早期磁共振成像对创伤性脊髓损伤发病率和死亡率的预后价值

Prognostic value of early magnetic resonance imaging in the morbidity and mortality of traumatic spinal cord injury.

作者信息

Mora-Boga Rubén, Vázquez Muíños Olalla, Pértega Díaz Sonia, Meijide-Faílde Rosa María, Rodríguez-Sotillo Antonio, Ferreiro-Velasco María Elena, Salvador-de la Barrera Sebastián, Montoto-Marqués Antonio

机构信息

Unidad de Lesionados Medulares, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.

Unidad de Neurorradiología, Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.

出版信息

Med Intensiva (Engl Ed). 2023 Mar;47(3):157-164. doi: 10.1016/j.medine.2022.07.020. Epub 2022 Sep 6.

DOI:10.1016/j.medine.2022.07.020

PMID:36068148

Abstract

OBJECTIVE

To assess in individuals with traumatic spinal cord injury (TSCI) the relationship between mortality and need for ICU and early magnetic resonance imaging (MRI), analyzing spinal parenchymal alterations, disruption of vertebral ligaments (DVL) and spinal cord compression (SCC).

DESIGN

Retrospective study.

SETTING

Third-level hospital, Spinal Cord Injury Unit and ICU.

PATIENTS

Individuals with acute TSCI between 2010 and 2019.

INTERVENTION

Analysis of MRI performed in the first 72 h.

VARIABLES OF INTEREST

Admission to ICU and mortality.

RESULTS

269 cases collected. The pattern that demonstrated higher mortality was cord hemorrhage (16.7%) for 12.5% of single-level edema and 6.5% of multilevel edema (p = 0.125). The same happened with ICU admissions: 69.0% in hemorrhage, 60.2% in multilevel edema and 46.3% in short edema (p = 0.018). Analyzing CCM, mortality was 13.4% with 59.2% of ICU admissions, for 2.2% and 42.2% of individuals without cord compression (p = 0.020 and p = 0.003). The figures of death and ICU admission among cord injuries with DVL were 15.0% and 67.3%, for 6.2% and 44.4% of the individuals without DLV (p < 0.001 and p = 0.013).

CONCLUSIONS

The presence of spinal cord hemorrhage, SCC and DVL was associated with a higher admission in ICU. A significant increase in mortality was observed in cases with SCC and DVL.

摘要

目的

评估创伤性脊髓损伤（TSCI）患者的死亡率与重症监护病房（ICU）需求及早期磁共振成像（MRI）之间的关系，分析脊髓实质改变、椎体韧带断裂（DVL）和脊髓压迫（SCC）情况。

设计

回顾性研究。

地点

三级医院，脊髓损伤科和ICU。

患者

2010年至2019年期间的急性TSCI患者。

干预措施

分析伤后72小时内进行的MRI检查结果。

感兴趣的变量

入住ICU情况和死亡率。

结果

共收集269例病例。死亡率较高的模式为脊髓出血（16.7%），单节段水肿为12.5%，多节段水肿为6.5%（p = 0.125）。入住ICU情况也是如此：出血患者为69.0%，多节段水肿患者为60.2%，单节段水肿患者为46.3%（p = 0.018）。分析脊髓压迫情况，无脊髓压迫患者的死亡率为13.4%，入住ICU率为59.2%，有脊髓压迫患者的死亡率为2.2%，入住ICU率为42.2%（p = 0.020和p = 0.003）。伴有DVL的脊髓损伤患者的死亡和入住ICU率分别为15.0%和67.3%，无DVL患者分别为6.2%和44.4%（p < 0.001和p = 0.013）。