Spinal cord injury--incidence, prognosis, and outcome: an analysis of the TraumaRegister DGU

BACKGROUND CONTEXT: Little is known about the incidence of spinal cord injury (SCI) in polytrauma patients.

PURPOSE: The purpose of this study was to analyze incidence, prognosis, and outcome of SCI in polytrauma patients.

STUDY DESIGN/SETTING: This is a retrospective multicenter cohort study.

PATIENT SAMPLE: A total of 57,310 patients of TraumaRegister DGU (2002-2012) of the German Trauma Society were included. Aim of this large multicentre database is a standardized documentation of severely injured patients.

OUTCOME MEASURES: Outcome measures were mortality and Glasgow Outcome 4Scale.

METHODS: Inclusion criteria were adult blunt trauma patients (age greater than 16 years) and injury severity score (ISS) greater than 16. The severity of SCI was based on the Abbreviated Injury Scale (AIS), and the outcome of patients was assessed with the Glasgow Outcome Scale (GOS). Factors with an impact on the outcome were analyzed with a logistic regression model.

RESULTS: Four thousand two hundred eighty five (7.5%) of 57,310 patients sustained SCI. Mean age was 48.9±20.7 years, ISS 28.0±12, and 72.7% were men. Two thousand two hundred twenty two (3.9%) SCIs involved the cervical, 1,388 (2.4%) the thoracic, and 791 (1.4%) the lumbar spine. One hundred fifty-nine (7.2%) cervical spine injuries were associated with transient neurologic deficit (TND) (AIS 3), 612 (27.5%) with an incomplete paraplegia (AIS 4), 1,101 (49.6%) with a complete paraplegia (AIS 5), and 350 (15.8%) with a complete lesion above C3 (AIS 6). Lesions of the thoracic spine showed in 93 (6.7%) of the 1,388 lesions a TND (AIS 3), in 332 (23.9%) an incomplete paraplegia (AIS 4), and in 963 (69.4%) a complete lesion (AIS 5). In the lumbar region, lesions were distributed as follows: TND (AIS 3) 145 (18.3%), incomplete paraplegia (AIS 4) 305 (38.6%), and complete lesion 341 (43.1%). Sepsis and multiorgan failure were found more often in patients with AIS 5/6 lesions (p<.001). The hospital length of stay in SCIs was significantly longer. Most of the patients (85.8%) with SCI were treated in Level I trauma centers. Spinal cord injuries had a minor impact in the mortality. Only AIS 6 injuries resulted in a significantly higher mortality (64.6%). Adjusted logistic regression analysis (target variable: GOS 4 or 5, good outcome) showed that the following factors were significantly associated with an unfavorable outcome (p≤.02): AIS greater than or equal to 4, age greater than or equal to 60 years, resuscitation, severe head injury, shock on scene, and severity of injury (ISS per point).

CONCLUSIONS: Spinal cord injury with a neurologic deficit could be found in every 13th patient with polytrauma. Over half of the patients with SCI suffer from complete cord lesion. In polytrauma patients, SCI only has a limited influence on the mortality, with exception of AIS 6 lesions. Complications such as multiorgan failure or sepsis and extended hospital length of stay are more frequent in SCI.