Risk factors for cervical spine injury among patients with traumatic brain injury

Abstract

Background:Diagnosis of cervical spine injury (CSI) is difficult in patients with an altered level of consciousness as a result of a traumatic brain injury (TBI). Patients with TBI and older adults are at increased risk for CSI. This study examined the various risk factors for CSI among trauma patients with TBI and whether adults who were older (≥55 years) were at higher risk for CSI when they sustained a fall-related TBI.Materials and Methods:Data used was the 2007 National Trauma Data Bank (NTDB), National Sample Project (NSP) for adults who sustained a TBI. This dataset contains 2007 admission records from 82 level I and II trauma centers. Logistic regression was used to identify potential risk factors for CSI and to test for interaction between age and injury mechanism. Additional model variables included gender, race, Glasgow Coma Score, multiple severe injuries, hypotension and respiratory distress.Results:An analysis of the NTDB NSP identified 187,709 adults with TBI, of which 16,078 were diagnosed with a concomitant CSI. In motor vehicle traffic injuries, the older age group had significantly higher odds of CSI (odds ratio [OR] = 1.26 [1.15-1.39]). In fall-related injuries the older age group did not have a higher odds of CSI compared to the younger age group. Skull/face fracture, other spine fracture/dislocation, upper limb injury, thorax injury, and hypotension were significantly associated with CSI. Pelvic injuries had an inverse association with CSI (OR = 0.60 [0.54-0.67]). Black had significantly higher odds of CSI compared to Whites (OR = 1.25 [1.07-1.46]).Conclusion:The identification of associated injuries and factors may assist physicians in evaluating CSI in patients with TBI.

Pediatric spinal injury in the US: epidemiology and disparities

“…17,25,27,32,37,42,52 Reported rates of cervical spine injury concomitant with traumatic coma are between 6% and 9%. Lower rates have been cited in reports that detail less precisely the severity of the TBI and the methods of evaluation.…”

Prevalence of concomitant traumatic cranio-spinal injury: a systematic review and meta-analysis

“…Examining subgroups of studies that reported the prevalence in patients with GCS 3-12 and GCS less than or equal to 8 did not reduce the heterogeneity. However, four studies reported the prevalence of concomitant cervical spinal injury in patients with TBI or head injury injured in a motor vehicle accident (MVA) [2,15,21,41]. The I 2 statistic indicated that there was only moderate heterogeneity between these studies (I 2 = 51.44%; 95% CI 0.00-83.95%).…”

“…Eleven publications reported the prevalence of concomitant cervical spinal injury in patients with a TBI [2,12,15,21,27,28,30,33,34,37,41]. The total sample size including all studies reporting this prevalence is 573,870 patients, with sample sizes of individual studies ranging from 265 [37] to 334,864 [28].…”

“…All other studies included in this review reported the prevalence of concomitant injury from review of a multi-centre trauma database [6,12,15,16,19,28,34].…”

“…Nine included studies were conducted in the USA [2,7,9,15,16,21,28,33,34]; 3 in the UK [1,12,19]; 2 in China [41,47]; and 1 in each of Pakistan [30], Taiwan [6], Australia [27], South Africa [37], Japan [23], Germany [24], and Canada [35]. Studies were not excluded based on publication year.…”