Epidemiology of spinal cord injury in the context of closed head injury.

Abstract

Design: Retrospective Study.

Background: The incidence of traumatic brain injury (TBI) in patients with spinal cord injury (SCI) is well documented. However, the incidence of SCI specifically in patients with closed head injury (CHI) is understudied. SCI and CHI are underdiagnosed, and this can be complicated history. Facilities are often focused on patients' primary issues, and with polytrauma patients' cognitive impairment, CHI can be missed. Thus, this study aimed to determine the incidence of SCI in patients with CHI.

Methods and materials: This retrospective study used Pennsylvania Trauma Systems Foundation database to identify patients with SCI among those with CHI (2010 through 2020 end) and described the patient demographics; incidence per year; frequencies of the various causes and types of injuries; and the underlying CHI in terms of frequencies of diagnosis and severity. The frequencies of various diagnoses associated with SCI, neurologic level of injury, severity and the associated vertebral fractures, and in-hospital mortality were also described.

Results: Among patients with CHI, 2.6% were found to have SCI. Patients mostly affected were male (73.5%), Caucasian (78.4%), and a mean age (SD, range) of 46.3 (15.5, 19-70) years. Blunt injury, predominantly in the form of motor vehicle collisions (55.7%) and falls (34.6%) constituted the main causes. Cervical spine was most affected (76.2%), with C1-C4 region comprising the most injuries (39%), followed by thoracic spine (26.4%). Vertebral Fracture (VF) was noted in 47.1%; C5-C7 was the most fractured region (28.9%). VF levels matched SCI levels in 52-70%. Complete SCI was diagnosed in 18.6% of patients. The mean duration of stay in hospital was 11 days (range 0-262). In-hospital mortality was noted in 8.2% of patients.

Conclusion: The CHI should not necessarily be severe to have a suspicion of SCI. The clinical findings of SCI in CHI mostly follow the pattern in dual diagnosis of TBI/SCI, such as frequent involvement of cervical spine with less involvement of the thoracic and lumbar sections of the spine. An appropriate clinical suspicion to screen and follow management protocols for SCI is recommended for the best patient care.