Department of Orthopaedic Surgery, Warren Alpert School of Medicine of Brown University, West Providence, RI, USA.
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Clin Orthop Relat Res. 2024 Dec 1;482(12):2222-2235. doi: 10.1097/CORR.0000000000003189. Epub 2024 Jul 16.
Vertebral fractures are associated with enduring back pain, diminished quality of life, as well as increased morbidity and mortality. Existing epidemiological data for cervical and thoracic vertebral fractures are limited by insufficiently powered studies and a failure to evaluate the mechanism of injury.
QUESTION/PURPOSE: What are the temporal trends in incidence, patient characteristics, and injury mechanisms of cervical and thoracic vertebral fractures in the United States from 2003 to 2021?
The United States National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) database collects data on all nonfatal injuries treated in US hospital emergency departments and is well suited to capture epidemiological trends in vertebral fractures. As such, the NEISS-AIP was queried from 2003 to 2021 for cervical and thoracic fractures. The initial search by upper trunk fractures yielded 156,669 injuries; 6% (9900) of injuries, with a weighted frequency of 638,999 patients, met the inclusion criteria. The mean age was 62 ± 25 years and 52% (334,746 of 638,999) of patients were females. Descriptive statistics were obtained. Segmented regression analysis, accounting for the year before or after 2019 when the NEISS sampling methodology was changed, was performed to assess yearly injury trends. Multivariable logistic regression models with age and sex as covariates were performed to predict injury location, mechanism, and disposition.
The incidence of cervical and thoracic fractures increased from 2.0 (95% CI 1.4 to 2.7) and 3.6 (95% CI 2.4 to 4.7) per 10,000 person-years in 2003 to 14.5 (95% CI 10.9 to 18.2) and 19.9 (95% CI 14.5 to 25.3) in 2021, respectively. Incidence rates of cervical and thoracic fractures increased for all age groups from 2003 to 2021, with peak incidence and the highest rate of change in individuals 80 years or older. Most injuries occurred at home (median 69%), which were more likely to impact older individuals (median [range] age 75 [2 to 106] years) and females (median 61% of home injuries); injuries at recreation/sports facilities impacted younger individuals (median 32 [3 to 96] years) and male patients (median 76% of sports facility injuries). Falls were the most common injury mechanism across all years, with females more likely to be impacted than males. The proportion of admissions increased from 33% in 2003 to 50% in 2021, while the proportion of treated and released patients decreased from 53% to 35% in the same period.
This epidemiological study identified a disproportionate increase in cervical and thoracic fracture incidence rates in patients older than 50 years from 2003 to 2021. Furthermore, high hospital admission rates were also noted resulting from these fractures. These findings indicate that current osteoporosis screening guidelines may be insufficient to capture the true population at risk of osteoporotic fractures, and they highlight the need to initiate screening at an earlier age.
Level III, prognostic study.
椎体骨折与持久的背痛、生活质量下降以及发病率和死亡率增加有关。现有的颈椎和胸腰椎骨折的流行病学数据受到研究力度不足和未能评估损伤机制的限制。
问题/目的：2003 年至 2021 年期间，美国颈椎和胸腰椎骨折的发病率、患者特征和损伤机制有何时间趋势？
美国国家电子伤害监测系统-所有伤害项目（NEISS-AIP）数据库收集了美国医院急诊部门治疗的所有非致命性伤害数据，非常适合捕捉椎体骨折的流行病学趋势。因此，从 2003 年至 2021 年，对 NEISS-AIP 进行了颈椎和胸腰椎骨折的查询。通过上躯干骨折的初步搜索得到了 156669 例损伤；6%（9900 例）的损伤，加权频率为 638999 例患者，符合纳入标准。平均年龄为 62±25 岁，52%（638999 例中的 334746 例）为女性。获取描述性统计数据。为了评估每年的损伤趋势，进行了分段回归分析，考虑了 2019 年前后（NEISS 抽样方法发生变化）的年份。使用多变量逻辑回归模型，以年龄和性别为协变量，预测损伤部位、机制和处置。
2003 年至 2021 年，颈椎和胸腰椎骨折的发病率分别从每 10000 人年 2.0（95%CI 1.4 至 2.7）和 3.6（95%CI 2.4 至 4.7）上升至 14.5（95%CI 10.9 至 18.2）和 19.9（95%CI 14.5 至 25.3）。2003 年至 2021 年，所有年龄组的颈椎和胸腰椎骨折发病率均呈上升趋势，80 岁及以上人群的发病率和变化率最高。大多数损伤发生在家庭（中位数 69%），更可能影响老年人（中位数[范围]年龄 75[2 至 106]岁）和女性（中位数 61%的家庭损伤）；在娱乐/运动设施发生的损伤影响年轻人（中位数 32[3 至 96]岁）和男性患者（中位数 76%的运动设施损伤）。跌倒是所有年份最常见的损伤机制，女性比男性更容易受到影响。入院比例从 2003 年的 33%上升到 2021 年的 50%，而同期接受治疗和出院的患者比例从 53%下降到 35%。
这项流行病学研究发现，2003 年至 2021 年，50 岁以上患者的颈椎和胸腰椎骨折发病率呈不成比例的上升。此外，这些骨折也导致了较高的住院率。这些发现表明，目前的骨质疏松症筛查指南可能不足以发现真正有骨质疏松性骨折风险的人群，这也强调了需要更早开始筛查。
III 级，预后研究。
