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Citation
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Chiu AK, Pease TJ, Prakash H, Oster BA, Smith RA, Sahlani M, Ratanpal AS, Amin I, Scalea TM, Bivona LJ, Jauregui JJ, Cavanaugh DL, Koh EY, Ludwig SC. Spine J. 2024; ePub(ePub): ePub. |
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Abstract
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BACKGROUND CONTEXT: Traumatic spinal injuries (TSI) are associated with high morbidity, mortality, and resource utilization. The epidemiology of TSI varies greatly across different countries and regions and is impacted by national income levels, infrastructure, and cultural factors. Further, there may be changes over time. It is essential to investigate TSI to gain useful epidemiologic information. However, there have been no recent studies on trends for TSI in the US, despite the changing population demographics, healthcare policy, and technology. As a result, re-examination is warranted to reflect how the modern era has affected the epidemiology of US spine trauma patients and their management.
PURPOSE: To determine epidemiologic trends in traumatic spine injuries over time.
STUDY DESIGN/SETTING: Retrospective analysis; level 1 trauma center in the United States.
PATIENT SAMPLE: A total of 21,811 patients, between the years of 1996 and 2022, who presented with traumatic spine injury.
OUTCOME MEASURES: Age, sex, race, Injury Severity Score, mechanism of injury, injury diagnosis, injury level, rate of operative intervention, hospital length of stay, intensive care unit length of stay, discharge disposition, in-hospital mortality.
METHODS: Data was collected from our institutional trauma registry over a 26-year period. Inclusion criteria involved at least one diagnosis of vertebral fracture, spinal cord injury, spinal subluxation, or intervertebral disc injury. Exclusion criteria consisted of patients with no diagnosed spine injury or a diagnosis of strain only. A total of 21,811 patients were included in the analysis. Descriptive statistics were tabulated and ordinary least squares linear regression was conducted for trends analysis.
RESULTS: Regression analysis showed a significant upward trend in patient age (+13.83 years, β=+0.65/year, p<0.001), female sex (+2.7%, β=+0.18%/year, p=0.004), falls (+10.5%, β=+0.82%/year, p<0.001), subluxations (+12.8%, β=+0.35%/year, p<0.001), thoracic injuries (+1.5%, β=+0.28%/year, p<0.001), and discharges to subacute rehab (+15.9%, β=+0.68%/year, p<0.001). There was a significant downward trend in motor vehicle crashes (-7.8%, β=-0.47%/year, p=0.016), firearms injuries (-3.4%, β=-0.19%/year, p<0.001), sports/recreation injuries (-2.9%, β=-0.18%/year, p<0.001), spinal cord injuries (-11.25%, β=-0.37%, p<0.001), complete spinal cord injuries (-7.6%, β=-0.24%/year, p<0.001), and discharges to home (+4.5%, β=-0.27%/year, p=0.011).
CONCLUSIONS: At our institution, the average spine trauma patient has trended toward older females. Falls represent an increasing proportion of the mechanism of injury, on a trajectory to become the most common cause. With time, there have been fewer spinal cord injuries and a lower proportion of complete injuries. At discharge, there has been a surge in the utilization of subacute rehabilitation facilities. Overall, there has been no significant change in injury severity, rate of operative intervention, length of stay, or mortality.
Language: en |