Tee Jin W, Chan Patrick C H, Fitzgerald Mark C B, Liew Susan M, Rosenfeld Jeffrey V
*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.
Spine (Phila Pa 1976). 2013 May 20;38(12):999-1007. doi: 10.1097/BRS.0b013e31828432a3.
Retrospective review on prospective cohort and explicit chart review.
To identify early spine trauma predictors of functional disability and to assess management compliance to established spine trauma treatment algorithms.
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.
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.
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.
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.
对前瞻性队列进行回顾性分析并进行明确的图表审查。
确定功能障碍的早期脊柱创伤预测因素，并评估对既定脊柱创伤治疗算法的管理依从性。
确定功能障碍的早期（48小时内）脊柱创伤预测因素是新颖的，可能有助于创伤患者的管理。此外，由于全球存在显著差异，脊柱创伤治疗算法至关重要。
对2009年5月1日至2011年1月1日期间的脊柱创伤患者进行分析。使用格拉斯哥预后量表（GOS）在1年时确定功能结局。应用单变量和多变量回归来研究损伤严重程度评分、年龄、血糖水平、生命体征、创伤性脑损伤、合并症、凝血指标、神经学和脊柱损伤特征的影响。使用SLIC和TLICS脊柱创伤算法进行依从性研究。
GOS的完成率为58.8%。与未完成GOS队列相比，完成GOS队列的平均年龄小4.2岁，严重多发伤患者数量更多，但严重脊髓损伤（美国脊髓损伤协会[A、B和C级]）患者数量更少。多变量逻辑回归显示3个具有统计学意义（P < 0.05）的功能障碍早期独立脊柱创伤预测因素。它们是（1）低血压（比值比[OR]=1.98；置信区间[CI]=1.13 - 3.49），（2）高血糖（OR = 1.67；CI = 1.09 - 2.56），以及（3）中度/重度创伤性脑损伤（OR = 5.88；CI = 1.71 - 20.16）。有305例亚轴颈段脊柱损伤患者和653例胸腰段脊柱损伤患者。亚轴颈段脊柱损伤分类以及胸腰段损伤分类和严重程度评分的依从性研究的一致性分别为96.1%和98.9%。
在一个对亚轴颈段脊柱损伤分类以及胸腰段损伤分类和严重程度评分算法具有高依从性的一级创伤中心，确定的功能障碍早期独立脊柱创伤预测因素是低血压、高血糖以及中度或重度创伤性脑损伤。单独的脊柱创伤损伤变量未显示出对功能障碍具有预测性。
3级。
