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European Review For Medical and... Dec 2021Traumatic spinal injury (TSI) is a serious trauma-related injury with a significant risk for mortality and morbidity. Road traffic accident (RTA) is the leading cause...
OBJECTIVE
Traumatic spinal injury (TSI) is a serious trauma-related injury with a significant risk for mortality and morbidity. Road traffic accident (RTA) is the leading cause for the spinal and orthopedic injuries globally. Detailed information on the association of orthopedic fractures with TSI and its influence on outcomes is lacking. In this study, RTA-related TSI with orthopedic associated fractures in terms of demographics, prevalence, patterns, and outcomes were studied.
PATIENTS AND METHODS
This was a single-center retrospective study conducted over ten years in the largest tertiary hospital in Southern Saudi Arabia. A total of 184 patients suffered TSI associated with orthopedic fractures out of the 810 RTA-related TSIs (22.71%) were recruited. The majority was males (86%), and 55% of the cohort was between 21-40 years.
RESULTS
The commonest spinal injury level was lumbar (25%) followed by the sacral spine (24.5%), while multiple regions orthopedic fractures and fracture pelvis were the commonest orthopedic fractures, 27.2% and 25%, respectively. The mortality rate was 4.3% and significantly correlated with the spinal injury level (p=.018). The region of orthopedic fracture has significant associations with the gender and hospital length of stay (p=.020 and p=.005, respectively). We also found a significant association between the spinal injury level and orthopedic fracture location (p<0001).
CONCLUSIONS
Traumatic spinal injuries due to traffic accidents are commonly associated with orthopedic fractures. This association has distinct patterns and influences the patient's outcomes.
Topics: Accidents, Traffic; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Fractures, Bone; Humans; Infant; Infant, Newborn; Male; Middle Aged; Retrospective Studies; Saudi Arabia; Spinal Injuries; Young Adult
PubMed: 34982450
DOI: 10.26355/eurrev_202112_27636 -
Clinical Spine Surgery Mar 2023The Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification hierarchically separates fractures based on their injury severity with A-type... (Review)
Review
The Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification hierarchically separates fractures based on their injury severity with A-type fractures representing less severe injuries and C-type fractures representing the most severe fracture types. C0 fractures represent moderately severe injuries and have historically been referred to as nondisplaced "U-type" fractures. Injury management of these fractures can be controversial. Therefore, the purpose of this narrative review is to first discuss the Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification System and describe the different fracture types and classification modifiers, with particular emphasis on C0 fracture types. The narrative review will then focus on the epidemiology and etiology of C0 fractures with subsequent discussion focused on the clinical presentation for patients with these injuries. Next, we will describe the imaging findings associated with these injuries and discuss the injury management of these injuries with particular emphasis on operative management. Finally, we will outline the outcomes and complications that can be expected during the treatment of these injuries.
Topics: Humans; Spinal Fractures; Spinal Injuries; Sacrum; Fractures, Bone; Retrospective Studies
PubMed: 36006406
DOI: 10.1097/BSD.0000000000001384 -
International Journal of Surgery... Dec 2023Traumatic spinal injury (TSI) is associated with significant fatality and social burden; however, the epidemiology and treatment of patients with TSI in the US remain...
BACKGROUND
Traumatic spinal injury (TSI) is associated with significant fatality and social burden; however, the epidemiology and treatment of patients with TSI in the US remain unclear.
MATERIALS AND METHODS
An adult population was selected from the National Inpatient Sample database from 2016 to 2019. TSI incidence was calculated and TSI-related hospitalizations were divided into operative and nonoperative groups according to the treatments received. TSIs were classified as fracture, dislocation, internal organ injury, nerve root injury, or sprain injuries based on their nature. The annual percentage change (APC) was calculated to identify trends. In-hospital deaths were utilized to evaluate the prognosis of different TSIs.
RESULTS
Overall, 95 047 adult patients were hospitalized with TSI in the US from 2016 to 2019, with an incidence rate of 48.4 per 100 000 persons in 2019 (95% CI: 46.2-50.6). The total incidence increased with an APC of 1.5% (95% CI: 0.1-3%) from 2016 to 2019. Operative TSI treatment was more common than nonoperative (32.8 vs. 3.8; 95% CI: 32.3-33.2 vs. 3.6-4%). The number of operations increased from 37 555 (95% CI: 34 674-40 436) to 40 460 (95% CI: 37 372-43 548); however, the operative rate only increased for internal organ injury (i.e. spinal cord injury [SCI])-related hospitalizations (APC, 3.6%; 95% CI: 2.8-4.4%). In-hospital mortality was highest among SCI-related hospitalizations, recorded at 3.9% (95% CI: 2.9-5%) and 28% (95% CI: 17.9-38.2%) in the operative and nonoperative groups, respectively.
CONCLUSIONS
The estimated incidence of TSI in US adults increased from 2016 to 2019. The number of operations increased; however, the proportion of operations performed on TSI-related hospitalizations did not significantly change. In 2019, SCI was the highest associated mortality TSI, regardless of operative or nonoperative treatment.
Topics: Adult; Humans; United States; Retrospective Studies; Spinal Injuries; Spinal Cord Injuries; Hospitalization; Hospital Mortality
PubMed: 37678281
DOI: 10.1097/JS9.0000000000000696 -
Traffic Injury Prevention 2022The objective was to develop a disability-based metric for quantifying disability rates as a result of motor vehicle crash (MVC) spine injuries and compare functional...
OBJECTIVE
The objective was to develop a disability-based metric for quantifying disability rates as a result of motor vehicle crash (MVC) spine injuries and compare functional outcomes between pediatric and adult subgroups.
METHODS
Disability rate was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System for the top 95% most frequent Abbreviated Injury Scale (AIS) 3 spine injuries (14 unique injuries). Pediatric (7-18 years), young adult (19-45 years), middle-aged adult (46-65 years), and older adult (66+ years) MVC occupants with FIM scores available and at least one of the 14 spine injuries were included. FIM scores of 1 or 2 at time of discharge were used to define disability and correspond to full functional or modified dependence in self-feeding, locomotion, and/or verbal expression. Disability rate was evaluated on a per injury basis for each AIS 3 spine injury and calculated as the proportion of cases associated with disability (i.e. FIM of 1 or 2) out of the total cases of that particular injury. Disability rates were calculated with and without the exclusion of cases with severe co-injuries (AIS 4+) to minimize bias from additional non-spinal injuries that could have contributed to disability. Associations between adjusted disability rates and existing mortality rates were investigated.
RESULTS
Locomotion impairment alone was the most frequent disability type for the top 14 AIS 3 spine injuries (7 cervical, 4 thoracic, and 3 lumbar) across all age groups and spine regions. Adjusted and unadjusted disability rates ranged from 0-69%. Adjusted disability rates increased with age: 14.8 ± 10% (mean ± SD) in pediatrics to 16.2 ± 6.6% (young adults), 29.2 ± 10.9% (middle-aged adults), and 45.0 ± 12.2% (older adults). Among all adult populations, adjusted mortality and disability rates were positively correlated (>0.24), with disability rates consistently greater than corresponding mortality rates.
CONCLUSIONS
Older adults had significantly greater disability rates associated with MVC spine injuries across all spinal regions. MVC disability rates for pediatrics were considerably lower. Overall, rates of mortality were significantly lower than rates of disability. The adjusted disability rates developed can supplement existing injury metrics by accounting for age- and location-specific functional implications of MVC spine injuries.
Topics: Abbreviated Injury Scale; Accidents, Traffic; Adolescent; Aged; Child; Humans; Middle Aged; Motor Vehicles; Pediatrics; Spinal Injuries; Young Adult
PubMed: 35709315
DOI: 10.1080/15389588.2022.2086980 -
Journal of Athletic Training Jun 2020Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with...
INTRODUCTION
Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs.
METHODS
A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review.
RESULTS
The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved.
CONCLUSIONS
These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.
Topics: Athletic Injuries; Emergency Medical Services; Football; Humans; Neck Injuries; Spinal Injuries; Sports Medicine; United States
PubMed: 32579668
DOI: 10.4085/1062-6050-0434.19 -
European Journal of Trauma and... Oct 2022The purpose of this study was to evaluate whether prolonged re-boarding of restraint children in motor vehicle accidents is sufficient to prevent severe injury.
PURPOSE
The purpose of this study was to evaluate whether prolonged re-boarding of restraint children in motor vehicle accidents is sufficient to prevent severe injury.
METHODS
Data acquisition was performed using the Trauma Register DGU® (TR-DGU) in the time period from 2010 to 2019 of seriously injured children (AIS 2 +) aged 0-5 years as motor vehicle passengers (MVP). Primarily treated and transferred patients where included.
RESULTS
The study group included 727 of 2030 (35.8%) children, who were severely injured (AIS 2 +) in road traffic accidents, among them 268 (13.2%) as MVPs in the age groups: 0-1 years (42.5%), 2-3 years (26.1%) and 4-5 years (31.3%). The pattern of severe injury was head/brain (56.0%), thoracic (42.2%), abdominal (13.1%), fractures (extremities and pelvis, 52.6%) and spine/severe whiplash (19.8%). The 0-1-year-old MVPs showed the significantly highest proportion of brain injuries with Glasgow Coma Score (GCS) < 8 and severe injury to the spine. The 2-3-year-olds showed the significantly highest proportion of fractures especially the lower extremity and highest proportion of cervical spine injuries of all spine injuries, while the 4-5-year-olds, the significantly highest proportion of abdominal injury and second highest proportion of cervical spine injury of all spine injuries. MVPs of the 0-1-year-old and 2-3-year-old groups showed a higher median Injury Severity Score (ISS) of 21.5 and 22.1 points than the older children (17.0 points). They also suffered an AIS-6-injury significantly more often (9 of 21) of spine (p = 0.001). Especially the cervical spine was significantly more often involved. Passengers at the age of 0-1 years were treated with cardiopulmonary resuscitation (CPR) three times as often as older children in the prehospital setting and twice as often at admission in the Trauma Resuscitation Unit (TRU). Their survival rate was 7 out of 8 (0-1 years), 1 out of 6 (2-3 years) and 1 out of 4 (4-5 years).
CONCLUSION
Although the younger MVPs are restraint in a re-boarding position, severe injury to the spine and head occurred more often, while older children as front-faced positioned MVPs suffered from significantly higher rates of abdominal and more often severe facial injury. Our data show, that it is more important to properly restrain children in their adequate car seats (i-size-Norm) and additionally consider the age-related physiological and anatomical specific risks of injury as well as co-factors in road traffic accidents, than only prolonging the re-boarding position over the age of 15 months as a single method.
Topics: Accidents, Traffic; Adolescent; Child; Child, Preschool; Fractures, Bone; Humans; Infant; Infant, Newborn; Injury Severity Score; Motor Vehicles; Spinal Injuries; Trauma Centers
PubMed: 35364691
DOI: 10.1007/s00068-022-01917-y -
Advances in Clinical and Experimental... 2012The spine as a motor organ is very often exposed to the action of forces released by an injury. The most frequent cause of spine and spinal cord injuries are traumas...
BACKGROUND
The spine as a motor organ is very often exposed to the action of forces released by an injury. The most frequent cause of spine and spinal cord injuries are traumas which are the result of accidents, and untreated osteoporosis or neoplasms as well.
OBJECTIVES
Aim of the study is an analysis of the causes of spine and spinal cord injuries as well as of the complications of these injuries.
MATERIAL AND METHODS
The material covers 130 patients hospitalized due to spine injury in 2008-2010 at the Clinical Department of Neurosurgery of Wroclaw Medical University. The data has been obtained on the basis of an analysis of medical and nursing documentation.
RESULTS
In the research group, men (64%) prevail over women (36% of the respondents). Most often, spine injuries affected patients aged over 60. Spine injuries without spinal cord injury comprised 84.6%, whereas with spinal cord injury only 15.4%. About 75% of the examined patients were admitted to the department as emergency admissions, within the time exceeding 12 hours since an injury occurrence (58.5%). The vast majority of patients (80%) were treated surgically. After completing treatment, most of the respondents were discharged (71.5%). After leaving the hospital, over half of the patients (52.3%) were not able to move on their own.
CONCLUSIONS
The most common causes of spine injuries in patients are pathologic injuries (28.5%), traffic collisions (27.7%) and falls from heights (20.0%). To the largest degrees, spine injuries concerned the thoracic segment (in 34.6%), cervical segment (32.3%) and lumbar (23.8%). Complications occurring after spine injuries included pain of a damaged spine segment (61.1%), pain in other location (36.6%) and gastroenterological complications (17.6%). In the case of complications after spine and spinal cord injuries, gastroenterological complications predominate (in 42.9% patients) along with complications of the urinary system (38.1%) and pain of the injured spine segment (38.1%).
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Spinal Cord Injuries; Spinal Injuries; Young Adult
PubMed: 23240453
DOI: No ID Found -
Journal of the American Academy of... Oct 2022In the management of a trauma patient with cervical spine injury, the need for accurate diagnostic imaging is key to ensure correct management. Different classification...
BACKGROUND
In the management of a trauma patient with cervical spine injury, the need for accurate diagnostic imaging is key to ensure correct management. Different classification systems have been developed including the Subaxial Injury Classification (SLIC) system and AO cervical spine fracture classification. Through a multicentre study, we have identified a group of cases where the use of CT alone to classify fractures by either SLIC or AO score may be deficient and the use of dynamic cervical spine radiographs could help identify instability.
METHODS
Three level 1 trauma centers retrospectively reviewed patients with cervical spine injuries. Cervical spine radiographs (AP and lateral) were undertaken in collar, in all patients with suspected cervical spine injury within 2 weeks, followed by reanalysis of scoring systems.
RESULTS
Eleven cases were identified in total, and 72% were male with a mean age of 65 years, with approximately 54% being older than 70 years. All patients reported their pain as severe using the Visual Analogue Scale scale. The predynamic radiograph mean SLIC score was 0.73, which is in contrast to the postdynamic radiograph mean SLIC score of 6. The statistical significance (P = 0.004) was found using the Wilcoxon signed-rank test.
CONCLUSION
Supine imaging eliminates the gravitational loads normally exerted on the c-spine. The cases show assumed cervical stability based on CT, but dynamic c-spine radiographs subsequently demonstrated instability. Therefore, we suggest a combination of SLIC and AO classification using radiologic imaging to classify fracture and correlate clinical symptoms with persistent neck pain, which warrants a Miami-J collar and dynamic c-spine radiograph to assess stability with re-evaluation of scoring.
Topics: Humans; Male; Aged; Female; Retrospective Studies; Spinal Fractures; Spinal Injuries; Cervical Vertebrae; Radiography; Neck Injuries
PubMed: 36734645
DOI: 10.5435/JAAOSGlobal-D-22-00067 -
European Journal of Trauma and... Jun 2021Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but...
PURPOSE
Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but currently not available. As a step in developing such a protocol, we determined the incidence of cervical spine injury and the degree of protocol adherence at our level 2 trauma centre.
METHODS
We analysed data from all patients aged < 16 years suspected of cervical spine injury after blunt trauma who had presented to our hospital during two periods: January 2010 to June 2012, and January 2017 to June 2019. In the intervening period, the imaging protocol for diagnostic workup was updated. Outcomes were the incidence of cervical spine injury and protocol adherence in terms of the indication for imaging and the type of imaging.
RESULTS
We included 170 children in the first study period and 83 in the second. One patient was diagnosed with cervical spine injury. Protocol adherence regarding the indication for imaging was > 80% in both periods. Adherence regarding the imaging type decreased over time, with 45.8% of the patients receiving a primary CT scan in the second study period versus 2.9% in the first.
CONCLUSION
Radiographic imaging is frequently performed when clearing the paediatric cervical spine, although cervical spine injury is rare. Particularly CT scan usage has wrongly been emerging over time. Stricter adherence to current protocols could limit overuse of radiographic imaging, but ultimately there is a need for an accurate rule predicting which children really are at risk of injury.
Topics: Aged; Cervical Vertebrae; Child; Humans; Magnetic Resonance Imaging; Retrospective Studies; Spinal Injuries; Tomography, X-Ray Computed; Trauma Centers; Wounds, Nonpenetrating
PubMed: 33108476
DOI: 10.1007/s00068-020-01520-z -
Scientific Reports Apr 2020There is currently no established injury criterion for the spine in compression with lateral load components despite this load combination commonly contributing to...
There is currently no established injury criterion for the spine in compression with lateral load components despite this load combination commonly contributing to spinal injuries in rollover vehicle crashes, falls and sports. This study aimed to determine an injury criterion and accompanying tolerance values for cervical spine segments in axial compression applied with varying coronal plane eccentricity. Thirty-three human cadaveric functional spinal units were subjected to axial compression at three magnitudes of lateral eccentricity of the applied force. Injury was identified by high-speed video and graded by spine surgeons. Linear regression was used to define neck injury tolerance values based on a criterion incorporating coronal plane loads accounting for specimen sex, age, size and bone density. Larger coronal plane eccentricity at injury was associated with smaller resultant coronal plane force. The level of coronal plane eccentricity at failure appears to distinguish between the types of injuries sustained, with hard tissue structure injuries more common at low levels of eccentricity and soft tissue structure injuries more common at high levels of eccentricity. There was no relationship between axial force and lateral bending moment at injury which has been previously proposed as an injury criterion. These results provide the foundation for designing and evaluating strategies and devices for preventing severe spinal injuries.
Topics: Adult; Aged; Aged, 80 and over; Biomechanical Phenomena; Cadaver; Crush Injuries; Female; Humans; Male; Middle Aged; Neck Injuries; Spinal Injuries; Weight-Bearing
PubMed: 32346007
DOI: 10.1038/s41598-020-63974-w