Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Trauma Surgery, University Medical Center Utrecht, Suite G04.232, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Sci Rep. 2022 Dec 13;12(1):21538. doi: 10.1038/s41598-022-25809-8.
Traumatic cervical spine injuries (TCSI) are rare injuries. With increasing age the incidence of TCSI is on the rise. TCSI and traumatic brain injury (TBI) are often associated. Both TCSI and TBI are allocated to the Abbreviated Injury Scale (AIS) head region. However, the nature and outcome of these injuries are potentially different. Therefore, the aim of this study was to investigate the epidemiology, demographics and outcome of severely injured patients with severe TCSI, and compare them with polytrauma patients with severe TBI in the strict sense. Consecutive polytrauma patients aged ≥ 15 years with AIShead ≥ 3 who were admitted to a level-1 trauma center Intensive Care Unit (ICU) from 2013 to 2021 were included. Demographics, treatment, and outcome parameters were analyzed for patients who had AIShead ≥ 3 based on TCSI and compared to patients with AIShead ≥ 3 based on proper TBI. Data on follow-up were collected for TCSI patients. Two hundred eighty-four polytrauma patients (68% male, Injury Severity Score (ISS) 33) with AIShead ≥ 3 were included; Thirty-one patients (11%) had AIShead ≥ 3 based on TCSI whereas 253 (89%) had AIShead ≥ 3 based on TBI. TCSI patients had lower systolic blood pressure in the Emergency Department (ED) and stayed longer in ICU than TBI patients. There was no difference in morbidity and mortality rates. TCSI patients died due to high cervical spine injuries or respiratory insufficiency, whereas TBI patients died primarily due to TBI. TCSI was mainly located at C2, and 58% had associated spinal cord injury. Median follow-up time was 22 months. Twenty-two percent had improvement of the spinal cord injury, and 10% died during follow-up. In this study the incidence of severe TCSI in polytrauma was much lower than TBI. Cause of death in TCSI was different compared to TBI demonstrating that AIShead based on TCSI is a different entity than based on TBI. In order to avoid data misinterpretation injuries to the cervical spine should be distinguished from TBI in morbidity and mortality analysis.
创伤性颈椎损伤（TCSI）较为罕见。随着年龄的增长，TCSI 的发病率呈上升趋势。TCSI 和创伤性脑损伤（TBI）通常相关。TCSI 和 TBI 均被分配到损伤严重程度评分（AIS）头部区域。然而，这些损伤的性质和结果可能不同。因此，本研究旨在调查严重 TCSI 患者的流行病学、人口统计学和结果，并将其与严格意义上的严重 TBI 多发伤患者进行比较。连续纳入 2013 年至 2021 年期间入住 1 级创伤中心重症监护病房（ICU）的年龄≥15 岁、AIS 头部≥3 的多发伤患者。分析了 AIS 头部≥3 的患者的人口统计学、治疗和结果参数，并与 AIS 头部≥3 的患者进行了比较基于适当的 TBI。收集了 TCSI 患者的随访数据。共纳入 284 例 AIS 头部≥3 的多发伤患者（68%为男性，损伤严重程度评分[ISS]为 33）；31 例（11%）患者 AIS 头部≥3 是基于 TCSI，而 253 例（89%）患者 AIS 头部≥3 是基于 TBI。TCSI 患者在急诊科（ED）的收缩压较低，在 ICU 的停留时间也比 TBI 患者长。发病率和死亡率无差异。TCSI 患者因高位颈椎损伤或呼吸功能不全而死亡，而 TBI 患者主要因 TBI 而死亡。TCSI 主要位于 C2，58%合并脊髓损伤。中位随访时间为 22 个月。22%的脊髓损伤患者有所改善，10%的患者在随访期间死亡。在本研究中，多发伤中严重 TCSI 的发生率明显低于 TBI。TCSI 的死亡原因与 TBI 不同，表明基于 TCSI 的 AIS 头部是与基于 TBI 的不同实体。为避免数据误解，在发病率和死亡率分析中应区分颈椎损伤和 TBI。
