Determining the Incidence of Concomitant Traumatic Brain Injury in Patients With Acute Spinal Cord Injury: A 10-Year Cross-sectional Study.

Abstract

Objective: A concomitant traumatic brain injury is often seen in patients with acute traumatic spinal cord injury. Unfortunately, the exact epidemiology of concomitant traumatic brain injury-traumatic spinal cord injury remains unknown. Our objective was to determine the incidence of concomitant traumatic brain injury-traumatic spinal cord injury and identify clinical factors associated with its occurrence.

Design: A prospective cross-sectional study of 476 traumatic spinal cord injury patients was conducted. In all patients, baseline characteristics were routinely collected and the presence of a traumatic brain injury was sought prospectively by a specialized neurosurgeon using standardized diagnostic criteria based on clinical and radiological variables.

Results: Of the 476 included patients, 250 (53%) had isolated traumatic spinal cord injury and 226 (47%) had concomitant traumatic brain injury-traumatic spinal cord injury. Almost 85% of diagnosed traumatic brain injuries were mild. At the univariate level, patients with concomitant traumatic brain injury-traumatic spinal cord injury were more likely to present a history of drug/alcohol abuse ( P = 0.014), be involved in a motor vehicle accident ( P < 0.001), sustain a high energy mechanism ( P < 0.001), or present tetraplegia rather than paraplegia ( P = 0.021). These factors all remained significant at the multivariate level.

Discussion: A concomitant traumatic brain injury can be found in around 50% of traumatic spinal cord injury individuals. There are several clinical variables that should increase clinical suspicion of underlying traumatic brain injury and warrant further investigation to facilitate prompt identification and treatment of affected patients.