Chen Weiting, Wu Haopeng, Yu Jiafei, Cao Lanxing, Zhang Gensheng
Department of Critical Care Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.
Department of Emergency Medicine, the First People's Hospital of Linhai, Taizhou 317000, China.
World J Emerg Med. 2024;15(6):455-464. doi: 10.5847/wjem.j.1920-8642.2024.085.
The objective of this retrospective hospital-based study was to describe the epidemiological features of traumatic spinal cord injury (TSCI) in the intensive care unit (ICU) and assess the incidence and possible risk factors for venous thromboembolism (VTE) following TSCI.
We retrospectively reviewed the medical records of 370 patients with TSCI who were admitted between January 2018 and March 2023. The following parameters were collected: age, sex, body mass index, occupation, underlying diseases, smoking history, education level, etiology of injury, injury segments, American Spinal Injury Association (ASIA) Impairment Scale score, severity of injury, injury severity score (ISS), VTE risk score (Caprini score), treatment, VTE prophylaxis, ICU length of stay, length of hospital stay, concomitant injuries, and complications. Descriptive statistics were used to summarize the demographic and clinical characteristics of the study participants. Logistic regression analysis was used to determine the risk factors for VTE.
The mean age of patients with TSCI was 55.5 ± 13.4 years, with a male-to-female ratio of 6.5:1. The leading cause of TSCI was falls from height (46.5%), followed by traffic accidents (36.5%). The cervical spinal cord was the most affected segment, followed by the thoracolumbar region. Among all the patients, 362 (97.8%) had concomitant injuries. Complications were observed in 255 patients (68.9%) during hospitalization. The incidence rate of VTE was 25.1%. Logistic regression analysis revealed that age (=1.721, 95%: 1.207-2.454, =0.003), mechanical ventilation (=3.427, 95%: 1.873-6.271, <0.001), and non-use of chemical prophylaxis (=2.986, 95%: 1.749-5.099, <0.001) were risk factors for VTE.
Falls from height and traffic accidents were the main causes of TSCIs in the ICU, especially for male patients with cervical spinal cord injuries. VTE is a frequent complication in patients with TSCI in the ICU. Age, mechanical ventilation, and non-use of chemical prophylaxis were found to be independent risk factors for VTE following TSCI.
这项基于医院的回顾性研究旨在描述重症监护病房（ICU）中创伤性脊髓损伤（TSCI）的流行病学特征，并评估TSCI后静脉血栓栓塞症（VTE）的发生率及可能的危险因素。
我们回顾性分析了2018年1月至2023年3月期间收治的370例TSCI患者的病历。收集了以下参数：年龄、性别、体重指数、职业、基础疾病、吸烟史、教育程度、损伤病因、损伤节段、美国脊髓损伤协会（ASIA）损伤分级评分、损伤严重程度、损伤严重度评分（ISS）、VTE风险评分（Caprini评分）、治疗情况、VTE预防措施、ICU住院时间、住院总时长、合并伤及并发症。采用描述性统计方法总结研究参与者的人口统计学和临床特征。采用逻辑回归分析确定VTE的危险因素。
TSCI患者的平均年龄为55.5±13.4岁，男女比例为6.5∶1。TSCI的主要原因是高处坠落（46.5%），其次是交通事故（36.5%）。颈髓是最常受累节段，其次是胸腰段。所有患者中，362例（97.8%）存在合并伤。住院期间255例患者（68.9%）出现并发症。VTE的发生率为25.1%。逻辑回归分析显示，年龄（=1.721，95%：1.207 - 2.454，=0.003）、机械通气（=3.427，95%：1.873 - 6.271，<0.001）以及未使用化学预防措施（=2.986，95%：1.749 - 5.099，<0.001）是VTE的危险因素。
高处坠落和交通事故是ICU中TSCI的主要原因，尤其是颈髓损伤的男性患者。VTE是ICU中TSCI患者的常见并发症。年龄、机械通气和未使用化学预防措施是TSCI后VTE的独立危险因素。
