Riemann Lennart, Alhalabi Obada T, Unterberg Andreas W, Younsi Alexander
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Front Neurol. 2022 Aug 18;13:861688. doi: 10.3389/fneur.2022.861688. eCollection 2022.
Spine injury is highly prevalent in patients with poly-trauma, but data on the co-occurrence of spine trauma in patients with traumatic brain injury (TBI) are scarce. In this study, we used the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) database to assess the prevalence, characteristics, and outcomes of patients with TBI and a concurrent traumatic spinal injury (TSI).
Data from the European multi-center CENTER-TBI study were analyzed. Adult patients with TBI (≥18 years) presenting with a concomitant, isolated TSI of at least serious severity (Abbreviated Injury Scale; AIS ≥3) were included. For outcome analysis, comparison groups of TBI patients with TSI and systemic injuries (non-isolated TSI) and without TSI were created using propensity score matching. Rates of mortality, unfavorable outcomes (Glasgow Outcome Scale Extended; GOSe < 5), and full recovery (GOSe 7-8) of all patients and separately for patients with only mild TBI (mTBI) were compared between groups at 6-month follow-up.
A total of 164 (4%) of the 4,254 CENTER-TBI core study patients suffered from a concomitant isolated TSI. The median age was 53 [interquartile range (IQR): 37-66] years and 71% of patients were men. mTBI was documented in 62% of cases, followed by severe TBI (26%), and spine injuries were mostly cervical (63%) or thoracic (31%). Surgical spine stabilization was performed in 19% of cases and 57% of patients were admitted to the ICU. Mortality at 6 months was 11% and only 36% of patients regained full recovery. There were no significant differences in the 6-month rates of mortality, unfavorable outcomes, or full recovery between TBI patients with and without concomitant isolated TSI. However, concomitant non-isolated TSI was associated with an unfavorable outcome and a higher mortality. In patients with mTBI, a negative association with full recovery could be observed for both concomitant isolated and non-isolated TSI.
Rates of mortality, unfavorable outcomes, and full recovery in TBI patients with and without concomitant, isolated TSIs were comparable after 6 months. However, in patients with mTBI, concomitant TSI was a negative predictor for a full recovery. These findings might indicate that patients with moderate to severe TBI do not necessarily exhibit worse outcomes when having a concomitant TSI, whereas patients with mTBI might be more affected.
脊柱损伤在多发伤患者中极为常见，但关于创伤性脑损伤（TBI）患者同时发生脊柱创伤的数据却很匮乏。在本研究中，我们使用欧洲创伤性脑损伤协作有效性研究（CENTER-TBI）数据库来评估TBI合并创伤性脊柱损伤（TSI）患者的患病率、特征及预后。
对欧洲多中心CENTER-TBI研究的数据进行分析。纳入成年TBI患者（≥18岁），其伴有至少严重程度的孤立性TSI（简明损伤定级标准；AIS≥3）。为进行预后分析，通过倾向评分匹配创建了伴有TSI和全身损伤（非孤立性TSI）的TBI患者以及不伴有TSI的TBI患者的对照组。在6个月随访时，比较所有患者以及仅患有轻度TBI（mTBI）患者的死亡率、不良预后（扩展格拉斯哥预后量表；GOSe<5）和完全恢复（GOSe 7 - 8）率。
在4254例CENTER-TBI核心研究患者中，共有164例（4%）患有合并的孤立性TSI。中位年龄为53岁[四分位间距（IQR）：37 - 66岁]，71%的患者为男性。62%的病例记录有mTBI，其次是重度TBI（26%），脊柱损伤大多为颈椎（63%）或胸椎（31%）。19%的病例进行了脊柱手术固定，57%的患者入住重症监护病房。6个月时的死亡率为11%，仅有36%的患者完全康复。伴有和不伴有合并孤立性TSI的TBI患者在6个月时的死亡率、不良预后或完全恢复率无显著差异。然而，合并非孤立性TSI与不良预后和更高的死亡率相关。在mTBI患者中，合并孤立性和非孤立性TSI均与完全恢复呈负相关。
伴有和不伴有合并孤立性TSI的TBI患者在6个月后的死亡率、不良预后和完全恢复率相当。然而，在mTBI患者中，合并TSI是完全恢复的负性预测因素。这些发现可能表明，中度至重度TBI患者合并TSI时不一定表现出更差的预后，而mTBI患者可能受影响更大。
