Polytrauma patients with severe cervical spine injuries are different than with severe TBI even though they have similar AIS scores

Abstract

Introduction 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. In calculating Injury Severity Score (ISS) TCSI and TBI are both included in the Abbreviated Injury Scale (AIS)head. However, outcome of TCSI and TBI might be different through the nature of the injuries. In this retrospective monocenter study the incidence and outcome of TCSI in polytrauma was investigated and compared to TBI. Methods Consecutive polytrauma patients aged > 15 years with AIShead > 3 who were admitted to a level-1 trauma center Intensive Care Unit (ICU) from 2015–2021 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. Results Two hundred eighty-seven polytrauma patients (68% male, Injury Severity Score (ISS) 33) with AIS head ≥ 3 were included; Thirty-four patients (12%) had AIShead ≥ 3 based on TCSI whereas 253( 88%) had AIShead ≥ 3 based on TBI. TCSI patients were slightly older, 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. The majority of TCSI patients died of respiratory insufficiency, whereas TBI patients died primarily of TBI. TCSI was mainly located at C2, 59% had associated spinal cord injury, and 9% had associated severe TBI. Median follow-up time was 24 months. Twenty percent had improvement of the spinal cord injury, and 15% died during follow-up. Discussion 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.