title: Early predictors of functional disability after spine trauma: a level 1 trauma center study.
abstract: METHODS
  Retrospective review on prospective cohort and explicit chart review.
  
  
  OBJECTIVE
  To identify early spine trauma predictors of functional disability and to assess management compliance to established spine trauma treatment algorithms.
  
  
  BACKGROUND
  Identification of early (within 48 hours) spine trauma predictors of functional disability is novel and may assist in the management of patients with trauma. Also, with significant global variation, spine trauma treatment algorithms are essential.
  
  
  METHODS
  Analysis was performed on patients with spine trauma from May 1, 2009, to January 1, 2011. Functional outcomes were determined using the Glasgow Outcome Scale (GOS) at 1 year. Univariate and multivariate regressions were applied to investigate the effects of the injury severity score, age, blood sugar level, vital signs, traumatic brain injury, comorbidities, coagulation profile, neurology, and spine injury characteristics. A compliance study was performed using the SLIC and TLICS spine trauma algorithms.
  
  
  RESULTS
  The completion rate for the GOS was 58.8%. The completed GOS cohort was 4.2 years younger in terms of mean age, had more number of patients with severe polytrauma, but less number of patients with severe spinal cord injuries (ASIA [American Spinal Injury Association] A, B, and C) in comparison with the uncompleted GOS cohort. Multivariate logistic regression revealed 3 independent early spine trauma predictors of functional disability with statistical significance (P < 0.05). They were (1) hypotension (OR [odds ratio] = 1.98; CI [confidence interval] = 1.13-3.49), (2) hyperglycemia (OR = 1.67; CI = 1.09-2.56), and (3) moderate/severe traumatic brain injury (OR = 5.88; CI = 1.71-20.16). There were 305 patients with subaxial cervical spine injuries and 653 patients with thoracolumbar spine injuries. The subaxial cervical spine injury classification and thoracolumbar injury classification and severity score compliance studies returned agreements of 96.1% and 98.9%, respectively.
  
  
  CONCLUSIONS
  Early independent spine trauma predictors of functional disability identified in a level 1 trauma center with high compliance to the subaxial cervical spine injury classification and thoracolumbar injury classification and severity score algorithms were hypotension, hyperglycemia, and moderate or severe traumatic brain injury. Spine trauma injury variables alone were shown not to be predictive of functional disability.
  
  
  METHODS
  3.
authors: *Department of Neurosurgery, The Alfred, Melbourne, Australia †Trauma Service, The Alfred, Melbourne, Australia ‡Department of Surgery, Monash University, Melbourne, Australia §Department of Emergency Medicine, The Alfred, Melbourne, Australia ¶Department of Orthopaedics, The Alfred, Melbourne, Australia; and ‖National Trauma Research Institute, Melbourne, Australia.
authors: Jin W
authors: JW
authors: Tee
authors: Patrick C H
authors: PC
authors: Chan
authors: Mark C B
authors: MC
authors: Fitzgerald
authors: Susan M
authors: SM
authors: Liew
authors: Jeffrey V
authors: JV
authors: Rosenfeld
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015897:Comorbidity; D019091:Critical Pathways; D004185:Disability Evaluation; D042241:Early Diagnosis; D005260:Female; D015600:Glasgow Coma Scale; D019983:Guideline Adherence; D006801:Humans; D015601:Injury Severity Score; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013124:Spinal Injuries / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D013131:Spine / Q000503:physiopathology*; D013997:Time Factors; D014193:Trauma Centers / Q000592:standards