Epidemiology of spinal fractures in polytrauma patients

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PURPOSE: The epidemiology of spinal fractures in polytrauma, population characteristics and their hospital outcomes are not well defined. This study aimed to describe the epidemiology and outcomes of spinal fractures in a consensus defined polytrauma cohort. METHODS: A 13-year (2009-2021) retrospective study was conducted on Newcastle Definition based polytrauma patients at a Level-1 centre. Polytrauma patients were categorised based on the presence of vertebral fractures and compared in demographics, injury mechanism, injury severity and pattern, physiological parameters, treatment aspects, and outcomes. RESULTS: From the 1425 polytrauma patients, 632 (44.4%) sustained spinal fractures. These patients were older (48 vs. 38 years, p < 0.001) with identical injury severity (ISS = 29), were more frequently admitted (62.8% vs. 57.4%, p = 0.037) and also stayed longer in ICU (6 vs. 3 days, p < 0.001) and in hospital (14.5 vs. 12 days, p = 0.002). Mortality did not differ significantly (10.4% vs. 13.5%, p = 0.08). The lumbar spine was the most frequently fractured segment (7.3%), followed by thoracic (3.3%), cervical (3.3%) and sacral (3.1%) levels. Spinal cord injury occurred in 41 (6.5%) spinal fracture patients and was associated with a high ISS and prolonged hospitalisation [ISS:34(IQR 20.5); ICU LOS:10(IQR21.75); Hospital LOS:22(IQR41)]. Spinal fracture patients that classified as polytrauma irrespective of the presence of spinal fracture had a higher ISS (34 vs. 22, p < 0.001), ICU admission rate (75.8% vs. 26.1%, p < 0.001), longer hospital LOS (18 vs. 9 days, p < 0.001), higher mortality (12.4% vs. 4.9%, p = 0.001) and lower spinal cord injury rate (4.5% vs. 12.1%, p = 0.001) compared to those who qualified as polytrauma due to the presence of spinal fracture. The subset of spinal fracture patients presenting in traumatic shock had the highest median ISS, hospital resource utilisation and mortality rate. CONCLUSION: Spinal fractures occur in nearly half of the polytrauma patients and 18% of them have multiple vertebral body fractures. These patients are older with similar injury severity and mortality but require more hospital resource utilisation compared to polytrauma patients without spine fractures. The high-risk for mortality spine fracture patients are the ones presenting in shock, with spinal cord injury and those who would meet polytrauma criteria irrespective of the presence of spinal fracture.

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