Predictors of Thoracic and Lumbar Spine Injuries in Patients with TBI: A Nationwide Analysis

Injury, 2022 · DOI: 10.1016/j.injury.2021.09.060 · Published: March 1, 2022

Spinal Fractures Brain Injury Public Health

Simple Explanation

This study examines the risk factors for thoracic and lumbar spine fractures in patients who have experienced a traumatic brain injury (TBI). Cervical spine injury screening is common for TBI patients, but less is known about injuries lower down the spine. The researchers analyzed data from a large national database to identify characteristics that make TBI patients more likely to also have a thoracic or lumbar spine fracture. This information can help doctors decide which patients need more extensive screening. The study found that factors such as the severity of the TBI, other injuries, and conditions like smoking and obesity were associated with a higher risk of having both thoracic and lumbar spine fractures.

Study Duration

2011-2014

Participants

768,718 TBI patients

Evidence Level

Not specified

Key Findings

1
Moderate and severe TBI, as defined by Glasgow Coma Scale (GCS), were significantly associated with both thoracic and lumbar spine fractures.
2
Factors such as epidural hematoma, upper and lower extremity injuries, smoking, and obesity were identified as common risk factors for both types of spinal fractures in TBI patients.
3
Patients with thoracic or lumbar spine fractures had a greater likelihood of requiring rehabilitation services and ICU admission compared to TBI patients without these fractures.

Research Summary

This study used a national trauma database to identify risk factors for concomitant thoracic and lumbar spine fractures in patients with traumatic brain injury (TBI). The analysis revealed that factors such as the severity of TBI (as measured by GCS), other injuries (upper/lower extremities, abdominal), and certain comorbidities (smoking, obesity) were significant predictors of these spinal fractures. The presence of thoracolumbar fractures was associated with increased morbidity, including higher rates of ICU admission and need for rehabilitation, underscoring the importance of considering these injuries in TBI patients.

Practical Implications

Improved Screening

Findings can inform clinical screening for thoracic and lumbar spine fractures in TBI patients.

Reduced Unnecessary Imaging

Evidence-based criteria to prioritize patients for additional screening could reduce unnecessary testing and radiation exposure.

Better Patient Management

Early identification of thoracolumbar fractures can lead to more appropriate and timely management, potentially improving patient outcomes.

Study Limitations

1
The study relies on data from initial hospitalizations, precluding analysis of long-term outcomes.
2
Patients who die prior to hospital arrival are not captured in the NTDB.
3
Reliance on ICD-9 codes may introduce error in clinical reporting.

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