Elsevier

Injury

Volume 39, Issue 12, December 2008, Pages 1437-1441
Injury

Risk factors predicting mortality after blunt traumatic cervical fracture

https://doi.org/10.1016/j.injury.2008.03.008Get rights and content

Summary

Objective

Risk factors for mortality after blunt cervical trauma have received little attention within the literature. Therefore, we performed a study, to determine which factors are associated with mortality in patients with blunt cervical trauma.

Study design

A retrospective study of 88 trauma patients, with cervical fractures, who were admitted to the emergency department of the St. Elisabeth hospital, Tilburg, The Netherlands.

Summary of background data

A retrospective cohort study was performed within the trauma department of the St. Elisabeth Hospital, in Tilburg, The Netherlands. From January 2000 to December 2005, all patients with cervical fractures after blunt trauma were included (N = 88). All patient records were reviewed. Patient and trauma characteristics were registered within a standardised electronic database. Our follow-up period was 1 year.

Results

In total, 12 (13.6%) patients died after a traumatic cervical fracture. Age (p = 0.005), gender (p = 0.005), involvement of the third cervical vertebrae (p = 0.003), involvement of three cervical vertebrae (p = 0.010) and involvement of the spinous process (p = 0.032) were associated with mortality. The multivariate analysis showed that age and the involvement of the third cervical vertebrae (both p = 0.016) are both independently associated with mortality.

Conclusion

Age and involvement of the third cervical vertebrae were both independent predictors of mortality. Age has been previously described as a risk factor for adverse prognosis in different diseases and trauma's. However, involvement of the third cervical vertebrae has not yet been described as a significant risk factor. Before implementation within trauma support further research is needed to evaluate the role of the third cervical vertebra regarding adverse prognosis and mortality in trauma patients.

Introduction

After blunt trauma, the incidence of injuries of the cervical spine is 2–3%. Because of the importance of the neurological network located at the cervical spine, these injuries are associated with significant morbidity and mortality.19

Several methods are designed to correlate the severity of trauma and probability of survival. The most frequently used method, is the Trauma Related Injury Severity Score (TRISS). However, the use of the TRISS has yielded mixed results.4, 12 Within TRISS, the injury severity level, respiratory rate, systolic blood pressure, Glasgow coma scale, age and type of injury (blunt and penetrating) are included as factors to predict the probability of survival. However, the importance of these factors in traumatic cervical fractures is not yet clear.

Studies on risk factors for mortality after blunt cervical trauma are rather scarce. In spinal cord injury, Furlan et al.11 found that gender was not a risk factor associated with survival. They did observe a trend for higher rates of reactive depression and deep venous thrombosis in women. Bouamra et al.5 identified factors that influence significantly the mortality rate, length of stay and discharge destination in blunt trauma. They found that the effect of age on the outcome differs with regard to gender. Within this study a significant difference in survival was found between men and women.

In order to make a valid general assessment in cervical trauma of patient status and to perform triage in emergency situations, it is important to identify which factors influence mortality. The aim of the present study is therefore to identify independent risk factors associated with mortality in cervical trauma patients.

Section snippets

Patients

A consecutive series of 88 patients with blunt cervical trauma, diagnosed at the emergency department of our institution, between January 2000 and December 2005, was analysed. All patients were retrospectively identified through our electronic patient database using the International Classification of Diseases (ICD-10) and the free description line of the diagnosis.

All patient data were registered prospectively in an electronic patient database.

Procedure

Upon arrival, all patients were screened according

Results

Eighty-eight patients were included in the present study. The majority of the patients in the current study were male (n = 62; 70.5%). The mean age of the patients was 43.7 (±19.6), ranging form 15 to 96 years. Twelve patients (13.6%) died within 1-year follow-up period.

Discussion and conclusion

The present study shows that age and involvement of the third cervical vertebrae are associated with mortality in patients with trauma. Age has previously been described as a risk factor for adverse prognosis in different diseases and in cervical spine injury.9, 15 This is due to underlying degenerative changes of the spine.19, 21, 22 However, involvement of the third cervical vertebrae has not yet been described as a significant risk factor.

In the literature it is known that the Injury

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