Department of Trauma, University Hospital Essen, Hand and Reconstructive, Surgery, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany.
Scand J Trauma Resusc Emerg Med. 2021 Jan 6;29(1):1. doi: 10.1186/s13049-020-00820-y.
Trauma is a significant cause of death and impairment. The Abbreviated Injury Scale (AIS) differentiates the severity of trauma and is the basis for different trauma scores and prediction models. While the majority of patients do not survive injuries which are coded with an AIS 6, there are several patients with a severe high cervical spinal cord injury that could be discharged from hospital despite the prognosis of trauma scores. We estimate that the trauma scores and prediction models miscalculate these injuries. For this reason, we evaluated these findings in a larger control group.
In a retrospective, multi-centre study, we used the data recorded in the TraumaRegister DGU® (TR-DGU) to select patients with a severe cervical spinal cord injury and an AIS of 3 to 6 between 2002 to 2015. We compared the estimated mortality rate according to the Revised Injury Severity Classification II (RISC II) score against the actual mortality rate for this group.
Six hundred and twelve patients (0.6%) sustained a severe cervical spinal cord injury with an AIS of 6. The mean age was 57.8 ± 21.8 years and 441 (72.3%) were male. 580 (98.6%) suffered a blunt trauma, 301 patients were injured in a car accident and 29 through attempted suicide. Out of the 612 patients, 391 (63.9%) died from their injury and 170 during the first 24 h. The group had a predicted mortality rate of 81.4%, but we observed an actual mortality rate of 63.9%.
An AIS of 6 with a complete cord syndrome above C3 as documented in the TR-DGU is survivable if patients get to the hospital alive, at which point they show a survival rate of more than 35%. Compared to the mortality prognosis based on the RISC II score, they survived much more often than expected.
创伤是导致死亡和伤残的重要原因。损伤严重度评分（AIS）区分了创伤的严重程度，是不同创伤评分和预测模型的基础。尽管大多数患者因 AIS 6 编码的损伤而无法存活，但仍有少数严重高颈段脊髓损伤患者尽管创伤评分的预后不佳，但仍可出院。我们估计这些创伤评分和预测模型会误判这些损伤。出于这个原因，我们在一个更大的对照组中评估了这些发现。
在一项回顾性、多中心研究中，我们使用 TraumaRegister DGU®（TR-DGU）中记录的数据，选择 2002 年至 2015 年间 AIS 为 3 至 6 的严重颈脊髓损伤患者。我们比较了根据修订创伤严重度分类 II（RISC II）评分估计的死亡率与该组的实际死亡率。
612 例（0.6%）患者发生严重颈脊髓损伤，AIS 为 6。平均年龄为 57.8±21.8 岁，441 例（72.3%）为男性。580 例（98.6%）为钝性创伤，301 例患者因车祸受伤，29 例患者因自杀受伤。在 612 例患者中，391 例（63.9%）因伤死亡，170 例在 24 小时内死亡。该组的预测死亡率为 81.4%，但我们观察到的实际死亡率为 63.9%。
如果患者活着到达医院，TR-DGU 中记录的 AIS 为 6 且 C3 以上完全脊髓综合征的患者是可以存活的，此时他们的存活率超过 35%。与基于 RISC II 评分的死亡率预测相比，他们的存活时间超出预期。
