Neurological disability among adults following traumatic spinal fractures in Saudi Arabia: a retrospective single-center medical record review

摘要

BACKGROUND: A traumatic spinal fracture (TSF) is a serious condition that has a tremendous impact on patients and their families. Understanding the causes and patterns of TSF is critical in developing prevention programs. OBJECTIVES: Identify causes and patterns of TSF and explore predictors of neurological disability in Saudi Arabia. DESIGN: A retrospective medical record review. SETTING: Level 1 trauma center in Riyadh. PATIENTS AND METHODS: The analysis included all consecutive patients who met the inclusion criteria for any acute TSF in patients 18 years of age and older from January 2001 to January 2016. A multivariate logistic regression model was used to identify predictors of neurological disability following TSF. MAIN OUTCOME MEASURES: Neurological disability in patients sustaining TSF. SAMPLE SIZE: 1128 patients. RESULTS: Of 1128 patients, 971 patients (86%) were male with a mean (SD) age 34.4 (16.6) years. The most common mechanism of injury was motor vehicle accidents (88.4%). Cervical spine was the most commonly affected region (48%, n=468) with a mortality rate of 7.6%. Neurological disability occurred in 74 (6.7%) patients, and 41 (8.7%) of those with cervical fractures died in the hospital. The Injury Severity Score was a significant predictor of neurological disability following TSF. CONCLUSION: A high proportion of neurological disability following TSF was found. Further studies should attempt to improve the documentation rate of seatbelt status in all traumatic cases including mild injuries. This data will increase our understanding of adult TSF and possibly facilitate injury prevention strategies. LIMITATIONS: Single hospital and may not be generalizable. CONFLICT OF INTEREST: None. INTRODUCTION Traumatic spinal fractures (TSF) are a significant consequence of traumatic injuries worldwide. TSF can cause permanent, profound functional disabilities and lead to significant changes in lifestyle and life quality for individuals and their families.sup 1 /sup TSFs occur at an annual incidence of 8 to 246 cases per million individuals per year around the globe.sup 2 /sup The mortality rate associated with traumatic spinal cord injury (TSCI) is higher in adults compared to children.sup 3 /sup The male to female ratio is 2:1, with a higher incidence in males than in females for the age range from 15 to 29 years.sup 4 /sup Moreover, the burden of severe TSCI cases is high in developed countries. In the United States, for example, it is estimated that the annual incidence of TSCI, not including those who died at the scene of the accident, is approximately 54 cases per million inhabitants, with approximately 17 500 new cases each year.sup 5 /sup A systematic review by the Canadian Spinal Cord Injury Rehabilitation Association found that the incidence of TSCI in North America varied from 17 to 83 people per million inhabitants annually, in most recent studies. Meanwhile, in Europe, the estimated incidence varied from 3.3 to 130.6 individuals with TSCI per million inhabitants a year.sup 6 /sup In addition, the leading cause of TSCI in the developed world appears to be motor vehicle accidents (MVA). According to the National Spinal Cord Injury Statistical Center, MVA account for 38.4% of TSCI in the United States, ranking first in causes of spinal cord injury. Accidental falls rank second at 30.5%. Violence, sports and recreational activities rank third and fourth, at 13.5% and 8.9%, respectively.sup 5 /sup On the other hand, a study based on 64 papers from 28 developing countries showed that the incidence of TSCI in developing countries was 25.5/million/year. Males (82.8%) were more likely to sustain TSCI than females. According to the same study, the two leading causes of TSCI in these countries were MVA (41.4%) and falls (34.9%).sup 7 /sup We report the proportion of neurological disability following TSF at a level 1 trauma center in Riyadh, Saudi Arabia, and its association with presenting factors. PATIENTS AND METHODS In this retrospective review, we included all consecutive patients who met the inclusion criteria for any acute TSF in patients 18 years of age and older. Exclusion criteria included individuals with pathological spinal fractures, minor injuries, transfers from other hospitals and pure ligamentous injuries. Data were retrieved from the trauma registry at a level 1 trauma centre from January 2001 to January 2016. The trauma registry is a prospectively recorded database of all admitted trauma cases. A full-time registrar is responsible for data collection and patient follow-up until discharge, death, or transfer. The data quality is annually evaluated by verifying the collection dates with the medical records. The database includes information about demographics and the list of injuries for each entry including any spinal fracture, and discharge disposition. A