Table_4_Concomitant spine trauma in patients with traumatic brain injury: Patient characteristics and outcomes.docx

ObjectiveSpine injury is highly prevalent in patients with poly-trauma, but data on the co-occurrence of spine trauma in patients with traumatic brain injury (TBI) are scarce. In this study, we used the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) database to assess the prevalence, characteristics, and outcomes of patients with TBI and a concurrent traumatic spinal injury (TSI).
MethodsData from the European multi-center CENTER-TBI study were analyzed. Adult patients with TBI (≥18 years) presenting with a concomitant, isolated TSI of at least serious severity (Abbreviated Injury Scale; AIS ≥3) were included. For outcome analysis, comparison groups of TBI patients with TSI and systemic injuries (non-isolated TSI) and without TSI were created using propensity score matching. Rates of mortality, unfavorable outcomes (Glasgow Outcome Scale Extended; GOSe < 5), and full recovery (GOSe 7–8) of all patients and separately for patients with only mild TBI (mTBI) were compared between groups at 6-month follow-up.
ResultsA total of 164 (4%) of the 4,254 CENTER-TBI core study patients suffered from a concomitant isolated TSI. The median age was 53 [interquartile range (IQR): 37–66] years and 71% of patients were men. mTBI was documented in 62% of cases, followed by severe TBI (26%), and spine injuries were mostly cervical (63%) or thoracic (31%). Surgical spine stabilization was performed in 19% of cases and 57% of patients were admitted to the ICU. Mortality at 6 months was 11% and only 36% of patients regained full recovery. There were no significant differences in the 6-month rates of mortality, unfavorable outcomes, or full recovery between TBI patients with and without concomitant isolated TSI. However, concomitant non-isolated TSI was associated with an unfavorable outcome and a higher mortality. In patients with mTBI, a negative association with full recovery could be observed for both concomitant isolated and non-isolated TSI.
ConclusionRates of mortality, unfavorable outcomes, and full recovery in TBI patients with and without concomitant, isolated TSIs were comparable after 6 months. However, in patients with mTBI, concomitant TSI was a negative predictor for a full recovery. These findings might indicate that patients with moderate to severe TBI do not necessarily exhibit worse outcomes when having a concomitant TSI, whereas patients with mTBI might be more affected.

研究目的：脊柱损伤在多发伤患者中患病率极高，但关于创伤性脑损伤（traumatic brain injury, TBI）患者合并脊柱创伤的相关数据仍较为匮乏。本研究依托欧洲创伤性脑损伤神经创伤有效性协作研究（Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury, CENTER-TBI）数据库，评估合并创伤性脊柱损伤（traumatic spinal injury, TSI）的TBI患者的患病率、临床特征与预后情况。
研究方法：本研究对欧洲多中心CENTER-TBI研究的数据集进行分析。纳入标准为年龄≥18岁的成年TBI患者，且合并至少达到严重程度的孤立性创伤性脊柱损伤（简明损伤定级标准（Abbreviated Injury Scale, AIS）≥3分）。为开展预后分析，通过倾向得分匹配法，分别构建合并创伤性脊柱损伤伴全身损伤（非孤立性创伤性脊柱损伤）、以及未合并创伤性脊柱损伤的TBI患者对照队列。对所有受试者及仅轻度TBI（mild TBI, mTBI）患者亚组，比较其在6个月随访时的死亡率、不良预后（扩展格拉斯哥预后量表（Glasgow Outcome Scale Extended, GOSe）评分<5分）与完全康复（GOSe评分7~8分）比例。
研究结果：在4254例CENTER-TBI核心研究受试者中，共164例（4%）合并孤立性创伤性脊柱损伤。该队列患者中位年龄为53岁[四分位距（interquartile range, IQR）：37~66岁]，其中男性占比71%。62%的患者为轻度TBI，其次为重度TBI（26%）；脊柱损伤部位以颈椎（63%）或胸椎（31%）为主。19%的患者接受了脊柱外科固定术，57%的患者收入重症监护室（Intensive Care Unit, ICU）。6个月死亡率为11%，仅36%的患者实现完全康复。合并孤立性创伤性脊柱损伤的TBI患者与未合并该损伤的患者相比，6个月死亡率、不良预后率及完全康复率均无显著差异。但合并非孤立性创伤性脊柱损伤的患者则表现出不良预后风险更高、死亡率更高的特征。在轻度TBI患者亚组中，无论合并孤立性还是非孤立性创伤性脊柱损伤，均与完全康复率降低存在负相关关联。
研究结论：6个月随访时，合并与未合并孤立性创伤性脊柱损伤的TBI患者，其死亡率、不良预后率及完全康复率均无显著差异。但在轻度TBI患者中，合并创伤性脊柱损伤是完全康复的负向预测因子。上述研究结果提示，中重度TBI患者合并创伤性脊柱损伤未必会导致预后更差，而轻度TBI患者则可能受其影响更大。