R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Neurocrit Care. 2010 Aug;13(1):29-39. doi: 10.1007/s12028-010-9359-9.
Traumatic injuries to the cervical spine cause significant disability. Much of the morbidity and mortality that occurs in patients afflicted with cervical spinal cord injury (SCI) occurs early after injury due to primary neurologic dysfunction, systemic inflammation, concomitant injuries, treatments to prevent and ameliorate secondary insults, and prolonged immobilization. This study was undertaken to determine the incidence of organ dysfunction and failure using validated measures: the Multiple Organ Dysfunction Score (MODS) and the Sequential Organ Failure Assessment (SOFA). We also sought to determine if certain patient or injury characteristics were associated with the development of organ dysfunction and failure.
All patients who sustained isolated blunt cervical SCIs admitted to the R Adams Cowley Shock Trauma Center over a 15-month period were identified. American Spinal Injury Association (ASIA) motor scores, ASIA impairment scale (AIS) scores, and level of injury were recorded. Admission, first daily, worst daily, and aggregate MOD and SOFA scores were assigned for each of six organ systems. A P < 0.05 was considered significant for all statistical tests.
Of 1,028 patients admitted with blunt spine injuries between January, 2007 and March, 2008, 40 patients were identified with an isolated cervical SCI that required an ICU length of stay (LOS) >24 h. Organ failure of at least one organ system occurred in 75% of patients as calculated by MOD score and 85% of patients calculated using SOFA criteria. Multiple organ failure was found in 55% by MOD and 62.5% by SOFA scores. The most frequent system to fail was the cardiovascular system by aggregate MODS (84%), while the respiratory system was the most frequently failed system by aggregate SOFA criteria (70%). There was a strong inverse correlation between ASIA motor score and aggregate MODS and SOFA scores (r = -0.56, P = 0.0002 and r = -0.51, P = 0.0009). AIS was also found to be inversely correlated with the development of organ failure (r = -0.47, P = 0.002 and r = -0.45, P = 0.004) while anatomic level of injury was found to correlate poorly with the incidence of organ failure (r = -0.11, P = 0.5 and r = -0.10, P = 0.5). Only ASIA motor score was significantly associated with sum aggregate organ dysfunction scores when controlling for age and injury severity score (parameter estimate = -0.082, P = 0.0005 for MODS and parameter estimate = -0.057, P = 0.006 for SOFA).
This study is the first to describe the incidence of organ dysfunction and failure in patients with isolated acute traumatic cervical SCI using validated organ system dysfunction scores. Respiratory, cardiovascular, neurologic, renal, hepatic, and hematologic dysfunction occurred commonly both on admission and over the ICU stay. Respiratory, cardiovascular, and neurologic failure were frequently found, while renal, hepatic, and hematologic failures were uncommon. Multiple organ failure occurred in the majority of patients. ASIA motor score and AIS were found to strongly correlate with the development of organ dysfunction and failure. Level of injury should be used with caution when describing the risk of complications and the need for medical interventions.
颈椎创伤会导致严重残疾。患有颈脊髓损伤（SCI）的患者中，很大一部分发病率和死亡率发生在损伤后的早期，原因是原发性神经功能障碍、全身炎症、合并损伤、预防和减轻二次损伤的治疗以及长时间固定。本研究旨在使用经过验证的测量方法确定器官功能障碍和衰竭的发生率：多器官功能障碍评分（MODS）和序贯器官衰竭评估（SOFA）。我们还试图确定某些患者或损伤特征是否与器官功能障碍和衰竭的发展有关。
确定在 15 个月期间因孤立性钝性颈 SCI 入住 R Adams Cowley 休克创伤中心的所有患者。记录美国脊髓损伤协会（ASIA）运动评分、ASIA 损伤量表（AIS）评分和损伤水平。为每个六个器官系统的入院、每日首次、每日最差和总和 MOD 和 SOFA 评分分配。所有统计检验均以 P < 0.05 为显著。
在 2007 年 1 月至 2008 年 3 月期间因钝性脊柱损伤入院的 1028 名患者中，有 40 名患者被确定为需要 ICU 住院时间（ LOS）>24 小时的孤立性颈 SCI。根据 MOD 评分，75%的患者发生至少一个器官系统衰竭，根据 SOFA 标准，85%的患者发生器官衰竭。根据 MOD 和 SOFA 评分，有 55%和 62.5%的患者发生多器官衰竭。心血管系统是最常衰竭的系统，根据总和 MODS（84%），而呼吸系统是最常衰竭的系统，根据总和 SOFA 标准（70%）。ASIA 运动评分与总和 MODS 和 SOFA 评分呈强烈负相关（r = -0.56，P = 0.0002 和 r = -0.51，P = 0.0009）。AIS 也与器官衰竭的发生呈负相关（r = -0.47，P = 0.002 和 r = -0.45，P = 0.004），而解剖损伤水平与器官衰竭的发生率相关性较差（r = -0.11，P = 0.5 和 r = -0.10，P = 0.5）。当控制年龄和损伤严重程度评分时，只有 ASIA 运动评分与总和器官功能障碍评分显著相关（MODS 的参数估计值=-0.082，P=0.0005，SOFA 的参数估计值=-0.057，P=0.006）。
这是第一项使用经过验证的器官系统功能障碍评分描述急性创伤性颈脊髓 SCI 患者器官功能和衰竭发生率的研究。入院时和 ICU 住院期间经常出现呼吸、心血管、神经、肾、肝和血液系统功能障碍。呼吸、心血管和神经衰竭很常见，而肾、肝和血液衰竭很少见。大多数患者发生多器官衰竭。ASIA 运动评分和 AIS 与器官功能障碍和衰竭的发展密切相关。在描述并发症风险和医疗干预需求时，应谨慎使用损伤水平。
