Description and prognostic factors of a cohort of polytraumatized patients with spinal injury in a level I trauma center

Abstract

Introduction: Traumatic spinal injuries are a significant public health issue due to their high frequency and severity, impacting the entire healthcare system, especially when neurological sequelae are involved. These injuries require comprehensive resuscitative management, prioritizing spinal injuries within the context of associated injuries. Understanding the epidemiology of spinal fractures in polytraumatized patients is essential for improving care planning, primary prevention methods, and hospital management.

Methods: This retrospective, single-center, observational study used the TRAUMABASE database from 2018 to 2022 to provide an epidemiological overview of polytraumatized patients with spinal fractures treated in a level I trauma center. Patients admitted to the Post-Anesthesia Care Unit (PACU) with at least one spinal fracture were included, excluding those with isolated transverse process fractures or incomplete clinical files. Data collected included demographics, injury mechanism, Injury Severity Score (ISS), type of spinal lesion, Glasgow Coma Scale (GCS), surgical management, length of hospital stay, and mortality.

Results: From 2018 to 2022, 561 patients with spinal fractures in the context of polytrauma were treated, with 386 patient records analyzed after exclusions. The mean age was 43 years, with a majority being male (75.1 %). The main injury mechanisms were falls from height (47.7 %) and traffic road accidents (46.4 %). Spinal surgery was performed on 53 % of patients, with a mean delay of 2.8 days from trauma to surgery. The overall mortality rate was 14.8 %, with neurological impairment, higher age, higher ISS score, lower GCS score, and absence of spinal surgery as unfavorable prognostic factors. The mean cost of hospitalization per patients was 76.854 ± 53.719 euros [3.502; 65.6623].

Discussion: This study highlights the severity of polytraumatized patients with spinal lesions, with a mean ISS score of 24.4 and frequent associated severe traumatic brain injuries. The main injury mechanisms were falls from height and traffic road accidents, with a high representation of self-inflicted injuries. Overall, the study provides valuable insights into the management and outcomes of polytraumatized patients with spinal injuries.

Keywords: Follow-up study; Multiple trauma; Spinal injury; injury severity score.