Prevalence of concomitant traumatic cranio-spinal injury: a systematic review and meta-analysis

Abstract

The biomechanical relationship between cranial and spinal structures makes concomitant injury likely. Concomitant craniospinal injuries are important to consider following trauma due to the serious consequences of a missed injury. The objective of this review was to estimate the prevalence of concomitant cranio-spinal injury in the adult trauma population. A systematic search of MEDLINE and EMBASE databases to identify observational studies reporting the prevalence of concomitant cranio-spinal injury in the general adult trauma population was conducted on 21 March 2017. The prevalence of concomitant cervical spinal injury in patients with a traumatic brain injury (TBI); the prevalence of concomitant spinal injury in patients with a TBI; the prevalence of concomitant TBI in patients with a cervical spinal injury; and the prevalence of concomitant TBI in patients with a spinal injury were calculated by meta-analysis. Twenty-one studies met the inclusion criteria and were included in this review. The prevalence of concomitant cervical spinal injury in patients with a TBI was found to be 6.5% (95% CI 6.0-7.1%); the prevalence of concomitant spinal injury in patients with a TBI to be 12.4-12.5%; the prevalence of concomitant TBI in patients with a cervical spinal injury to be 40.4% (95% CI 33.0-48.0%); and the prevalence of concomitant TBI in patients with a spinal injury to be 32.5% (95% CI 10.8-59.3%). This review reports the prevalence of concomitant cranio-spinal injury and highlights the importance of considering concomitant injury in patients with a cranial or spinal traumatic injury.

The Functional Outcome of Patients Following Spinal Injury in Asia Metropolitans: Does the Prehospital Spine Immobilization Matter?

“…Excluding patients with TBI may be a cause. The prevalence of concomitant TBI in patients with an SI was 32.5% (95%CI 10.8-59.3%) and 40.4% (95%CI 33.0-48.0%) in patients with cervical SI 21 . Severe TBI can cause severe functional disability or death; approximately 38% of patients die 40 and, as estimated, 43% are discharged with long-term disability 41 .…”

“…The diagnosis was selected using ICD-9 (other paralytic syndromes 344.0-344.9; fracture of vertebral column without mention of SCI 805.0-805.5; fracture of the vertebral column with SCI 806.0-806.6; dislocation of vertebra 839.4; SCI without evidence of spinal bone injury 952.0-952.9) or ICD-10 (fracture of vertebra S12.0-S12.9, S22.0, S32.0, S32.9; dislocation, subluxation of vertebrae, traumatic rupture of intervertebral disc S13.0-S13.1, S23.0-S23.1, S33.0-S33.1; injury of nerves and spinal cord S14.0-S14.9, S24.0-S24.2, S34.0-S34.2) based on the registry data, we excluded patients with preexisting disability (de ned as Glasgow Outcome Score [GOS] <4 before the injury), traumatic brain injury (TBI) (de ned as traumatic cerebral edema, diffuse/focal TBI, epidural hemorrhage, traumatic subdural hemorrhage, traumatic subarachnoid hemorrhage using ICD-9 854.0, 851.0-852.5; ICD-10 S06.1-S06.9), incomplete data on immobilization, Injury Severity Score (ISS), Revised Trauma Score (RTS) at the ED, functional outcome at discharge or prehospital time interval. We excluded patients with TBI because the prevalence of concomitant TBI in patients with an SI can be as high as 32.5% 21 , and we could not differentiate whether the disability resulted from TBI or SI.…”

A multicenter cohort study on the association between prehospital immobilization and functional outcome of patients following spinal injury in Asia

“…The diagnosis was selected using ICD-9 (other paralytic syndromes 344.0–344.9; fracture of vertebral column without mention of SCI 805.0–805.5; fracture of the vertebral column with SCI 806.0–806.6; dislocation of vertebra 839.4; SCI without evidence of spinal bone injury 952.0–952.9) or ICD-10 (fracture of vertebra S12.0–S12.9, S22.0, S32.0, S32.9; dislocation, subluxation of vertebrae, traumatic rupture of intervertebral disc S13.0–S13.1, S23.0–S23.1, S33.0–S33.1; injury of nerves and spinal cord S14.0–S14.9, S24.0–S24.2, S34.0–S34.2) based on the registry data, we excluded patients with pre-existing disability (defined as Glasgow Outcome Score [GOS] < 4 before the injury), traumatic brain injury (TBI) (defined as traumatic cerebral edema, diffuse/focal TBI, epidural hemorrhage, traumatic subdural hemorrhage, traumatic subarachnoid hemorrhage using ICD-9 854.0, 851.0–852.5; ICD-10 S06.1–S06.9), incomplete data on immobilization, Injury Severity Score (ISS), Revised Trauma Score (RTS) at the ED, functional outcome at discharge or prehospital time interval. We excluded patients with TBI because the prevalence of concomitant TBI in patients with an SI can be as high as 32.5% 21 , and we could not differentiate whether the disability resulted from TBI or SI.…”

Effects on Outcomes of Hyperglycemia in the Hyperacute Stage after Acute Traumatic Spinal Cord Injury

“…[29][30][31][32][33] Second, the frequency of concomitant TBI among individuals with acute traumatic SCI was estimated to be 32.5% (95% confidence interval [CI]: 10.8-59.3%) in a recent meta-analysis. 34 Moreover, hyperglycemia post-injury has a negative impact on neurological and functional recovery after moderate-to-severe TBI, which justifies consideration of concomitant TBI as a major potential confounder in any data analysis focused on recovery after acute traumatic SCI. 10,17,20 Third, the kidneys play the foremost role in glucose and insulin metabolism, and current knowledge suggests kidneys are intimately involved in the development, maintenance, and resolution of hyperglycemia in critically ill patients.…”