Session VII - Spine

Fri., 10/21/05 Spine, Paper #29, 3:06 pm

Timing of Thoracic Spine Stabilization in Trauma Patients: Impact on Clinical Course and Outcome

Christian Schinkel, MD, FACS (n); Andrej Kmetic, MD (n); Gert Muhr, MD (n); AG Polytrauma DGU (German National Trauma Registry)
BG Kliniken Bergmannsheil; Ruhr-University, Bochum, Germany

Purpose: Optimal timing of stabilization for thoracic spine injuries in multiply injured patients remains controversial because additional lung injury occurs frequently. Early surgery might be beneficial in the clinical course and outcome for this patient population.

Methods: We analyzed the National Trauma Database (n=8057) and compared clinical parameters and outcome of patients with severe thoracic spine injuries (AIS>2; n=299) that underwent spine stabilization within (group I) or after 72 hours (group II) posttrauma.

Results: 95% of all patients had additional severe thoracic injuries such as lung contusion or pneumohemothorax. Despite comparable demographic datamedian age group I 33 years (range, 13 to 80), group II median age 37 (range, 16 to 66); mean ISS group I 29 points (range, 9 to 66), group II mean 29 points (range, 14 to 57); hemoglobin on admission group I 11.8 mg/dl (range, 4.9 to 16.7), group II 10.2 mg/dl (range, 4.4 to 15.9); systolic blood pressure on admission group I 120 mmHg (range, 65 to 190), group II: 120 mmHg (range, 80 to 170); initial GCS group I 13 pts (range, 3 to 15), group II 11 pts (range, 3 to 15)patients in group I had a significant shorter ICU stay (median 8 days, range 0 to 237 versus group II with median 16 days, range 2 to 91; shorter dependence on mechanical ventilation (median 2 days, range 0 to 48 versus group II median 5 days, range 0 to 274; and shorter in-hospital stay (mean 22 days, range 1 to 255 versus group II mean 32 days, range 6 to 91). Expected mortality calculated by TRISS was significantly reduced in group I (calculated 16.4%, documented 6.3%) but not in group II (18.8% versus 17%).

Conclusions/Significance: Almost 10% of all patients in the National Trauma Registry had severe spine injuries. The extent of injury was often underestimated in the preclinical setting. There was a 95% coincidence of severe thoracic injuries in thoracic spine trauma. Our data provide evidence that early stabilization of thoracic spine injuries in trauma patients reduces overall hospital and ICU stay and improves outcome. Thus early stabilization of thoracic spine injuries within 3 days after trauma appears to be favorable.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.