Spinal cord injury in severely injured patients: results from the Swiss Trauma Registry

Abstract

Background and objectives: Traumatic spinal cord injuries (SCIs) in the context of severe trauma are rare, and patient demographics are infrequently reported. This study aimed to assess patient demographics in acute traumatic SCI in the context of severe injuries in Switzerland and to evaluate differences in demographics and outcomes stratified by timing of surgery.

Methods: We analyzed data from the Swiss Trauma Registry (STR) from 2015 to 2024. The STR includes patients with major trauma (injury severity score [ISS] ≥ 16 and/or abbreviated injury scale [AIS] head ≥ 3) admitted to any level-one trauma centre in Switzerland. We evaluated patient characteristics, complications, and hospital outcomes, which were further stratified by early (< 24 h) and late (≥ 24 h) surgery.

Results: Among 24,328 patients, 6,819 (28%) sustained spinal injuries, and 383 (1.6%) had a concurrent SCI with an incidence of 0.44 cases per 100’000 inhabitants. The median age was 52 years (IQR 31–70) and 73.6% were male. The primary causes were falls (63.1%) and road traffic accidents (29.6%). The in-hospital mortality rate was 4.7%. Late surgery patients more often had concomitant moderate or severe traumatic brain injuries (31% vs. 14%, p = 0.009) and were more likely to have no fractures or dislocations of the spine (22.8% versus 6.8%, p = 0.001). Patients who underwent early surgery had shorter hospital stays (9d [5-16], versus 16 d [9-24]; F = 13.92, p < 0.001). Late surgery was associated with a higher likelihood of developing two and more complications (OR 2.57, 95% CI 1.18–5.63, p = 0.018), including urinary tract infections (OR 12.13, 95% CI 2.76–53.41, p = 0.001) and multiple organ failure (OR 12.99, 95% CI 1.64-102.83, p = 0.015).

Conclusions: This study offers insights into the characteristics and outcomes of acute SCI care in severely injured patients. Despite its low incidence, the acute management of this patient population remains highly challenging. Our findings suggest early stabilization of spinal injuries in severely injured patients may reduce hospital stays and complications.

Fig. 1

Trends of Trauma Mechanisms. Coefficient of Determination shows that trends of trauma mechanisms were not significant for both falls (R² = 0.086, p = 0.411) and traffic accidents (R² = 0.01, p = 0.779). The trends for the category of “other trauma mechanisms” is not depicted

Fig. 2

Trends of Age and Sex. Coefficient of Determination shows a significant positive trend for male sex (R² = 0.448, p = 0.034). Trend of age was not signifcant (R² = 0.158, p = 0.256)

Fig. 3

Trauma Mechanisms by Level of Injury. A. Falls were the most common trauma mechanism across all injury levels, followed by traffic accidents. B. Injury Pattern by Level of Injury. The most frequent injuries leading to SCI in the cervical and thoracic spine were facture-dislocations, followed by isolated fractures. Facture-dislocations and isolated fractures were nearly equally distributed in the lumbar spine. The cervical spine exhibited the highest number of spinal cord injuries caused by trauma without evidence of fractures or dislocations. Injury patterns were significantly different between cervical and thoracic (***p < 0.001) and cervical and lumbar SCIs (**p = 0.005)