A case series of penetrating spinal trauma: comparisons to blunt trauma, surgical indications, and outcomes
| Autor: | Casey P Spinelli, Clifford L Crutcher, Gabriel C. Tender, Anthony M DiGiorgio, Kevin Morrow, Adam Podet, Jason D Wilson, Lindsay Lasseigne |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Patient Transfer medicine.medical_specialty Adolescent Alcohol Drinking Cauda Equina Databases Factual Neurological examination Wounds Penetrating Comorbidity Wounds Nonpenetrating Insurance Coverage Neurosurgical Procedures 03 medical and health sciences Young Adult 0302 clinical medicine Blunt Injury Severity Score Epidemiology medicine Ethnicity Humans Hospital Mortality Spinal Cord Injuries Aged Retrospective Studies medicine.diagnostic_test business.industry 030208 emergency & critical care medicine General Medicine Length of Stay Middle Aged Surgery Treatment Outcome Blunt trauma Spinal Injuries Concomitant Spinal Fractures Spine injury Female Wounds Gunshot Neurology (clinical) Complication business 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgical focus. 46(3) |
| ISSN: | 1092-0684 |
| Popis: | OBJECTIVEWhile blunt spinal trauma accounts for the majority of spine trauma, penetrating injuries affect a substantial number of patients. The goal of this study was to examine the epidemiology of penetrating spine injuries compared with blunt injuries and review the operative interventions and outcomes in the penetrating spine injury group.METHODSThe prospectively maintained trauma database was queried for spinal fractures from 2012 to 2018. Charts from patients with penetrating spine trauma were reviewed.RESULTSA total of 1130 patients were evaluated for traumatic spinal fractures; 154 injuries (13.6%) were secondary to penetrating injuries. Patients with penetrating injuries were significantly younger (29.2 years vs 44.1 years, p < 0.001), more likely male (87.7% vs 69.2%, p < 0.001), and more commonly African American (80.5% vs 33.3%, p < 0.05). When comparing primary insurers, the penetrating group had a significantly higher percentage of patients covered by Medicaid (60.4% vs 32.6%, p < 0.05) or prison (3.9% vs 0.1%, p < 0.05) or being uninsured (17.5% vs 10.3%, p < 0.05). The penetrating group had a higher Injury Severity Score on admission (20.2 vs 15.6, p < 0.001) and longer hospital length of stay (20.1 days vs 10.3 days, p < 0.001) and were less likely to be discharged home (51.3% vs 65.1%, p < 0.05). Of the penetrating injuries, 142 (92.2%) were due to firearms. Sixty-three patients (40.9%) with penetrating injuries had a concomitant spinal cord or cauda equina injury. Of those, 44 (69.8%) had an American Spinal Injury Association Impairment Scale (AIS) grade of A. Ten patients (15.9%) improved at least 1 AIS grade, while 2 patients (3.2%) declined at least 1 AIS grade. Nine patients with penetrating injuries underwent neurosurgical intervention: 5 for spinal instability, 4 for compressive lesions with declining neurological examination results, and 2 for infectious concerns, with some patients having multiple indications. Patients undergoing neurosurgical intervention did not show a significantly greater change in AIS grade than those who did not. No patient experienced a complication directly related to neurosurgical intervention.CONCLUSIONSPenetrating spinal trauma affects a younger, more publicly funded cohort than blunt spinal trauma. These patients utilize more healthcare resources and are more severely injured. Surgery is undertaken for limiting progression of neurological deficit, stabilization, or infection control. |
| Databáze: | OpenAIRE |
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