Aarabi Bizhan, Albrecht Jennifer S, Simard J Marc, Chryssikos Timothy, Schwartzbauer Gary, Sansur Charles A, Crandall Kenneth, Gertner Melanie, Howie Benjamin, Wessell Aaron, Cannarsa Gregory, Caffes Nick, Oliver Jeffrey, Shanmuganathan Kathirkamanathan, Olexa Joshua, Lomangino Cara Diaz, Scarboro Maureen
Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.
J Neurotrauma. 2021 Mar 15;38(6):756-764. doi: 10.1089/neu.2020.7415. Epub 2021 Jan 8.
Over the past four decades, there have been progressive changes in the epidemiology of traumatic spinal cord injury (tSCI). We assessed trends in demographic and injury-related variables in traumatic cervical spinal cord injury (tCSCI) patients over an 18-year period at a single Level I trauma center. We included all magnetic resonance imaging-confirmed tCSCI patients ≥15 years of age for years 2001-2018. Among 1420 patients, 78.3% were male with a mean age 51.5 years. Etiology included falls (46.9%), motor vehicle collisions (MVCs; 34.2%), and sports injuries (10.9%). Median American Spinal Injury Association (ASIA) Motor Score (AMS) was 44, complete tCSCI was noted in 29.6% of patients, fracture dislocations were noted in 44.7%, and median intramedullary lesion length (IMLL) was 30.8 mm (complete injuries 56.3 mm and incomplete injuries 27.4 mm). Over the study period, mean age and proportion of falls increased ( < 0.001) whereas proportion attributable to MVCs and sports injuries decreased ( < 0.001). Incomplete injuries, AMS, and the proportion of patients with no fracture dislocations increased whereas complete injuries decreased significantly. IMLL declined ( = 0.17) and proportion with hematomyelia did not change significantly. In adjusted regression models, increase in age and decreases in prevalence of MVC mechanism and complete injuries over time remained statistically significant. Changes in demographic and injury-related characteristics of tCSCI patients over time may help explain the observed improvement in outcomes. Further, improved clinical outcomes and drop in IMLL may reflect improvements in initial risk assessment and pre-hospital management, advances in healthcare delivery, and preventive measures including public education.
在过去的四十年里，创伤性脊髓损伤（tSCI）的流行病学发生了渐进性变化。我们评估了在一家一级创伤中心18年间创伤性颈脊髓损伤（tCSCI）患者的人口统计学和损伤相关变量的趋势。我们纳入了2001年至2018年所有经磁共振成像确诊的≥15岁的tCSCI患者。在1420例患者中，78.3%为男性，平均年龄51.5岁。病因包括跌倒（46.9%）、机动车碰撞（MVCs；34.2%）和运动损伤（10.9%）。美国脊髓损伤协会（ASIA）运动评分（AMS）中位数为44，29.6%的患者为完全性tCSCI，44.7%的患者有骨折脱位，髓内病变长度（IMLL）中位数为30.8mm（完全性损伤为56.3mm，不完全性损伤为27.4mm）。在研究期间，平均年龄和跌倒比例增加（<0.001），而MVCs和运动损伤所致比例下降（<0.001）。不完全性损伤、AMS以及无骨折脱位患者的比例增加，而完全性损伤显著下降。IMLL下降（=0.17），脊髓出血比例无显著变化。在调整后的回归模型中，年龄增加以及MVC机制患病率和完全性损伤随时间的下降在统计学上仍具有显著性。tCSCI患者人口统计学和损伤相关特征随时间的变化可能有助于解释所观察到的预后改善。此外，临床预后的改善和IMLL的下降可能反映了初始风险评估和院前管理的改善、医疗服务的进步以及包括公众教育在内的预防措施。
