儿童和青少年伴有脊髓损伤的颈椎骨折：4418例患者的流行病学、费用及住院死亡率

Cervical fractures with associated spinal cord injury in children and adolescents: epidemiology, costs, and in-hospital mortality rates in 4418 patients.

作者信息

Jain Amit, Brooks Jaysson T, Rao Sandesh S, Ain Michael C, Sponseller Paul D

机构信息

Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA.

出版信息

J Child Orthop. 2015 Jun;9(3):171-5. doi: 10.1007/s11832-015-0657-9. Epub 2015 May 8.

DOI:10.1007/s11832-015-0657-9

PMID:25953413

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4486498/

Abstract

BACKGROUND

Cervical spine fractures with spinal cord injury (CFSCI) can be devastating. We describe the epidemiology of children and adolescents with CFSCI.

METHODS

Using the Nationwide Inpatient Sample (NIS) database, we identified 4418 patients (≤18 years old) who had CFSCI from 2000 through 2010. Outcomes of interest were patient characteristics (age, sex), injury characteristics [fracture location, spinal cord injury (SCI) pattern], economic variables (duration of hospital stay, total hospital charges), and mortality.

RESULTS

Upper cervical fractures (UCFs) occurred half as often (31.4 %) as lower cervical fractures (LCFs; 68.8 %). Among patients <8 years old, 73.6 % had UCFs; among patients ≥8 years old, 72.3 % had LCFs. Overall, 68.7 % had incomplete SCI, 22.4 % had complete SCI, 6.6 % had central cord syndrome, and 2.3 % had anterior cord syndrome. Patients with complete SCI had the longest hospital stays and highest hospital charges. The overall in-hospital mortality rate was 7.3 %, with a sixfold higher rate in patients <8 (30.6 %) vs. those ≥8 (5.1 %) years old (p < 0.001). There was a threefold higher mortality rate in patients with upper (13.5 %) vs. lower (4.3 %) cervical fractures (p < 0.001). Patients with complete SCI had a 1.85-fold higher mortality rate than patients with other cord syndromes (p < 0.001).

CONCLUSIONS

Patients <8 years old were more likely than older patients to sustain UCFs. Patients with UCFs had a significantly higher mortality rate than those with LCFs. Patients with complete SCI had the longest duration of hospital stay and highest hospital charges and in-hospital mortality rate.

摘要

背景

伴有脊髓损伤的颈椎骨折（CFSCI）可能具有毁灭性。我们描述了患有CFSCI的儿童和青少年的流行病学情况。

方法

利用全国住院患者样本（NIS）数据库，我们确定了2000年至2010年间4418例年龄≤18岁的患有CFSCI的患者。感兴趣的结果包括患者特征（年龄、性别）、损伤特征[骨折部位、脊髓损伤（SCI）类型]、经济变量（住院时间、总住院费用）和死亡率。

结果

上颈椎骨折（UCFs）的发生率（31.4%）是下颈椎骨折（LCFs；68.8%）的一半。在8岁以下的患者中，73.6%发生UCFs；在8岁及以上的患者中，72.3%发生LCFs。总体而言，68.7%为不完全性SCI，22.4%为完全性SCI，6.6%为中央脊髓综合征，2.3%为前脊髓综合征。完全性SCI患者的住院时间最长，住院费用最高。总体住院死亡率为7.3%，8岁以下患者（30.6%）的死亡率是8岁及以上患者（5.1%）的6倍（p<0.001）。上颈椎骨折患者（13.5%）的死亡率是下颈椎骨折患者（4.3%）的3倍（p<0.001）。完全性SCI患者的死亡率比其他脊髓综合征患者高1.85倍（p<0.001）。