Fujii Tomoko, Faul Mark, Sasser Scott
Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania.
J Emerg Trauma Shock. 2013 Oct;6(4):252-8. doi: 10.4103/0974-2700.120365.
Diagnosis of cervical spine injury (CSI) is difficult in patients with an altered level of consciousness as a result of a traumatic brain injury (TBI). Patients with TBI and older adults are at increased risk for CSI. This study examined the various risk factors for CSI among trauma patients with TBI and whether adults who were older (≥55 years) were at higher risk for CSI when they sustained a fall-related TBI.
Data used was the 2007 National Trauma Data Bank (NTDB), National Sample Project (NSP) for adults who sustained a TBI. This dataset contains 2007 admission records from 82 level I and II trauma centers. Logistic regression was used to identify potential risk factors for CSI and to test for interaction between age and injury mechanism. Additional model variables included gender, race, Glasgow Coma Score, multiple severe injuries, hypotension and respiratory distress.
An analysis of the NTDB NSP identified 187,709 adults with TBI, of which 16,078 were diagnosed with a concomitant CSI. In motor vehicle traffic injuries, the older age group had significantly higher odds of CSI (odds ratio [OR] = 1.26 [1.15-1.39]). In fall-related injuries the older age group did not have a higher odds of CSI compared to the younger age group. Skull/face fracture, other spine fracture/dislocation, upper limb injury, thorax injury, and hypotension were significantly associated with CSI. Pelvic injuries had an inverse association with CSI (OR = 0.60 [0.54-0.67]). Black had significantly higher odds of CSI compared to Whites (OR = 1.25 [1.07-1.46]).
The identification of associated injuries and factors may assist physicians in evaluating CSI in patients with TBI.
对于因创伤性脑损伤（TBI）导致意识水平改变的患者，颈椎损伤（CSI）的诊断较为困难。TBI患者和老年人发生CSI的风险增加。本研究调查了TBI创伤患者中CSI的各种风险因素，以及年龄较大（≥55岁）的成年人在遭受与跌倒相关的TBI时发生CSI的风险是否更高。
使用的数据来自2007年国家创伤数据库（NTDB）中的国家样本项目（NSP），该项目针对遭受TBI的成年人。该数据集包含来自82个一级和二级创伤中心的2007年入院记录。采用逻辑回归来确定CSI的潜在风险因素，并检验年龄与损伤机制之间的相互作用。其他模型变量包括性别、种族、格拉斯哥昏迷评分、多处重伤、低血压和呼吸窘迫。
对NTDB NSP的分析确定了187,709例TBI成人患者，其中16,078例被诊断为合并CSI。在机动车交通事故损伤中，年龄较大的组发生CSI的几率显著更高（优势比[OR]=1.26[1.15-1.39]）。在与跌倒相关的损伤中，与较年轻的组相比，年龄较大的组发生CSI的几率并没有更高。颅骨/面部骨折、其他脊柱骨折/脱位、上肢损伤、胸部损伤和低血压与CSI显著相关。骨盆损伤与CSI呈负相关（OR=0.60[0.54-0.67]）。与白人相比，黑人发生CSI的几率显著更高（OR=1.25[1.07-1.46]）。
识别相关损伤和因素可能有助于医生评估TBI患者的CSI情况。
