Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
Clin Spine Surg. 2024 Jul 1;37(6):275-281. doi: 10.1097/BSD.0000000000001596. Epub 2024 Mar 11.
Case control.
Traumatic cervical spine injuries are associated with a substantial risk of mortality. The aim of this study is to develop a novel mortality prediction model for patients with cervical trauma who require operative treatment.
Patients with cervical spine trauma have a high risk of postoperative complications and mortality. There are few reliable systems that can accurately predict mortality after surgery for cervical spine trauma, and those that do exist are typically not specific to cervical trauma.
The National Surgical Quality Improvement Program (NSQIP) database was used to identify patients undergoing surgery for cervical spine trauma. Univariate analyses were performed to identify variables associated with mortality. Variables that were found to be significant in the univariate models were compiled into a multivariable model. The final model was compared with the American Society of Anesthesiologists (ASA), a modified Charlson comorbidity index (mCCI), and the 5-factor modified frailty index (mFI-5) in respect to predicting 30-day mortality after cervical trauma. The score was then externally validated using the Nationwide Inpatient Sample (NIS) database.
Fifty-five (6.7%) of 822 patients did not survive 30 days after surgery. The final multivariable logistic regression model consisted of the following variables: circumferential fusion "C." long "L" fusion (more than 4 levels), anemia "A," age over 60 "A," and dialysis "D." The risk of mortality increased with increasing CLAAD score, with mortality rates of 0.9%, 3.1%, 7.4%, 22.7%, and 14.3% for scores of 0, 1, 2, 3, and 4, respectively. The CLAAD model had an AUC of 0.73 for predicting mortality after cervical trauma.
The CLAAD score is a simple and effective system that can help identify patients at risk of increased mortality within 30 days of cervical trauma.
Level III.
病例对照。
创伤性颈椎损伤与死亡率有很大关系。本研究的目的是为需要手术治疗的颈椎外伤患者建立一种新的死亡率预测模型。
颈椎创伤患者术后并发症和死亡率风险高。目前，能够准确预测颈椎创伤术后死亡率的可靠系统很少，而且现有的系统通常不是专门针对颈椎创伤的。
使用国家手术质量改进计划（NSQIP）数据库来确定接受颈椎创伤手术的患者。进行单变量分析以确定与死亡率相关的变量。在单变量模型中发现有统计学意义的变量被编入多变量模型。最后一个模型与美国麻醉医师协会（ASA）、改良 Charlson 合并症指数（mCCI）和 5 因素改良虚弱指数（mFI-5）在预测颈椎外伤后 30 天死亡率方面进行比较。然后使用全国住院患者样本（NIS）数据库对该评分进行外部验证。
822 例患者中有 55 例（6.7%）在手术后 30 天内未存活。最终的多变量逻辑回归模型包括以下变量：环形融合“C”、长“L”融合（超过 4 个节段）、贫血“A”、年龄大于 60 岁“A”和透析“D”。随着 CLAAD 评分的增加，死亡率也随之增加，评分分别为 0、1、2、3 和 4 时，死亡率分别为 0.9%、3.1%、7.4%、22.7%和 14.3%。CLAAD 模型预测颈椎外伤后死亡率的 AUC 为 0.73。
CLAAD 评分是一种简单有效的系统，可以帮助识别颈椎外伤后 30 天内死亡风险增加的患者。
III 级。
