This is a European cohort study on predictors of spinal injury in adult (≥16 years) major trauma patients, using prospectively collected data of the Trauma Audit and Research Network from 1988 to 2009. Predictors for spinal fractures/dislocations or spinal cord injury were determined using univariate and multivariate logistic regression analysis. 250,584 patients were analysed. 24,000 patients (9.6) sustained spinal fractures/dislocations alone and 4,489 (1.8) sustained spinal cord injury with or without fractures/dislocations. Spinal injury patients had a median age of 44.5 years (IQR = 28.8–64.0) and Injury Severity Score of 9 (IQR = 4–17). 64.9 were male. 45 of patients suffered associated injuries to other body regions. Age 45 years (≥45 years OR 0.83–0.94), Glasgow Coma Score (GCS) 3–8 (OR 1.10, 95 CI 1.02–1.19), falls 2 m (OR 4.17, 95 CI 3.98–4.37), sports injuries (OR 2.79, 95 CI 2.41–3.23) and road traffic collisions (RTCs) (OR 1.91, 95 CI 1.83–2.00) were predictors for spinal fractures/dislocations. Age 45 years (≥45 years OR 0.78–0.90), male gender (female OR 0.78, 95 CI 0.72–0.85), GCS 15 (OR 1.36–1.93), associated chest injury (OR 1.10, 95 CI 1.01–1.20), sports injuries (OR 3.98, 95 CI 3.04–5.21), falls 2 m (OR 3.60, 95 CI 3.21–4.04), RTCs (OR 2.20, 95 CI 1.96–2.46) and shooting (OR 1.91, 95 CI 1.21–3.00) were predictors for spinal cord injury. Multilevel injury was found in 10.4 of fractures/dislocations and in 1.3 of cord injury patients. As spinal trauma occurred in 10 of major trauma patients, aggressive evaluation of the spine is warranted, especially, in males, patients 45 years, with a GCS 15, concomitant chest injury and/or dangerous injury mechanisms (falls 2 m, sports injuries, RTCs and shooting). Diagnostic imaging of the whole spine and a diligent search for associated injuries are substantial...
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