孤立性创伤性脊髓损伤(t-SCI)和创伤性脑损伤(TBI)代表了重大的公共卫生问题,导致长期残疾,需要复杂的护理,特别是同时发生的时候。这些综合伤害的影响,虽然在创伤管理中至关重要,在临床上,社会经济,医疗保健结果在很大程度上是未知的。为了解决这个差距,我们的次要回顾性队列研究使用来自日本创伤数据库的数据,涵盖13年(2006-2018年)登记的患者,阐明并发t-SCI和TBI对院内死亡率的影响。患者人口统计数据,损伤特征,治疗方式,并对结果进行了分析。进行了多因素logistic回归分析,以检查与住院死亡率相关的预后变量,包括t-SCI严重程度和TBI存在之间的相互作用项。这项研究包括91,983例神经创伤患者,年龄中位数为62岁(男性占69.7%)。在患者中,9,018(9.8%)在医院死亡。2,954(3.2%)患者并发t-SCI和TBI。t-SCI仅发生在9,590(10.4%)患者中,而TBI仅发生在这些病例中的大多数(79,439,86.4%)。多因素logistic回归分析显示年龄;性别;合并症总数;就诊时收缩压;就诊时格拉斯哥昏迷量表评分;头部简化损伤量表(AIS)评分,脸,胸部,腹部,颈SCI,胸SCI和腰SCI是院内死亡率的重要独立因素.作为交互项的宫颈SCI×头部AIS的比值比为0.85(95%置信区间:0.77-0.95),表示消极的互动。总之,我们确定了与t-SCI患者院内死亡率相关的12个因素.此外,宫颈t-SCI和TBI之间的负交互作用提示TBI患者中t-SCI的存在可能被低估了.这项研究强调了早期识别和综合管理这些复杂创伤状况的重要性,同时考虑了TBI患者合并t-SCI的可能性。
Isolated traumatic spinal cord injury (t-SCI) and traumatic brain injury (TBI) represent significant public health concerns, resulting in long-term disabilities and necessitating sophisticated care, particularly when occurring concurrently. The impact of these combined injuries, while crucial in trauma management, on clinical, socioeconomic, and health care outcomes is largely unknown. To address this gap, our secondary retrospective cohort study used data from the Japan Trauma Data Bank, covering patients enrolled over a 13-year period (2006-2018), to elucidate the effects of concurrent t-SCI and TBI on in-hospital mortality. Data on patient demographics, injury characteristics, treatment modalities, and outcomes were analyzed. Multivariate logistic regression analysis was performed to examine prognostic variables associated with in-hospital mortality, including interaction terms between t-SCI severity and TBI presence. This study included 91,983 patients with neurotrauma, with a median age of 62 years (69.7% men). Among the patients, 9,018 (9.8%) died in the hospital. Concomitant t-SCI and TBI occurred in 2,954 (3.2%) patients. t-SCI only occurred in 9,590 (10.4%) patients, whereas TBI only occurred in the majority of these cases (79,439, 86.4%). Multivariate logistic regression analysis revealed age; sex; total number of comorbidities; systolic blood pressure at presentation; Glasgow coma scale score at presentation; and Abbreviated Injury Scale (AIS) scores for head, face, chest, abdomen, cervical-SCI, thoracic-SCI, and lumbar-SCI as significant independent factors for in-hospital mortality. The odds ratio of cervical-SCI × head AIS as an interaction term was 0.85 (95% confidence interval: 0.77-0.95), indicating a negative interaction. In conclusion, we identified 12 factors associated with in-hospital mortality in patients with t-SCI. In addition, the negative interaction between cervical t-SCI and TBI suggests that the presence of t-SCI in patients with TBI may be underestimated. This study highlights the importance of early recognition and comprehensive management of these complex trauma conditions while considering the possibility of concomitant t-SCI in patients with TBI.