Early predictors of functional disability after spine trauma: a level 1 trauma center study
Retrospective review on prospective cohort and explicit chart review. To identify early spine trauma predictors of functional disability and to assess management compliance to established spine trauma treatment algorithms. Identification of early (within 48 hours) spine trauma predictors of function...
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2013-05, Vol.38 (12), p.999-1007 |
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| creator | Tee, Jin W Chan, Patrick C H Fitzgerald, Mark C B Liew, Susan M Rosenfeld, Jeffrey V |
| description | Retrospective review on prospective cohort and explicit chart review.
To identify early spine trauma predictors of functional disability and to assess management compliance to established spine trauma treatment algorithms.
Identification of early (within 48 hours) spine trauma predictors of functional disability is novel and may assist in the management of patients with trauma. Also, with significant global variation, spine trauma treatment algorithms are essential.
Analysis was performed on patients with spine trauma from May 1, 2009, to January 1, 2011. Functional outcomes were determined using the Glasgow Outcome Scale (GOS) at 1 year. Univariate and multivariate regressions were applied to investigate the effects of the injury severity score, age, blood sugar level, vital signs, traumatic brain injury, comorbidities, coagulation profile, neurology, and spine injury characteristics. A compliance study was performed using the SLIC and TLICS spine trauma algorithms.
The completion rate for the GOS was 58.8%. The completed GOS cohort was 4.2 years younger in terms of mean age, had more number of patients with severe polytrauma, but less number of patients with severe spinal cord injuries (ASIA [American Spinal Injury Association] A, B, and C) in comparison with the uncompleted GOS cohort. Multivariate logistic regression revealed 3 independent early spine trauma predictors of functional disability with statistical significance (P < 0.05). They were (1) hypotension (OR [odds ratio] = 1.98; CI [confidence interval] = 1.13-3.49), (2) hyperglycemia (OR = 1.67; CI = 1.09-2.56), and (3) moderate/severe traumatic brain injury (OR = 5.88; CI = 1.71-20.16). There were 305 patients with subaxial cervical spine injuries and 653 patients with thoracolumbar spine injuries. The subaxial cervical spine injury classification and thoracolumbar injury classification and severity score compliance studies returned agreements of 96.1% and 98.9%, respectively.
Early independent spine trauma predictors of functional disability identified in a level 1 trauma center with high compliance to the subaxial cervical spine injury classification and thoracolumbar injury classification and severity score algorithms were hypotension, hyperglycemia, and moderate or severe traumatic brain injury. Spine trauma injury variables alone were shown not to be predictive of functional disability.
3. |
| doi_str_mv | 10.1097/BRS.0b013e31828432a3 |
| format | Article |
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To identify early spine trauma predictors of functional disability and to assess management compliance to established spine trauma treatment algorithms.
Identification of early (within 48 hours) spine trauma predictors of functional disability is novel and may assist in the management of patients with trauma. Also, with significant global variation, spine trauma treatment algorithms are essential.
Analysis was performed on patients with spine trauma from May 1, 2009, to January 1, 2011. Functional outcomes were determined using the Glasgow Outcome Scale (GOS) at 1 year. Univariate and multivariate regressions were applied to investigate the effects of the injury severity score, age, blood sugar level, vital signs, traumatic brain injury, comorbidities, coagulation profile, neurology, and spine injury characteristics. A compliance study was performed using the SLIC and TLICS spine trauma algorithms.
The completion rate for the GOS was 58.8%. The completed GOS cohort was 4.2 years younger in terms of mean age, had more number of patients with severe polytrauma, but less number of patients with severe spinal cord injuries (ASIA [American Spinal Injury Association] A, B, and C) in comparison with the uncompleted GOS cohort. Multivariate logistic regression revealed 3 independent early spine trauma predictors of functional disability with statistical significance (P < 0.05). They were (1) hypotension (OR [odds ratio] = 1.98; CI [confidence interval] = 1.13-3.49), (2) hyperglycemia (OR = 1.67; CI = 1.09-2.56), and (3) moderate/severe traumatic brain injury (OR = 5.88; CI = 1.71-20.16). There were 305 patients with subaxial cervical spine injuries and 653 patients with thoracolumbar spine injuries. The subaxial cervical spine injury classification and thoracolumbar injury classification and severity score compliance studies returned agreements of 96.1% and 98.9%, respectively.
Early independent spine trauma predictors of functional disability identified in a level 1 trauma center with high compliance to the subaxial cervical spine injury classification and thoracolumbar injury classification and severity score algorithms were hypotension, hyperglycemia, and moderate or severe traumatic brain injury. Spine trauma injury variables alone were shown not to be predictive of functional disability.
3.</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0b013e31828432a3</identifier><identifier>PMID: 23459136</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Aged ; Algorithms ; Comorbidity ; Critical Pathways ; Disability Evaluation ; Early Diagnosis ; Female ; Glasgow Coma Scale ; Guideline Adherence ; Humans ; Injury Severity Score ; Linear Models ; Logistic Models ; Male ; Medical Records ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Practice Guidelines as Topic ; Practice Patterns, Physicians ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Risk Factors ; Spinal Injuries - diagnosis ; Spinal Injuries - physiopathology ; Spinal Injuries - therapy ; Spine - physiopathology ; Time Factors ; Trauma Centers - standards</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2013-05, Vol.38 (12), p.999-1007</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-288b8c700fbe317d72442f532e157ff91413b26f0a3895c1c8a81923e50cbca93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23459136$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tee, Jin W</creatorcontrib><creatorcontrib>Chan, Patrick C H</creatorcontrib><creatorcontrib>Fitzgerald, Mark C B</creatorcontrib><creatorcontrib>Liew, Susan M</creatorcontrib><creatorcontrib>Rosenfeld, Jeffrey V</creatorcontrib><title>Early predictors of functional disability after spine trauma: a level 1 trauma center study</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>Retrospective review on prospective cohort and explicit chart review.
To identify early spine trauma predictors of functional disability and to assess management compliance to established spine trauma treatment algorithms.
Identification of early (within 48 hours) spine trauma predictors of functional disability is novel and may assist in the management of patients with trauma. Also, with significant global variation, spine trauma treatment algorithms are essential.
Analysis was performed on patients with spine trauma from May 1, 2009, to January 1, 2011. Functional outcomes were determined using the Glasgow Outcome Scale (GOS) at 1 year. Univariate and multivariate regressions were applied to investigate the effects of the injury severity score, age, blood sugar level, vital signs, traumatic brain injury, comorbidities, coagulation profile, neurology, and spine injury characteristics. A compliance study was performed using the SLIC and TLICS spine trauma algorithms.
The completion rate for the GOS was 58.8%. The completed GOS cohort was 4.2 years younger in terms of mean age, had more number of patients with severe polytrauma, but less number of patients with severe spinal cord injuries (ASIA [American Spinal Injury Association] A, B, and C) in comparison with the uncompleted GOS cohort. Multivariate logistic regression revealed 3 independent early spine trauma predictors of functional disability with statistical significance (P < 0.05). They were (1) hypotension (OR [odds ratio] = 1.98; CI [confidence interval] = 1.13-3.49), (2) hyperglycemia (OR = 1.67; CI = 1.09-2.56), and (3) moderate/severe traumatic brain injury (OR = 5.88; CI = 1.71-20.16). There were 305 patients with subaxial cervical spine injuries and 653 patients with thoracolumbar spine injuries. The subaxial cervical spine injury classification and thoracolumbar injury classification and severity score compliance studies returned agreements of 96.1% and 98.9%, respectively.
Early independent spine trauma predictors of functional disability identified in a level 1 trauma center with high compliance to the subaxial cervical spine injury classification and thoracolumbar injury classification and severity score algorithms were hypotension, hyperglycemia, and moderate or severe traumatic brain injury. Spine trauma injury variables alone were shown not to be predictive of functional disability.
3.</description><subject>Adult</subject><subject>Aged</subject><subject>Algorithms</subject><subject>Comorbidity</subject><subject>Critical Pathways</subject><subject>Disability Evaluation</subject><subject>Early Diagnosis</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Guideline Adherence</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>Linear Models</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical Records</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Practice Guidelines as Topic</subject><subject>Practice Patterns, Physicians</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Spinal Injuries - diagnosis</subject><subject>Spinal Injuries - physiopathology</subject><subject>Spinal Injuries - therapy</subject><subject>Spine - physiopathology</subject><subject>Time Factors</subject><subject>Trauma Centers - standards</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkE1LxDAQhoMouq7-A5EcvXTNZJI09abL-gELgh8nDyVNE6h025q0Qv-91V09eBoYnvcd5iHkDNgCWJZe3jw9L1jBAB2C5logN7hHZiC5TgBktk9mDBVPuEB1RI5jfGeMKYTskBxxFDIDVDPytjKhHmkXXFnZvg2Rtp76obF91TampmUVTVHVVT9S43sXaOyqxtE-mGFjrqihtft0NYXdhlrX_FD9UI4n5MCbOrrT3ZyT19vVy_I-WT_ePSyv14nlUvUJ17rQNmXMF9MraZlyIbiXyB3I1PsMBGDBlWcGdSYtWG00ZBydZLawJsM5udj2dqH9GFzs800Vratr07h2iDkoyYViDHFCxRa1oY0xOJ93odqYMObA8m-t-aQ1_691ip3vLgzFxpV_oV-P-AXE-3PA</recordid><startdate>20130520</startdate><enddate>20130520</enddate><creator>Tee, Jin W</creator><creator>Chan, Patrick C H</creator><creator>Fitzgerald, Mark C B</creator><creator>Liew, Susan M</creator><creator>Rosenfeld, Jeffrey V</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130520</creationdate><title>Early predictors of functional disability after spine trauma: a level 1 trauma center study</title><author>Tee, Jin W ; Chan, Patrick C H ; Fitzgerald, Mark C B ; Liew, Susan M ; Rosenfeld, Jeffrey V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-288b8c700fbe317d72442f532e157ff91413b26f0a3895c1c8a81923e50cbca93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Algorithms</topic><topic>Comorbidity</topic><topic>Critical Pathways</topic><topic>Disability Evaluation</topic><topic>Early Diagnosis</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Guideline Adherence</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>Linear Models</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical Records</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Practice Guidelines as Topic</topic><topic>Practice Patterns, Physicians</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Spinal Injuries - diagnosis</topic><topic>Spinal Injuries - physiopathology</topic><topic>Spinal Injuries - therapy</topic><topic>Spine - physiopathology</topic><topic>Time Factors</topic><topic>Trauma Centers - standards</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tee, Jin W</creatorcontrib><creatorcontrib>Chan, Patrick C H</creatorcontrib><creatorcontrib>Fitzgerald, Mark C B</creatorcontrib><creatorcontrib>Liew, Susan M</creatorcontrib><creatorcontrib>Rosenfeld, Jeffrey V</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tee, Jin W</au><au>Chan, Patrick C H</au><au>Fitzgerald, Mark C B</au><au>Liew, Susan M</au><au>Rosenfeld, Jeffrey V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early predictors of functional disability after spine trauma: a level 1 trauma center study</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2013-05-20</date><risdate>2013</risdate><volume>38</volume><issue>12</issue><spage>999</spage><epage>1007</epage><pages>999-1007</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><abstract>Retrospective review on prospective cohort and explicit chart review.
To identify early spine trauma predictors of functional disability and to assess management compliance to established spine trauma treatment algorithms.
Identification of early (within 48 hours) spine trauma predictors of functional disability is novel and may assist in the management of patients with trauma. Also, with significant global variation, spine trauma treatment algorithms are essential.
Analysis was performed on patients with spine trauma from May 1, 2009, to January 1, 2011. Functional outcomes were determined using the Glasgow Outcome Scale (GOS) at 1 year. Univariate and multivariate regressions were applied to investigate the effects of the injury severity score, age, blood sugar level, vital signs, traumatic brain injury, comorbidities, coagulation profile, neurology, and spine injury characteristics. A compliance study was performed using the SLIC and TLICS spine trauma algorithms.
The completion rate for the GOS was 58.8%. The completed GOS cohort was 4.2 years younger in terms of mean age, had more number of patients with severe polytrauma, but less number of patients with severe spinal cord injuries (ASIA [American Spinal Injury Association] A, B, and C) in comparison with the uncompleted GOS cohort. Multivariate logistic regression revealed 3 independent early spine trauma predictors of functional disability with statistical significance (P < 0.05). They were (1) hypotension (OR [odds ratio] = 1.98; CI [confidence interval] = 1.13-3.49), (2) hyperglycemia (OR = 1.67; CI = 1.09-2.56), and (3) moderate/severe traumatic brain injury (OR = 5.88; CI = 1.71-20.16). There were 305 patients with subaxial cervical spine injuries and 653 patients with thoracolumbar spine injuries. The subaxial cervical spine injury classification and thoracolumbar injury classification and severity score compliance studies returned agreements of 96.1% and 98.9%, respectively.
Early independent spine trauma predictors of functional disability identified in a level 1 trauma center with high compliance to the subaxial cervical spine injury classification and thoracolumbar injury classification and severity score algorithms were hypotension, hyperglycemia, and moderate or severe traumatic brain injury. Spine trauma injury variables alone were shown not to be predictive of functional disability.
3.</abstract><cop>United States</cop><pmid>23459136</pmid><doi>10.1097/BRS.0b013e31828432a3</doi><tpages>9</tpages></addata></record> |
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| identifier | ISSN: 0362-2436 |
| ispartof | Spine (Philadelphia, Pa. 1976), 2013-05, Vol.38 (12), p.999-1007 |
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| subjects | Adult Aged Algorithms Comorbidity Critical Pathways Disability Evaluation Early Diagnosis Female Glasgow Coma Scale Guideline Adherence Humans Injury Severity Score Linear Models Logistic Models Male Medical Records Middle Aged Multivariate Analysis Odds Ratio Practice Guidelines as Topic Practice Patterns, Physicians Predictive Value of Tests Prognosis Retrospective Studies Risk Factors Spinal Injuries - diagnosis Spinal Injuries - physiopathology Spinal Injuries - therapy Spine - physiopathology Time Factors Trauma Centers - standards |
| title | Early predictors of functional disability after spine trauma: a level 1 trauma center study |
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