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| The association between survival rate and clinical features of patients with upper cervical spine injury in ICU |
| Huang Xiao-shun, Liu Chuan-fang, He Wen-jiang, Zhong Zu-xin, Zhong Zhi |
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Abstract Objective To evaluate the association between survival rate and clinical features in patients with upper cervical spine injuries treated with ICU. Methods A retrospective analysis of 138 patients with upper cervical spine injuries in the Department of Orthopedics ICU in our hospital was included. The clinical data were collected, including age, gender, injury reason, the cardiopulmonary arrest(CPA) incidence, the American Spinal Cord Injury Association classification (AIS) and the Injury Severity Score(ISS). The distribution and morphology of upper cervical injuries in patients,and spinal cord injuries at admission and discharge were respectively assessed.The patients were divided into two groups: discharge group (survival group) and in-hospital death group (death group). The clinical characteristics were compared between the two groups. Results The incidence of upper cervical injury was 18.8%(138/736). The average age of the patients was(59.7±9.5) years. The average ISS was (34.7±5.2), and the overall survival rate was 77.5%(107/138). 45 (32.6%) patients were completely paralyzed (AIS is A). The most common type of upper cervical injury was C2 fracture［67.4%(93/138)］, and the most common type of C2 fracture was type Ⅲ odontoid fracture［27.5%(38/138)］.86 (62.3%) patients had spinal cord injury (AIS A~D grade). Neurological function was improved in 15 (10.8%) patients(2 of AIS A, 3 of B, 10 of C). The age of the death group (t=2.681, P=0.039), the proportion of patients with complete paralysis (AIS A,χ2=22.457, P<0.001), the incidence of CPA (χ2=74.965, P<0.001) and ISS (t=35.720,P<0.001) were significantly higher than those in the survival group. Conclusion The most common fracture of the upper cervical spine is type Ⅲ odontoid fracture, and more than 60% of the patients have spinal cord injuries. The most common degree of paralysis is AIS class A. Compared with the young, the elderly are more likely to suffer from upper cervical injury, and the mortality rate is significantly higher. The proportion of complete paralysis, ISS and CPA incidence of the dead patients improve obviously.
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Received: 02 May 2017
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