGROUND
Spine trauma consists of spinal cord and spine column injury. The ability to identify early (within 24 hours) risk factors predictive of mortality in spine trauma has the potential to reduce mortality and improve spine trauma management.


METHODS
Analysis was performed on 215 spine column and/or spinal cord injured patients from July 2008 to August 2011. Univariate and multivariate logistic regression models were applied to investigate the effects of the Injury Severity Score, age, mechanism of injury, blood glucose level, vital signs, brain trauma severity, morbidity before trauma, coagulation profile, neurological status, and spine injuries on the risk of in-hospital death.


RESULTS
Applying a multivariate logistic regression model, there were 7 independent early predictive factors for mortality after spine injury. They were (1) Injury Severity Score more than 15 (odds ratio [OR] = 3.67; P = 0.009), (2) abnormal coagulation profile (OR = 6; P < 0.0001), (3) patients 65 years or older (OR = 3.49; P = 0.007), (4) hypotension (OR = 2.9; P = 0.033), (5) tachycardia (OR = 4.04; P = 0.005), (6) hypoxia (OR = 2.9; P = 0.033), and (7) multiple comorbidities (OR = 3.49; P = 0.007). Severe traumatic brain injury was also associated with mortality but was excluded from multivariate analysis because there were no patients with this variable in the comparison group.


CONCLUSIONS
Mortality predictors for spine trauma patients are similar to those for general trauma patients. Spine injury variables were shown not to be independent predictors of spine trauma mortality.
Department of Neurosurgery, The Alfred, Commercial Road, Melbourne, Australia. Jin_Wee@hotmail.com
Jin W
JW
Tee
Patrick C H
PC
Chan
Russell L
RL
Gruen
Mark C B
MC
Fitzgerald
Susan M
SM
Liew
Peter A
PA
Cameron
Jeffrey V
JV
Rosenfeld
D000368:Aged; D001315:Australia / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000401:mortality; D013124:Spinal Injuries / Q000175:diagnosis* / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D015599:Trauma Severity Indices; D055986:Vital Signs