Artikel
Does concomitant spine injury in patients with traumatic brain injury affect the outcome? Data on 164 patients from the CENTER-TBI study
Wirkt sich ein zusätzliches spinales Trauma bei Patienten mit Schädel-Hirn-Trauma auf das Behandlungsergebnis aus? Daten von 164 Patienten aus der CENTER-TBI Studie
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Veröffentlicht: | 4. Juni 2021 |
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Objective: Spine injury is highly prevalent in poly-trauma patients, but data on the co-occurrence of spine trauma in TBI patients is scarce. This study used the CENTER-TBI database to assess patients’ prevalence, characteristics, and outcomes with TBI and concurrent spine trauma.
Methods: Data from the European multi-center CENTER-TBI study were analyzed. Only adult TBI patients (≥18 years) presenting with a concomitant, isolated (no injuries in other body regions) serious (AIS ≥3) spine injury were included. For outcome analysis, a comparison group of TBI patients without spine trauma was created by propensity score matching. Hospital length-of-stay and 6-month GOSE and mortality were compared between both groups (p<0.05 was considered significant).
Results: From the 4255 adult patients within the CENTER-TBI core study, a total of 164 (4%) suffered from a concomitant isolated spine trauma of at least serious severity. The median age was 53 (IQR: 37-66) years, 70% of patients were males, and alcohol intoxication was present in 24%. Incidental falls were the most common injury type (47%), and on admission, mild TBI was documented in 62% of cases, followed by severe TBI in 26%. Spine injuries were mostly located in the cervical spine (65%), followed by the thoracic spine (32%). In total, 57% of patients were admitted to the ICU. Surgical spine stabilization was performed in 23% of cases, and cranial surgery was necessary for 20%. The median hospital length-of-stay was 8 (5-105) days and thus significantly longer compared to the matched cohort without spine trauma (3 (1-90) days). Moreover, only 48% of patients with a combined injury compared to 57% with TBI only could be discharged home (p=0.0356). After six months, with 11%, the mortality rate in patients with TBI and spine trauma was not significantly different from the TBI only group (14%; p=0.6127). However, significantly fewer patients with TBI and spine trauma regained full recovery (GOSE 8) than the matched patients with TBI only (23% vs. 35%; p=0.0379).
Conclusion: Concurrent, isolated, serious spine trauma was identified in 4% of TBI patients in the CENTER-TBI study. While mortality was not increased, patients with both injuries had longer hospital length-of-stays and regained full recovery less frequently.