Epidemiological characteristics of traumatic spinal cord injuries in the intensive care unit from 2018 to 2023: a retrospective hospital-based study

doi:10.5847/wjem.j.1920-8642.2024.085

Abstract

Abstract:

BACKGROUND: The objective of this retrospective hospital-based study was to describe the epidemiological features of traumatic spinal cord injury (TSCI) in the intensive care unit (ICU) and assess the incidence and possible risk factors for venous thromboembolism (VTE) following TSCI.

METHODS: We retrospectively reviewed the medical records of 370 patients with TSCI who were admitted between January 2018 and March 2023. The following parameters were collected: age, sex, body mass index, occupation, underlying diseases, smoking history, education level, etiology of injury, injury segments, American Spinal Injury Association (ASIA) Impairment Scale score, severity of injury, injury severity score (ISS), VTE risk score (Caprini score), treatment, VTE prophylaxis, ICU length of stay, length of hospital stay, concomitant injuries, and complications. Descriptive statistics were used to summarize the demographic and clinical characteristics of the study participants. Logistic regression analysis was used to determine the risk factors for VTE.

RESULTS: The mean age of patients with TSCI was 55.5 ± 13.4 years, with a male-to-female ratio of 6.5:1. The leading cause of TSCI was falls from height (46.5%), followed by traffic accidents (36.5%). The cervical spinal cord was the most affected segment, followed by the thoracolumbar region. Among all the patients, 362 (97.8%) had concomitant injuries. Complications were observed in 255 patients (68.9%) during hospitalization. The incidence rate of VTE was 25.1%. Logistic regression analysis revealed that age (OR=1.721, 95%CI: 1.207-2.454, P=0.003), mechanical ventilation (OR=3.427, 95%CI: 1.873-6.271, P<0.001), and non-use of chemical prophylaxis (OR=2.986, 95%CI: 1.749-5.099, P<0.001) were risk factors for VTE.

CONCLUSION: Falls from height and traffic accidents were the main causes of TSCIs in the ICU, especially for male patients with cervical spinal cord injuries. VTE is a frequent complication in patients with TSCI in the ICU. Age, mechanical ventilation, and non-use of chemical prophylaxis were found to be independent risk factors for VTE following TSCI.

Key words: Traumatic spinal cord injury, Epidemiology, Venous thromboembolism, Intensive care unit

Weiting Chen, Haopeng Wu, Jiafei Yu, Lanxing Cao, Gensheng Zhang. Epidemiological characteristics of traumatic spinal cord injuries in the intensive care unit from 2018 to 2023: a retrospective hospital-based study[J]. World Journal of Emergency Medicine, 2024, 15(6): 455-464.

Figures/Tables 6

Figure 1.

Table 1.

Demographic and clinical characteristics of patients with TSCI from 2018 to 2023

Characteristics	Year 2018 (n=50)	Year 2019 (n=52)	Year 2020 (n=58)	Year 2021 (n=89)	Year 2022 (n=98)	Year 2023 (n=23)	Total (n=370)
Age, years, n (%)
18-30	3 (0.8)	4 (1.1)	3 (0.8)	5 (1.4)	5 (1.4)	1 (0.3)	21 (5.7)
31-45	5 (1.4)	9 (2.4)	10 (2.7)	14 (3.8)	11 (3.0)	2 (0.5)	51 (13.8)
46-60	25 (6.8)	24 (6.5)	26 97.0)	34 (9.2)	37 (10.0)	9 (2.4)	155 (41.9)
61-75	15 (4.1)	13 (3.5)	17 (4.6)	32 (8.6)	37 (10.0)	11 (3.0)	125 (33.8)
>75	2 (0.5)	2 (0.5)	2 (0.5)	4 (1.1)	8 (2.2)	0 (0)	18 (4.9)
Age, years, mean±SD	54.4 ± 11.9	52.3 ± 13.7	54.0 ± 13.3	55.4 ± 13.9	58.3 ± 13.8	58.1 ± 12.1	55.5 ± 13.4
BMI, kg/m², median (IQR)	22.3 (20.5, 25.1)	22.4 (20.2, 24.2)	23.4 (21.7, 25.4)	23.4 (21.0, 25.3)	23.0 (20.7, 24.8)	22.5 (21.0, 25.7)	22.9 (21.8, 25.1)
Smoking history, n (%)
Yes	31 (8.4)	25 (6.8)	31 (15.4)	47 (12.7)	52 (14.1)	15 (4.1)	201 (54.3)
No	19 (5.1)	27 (7.3)	27 (7.3)	42 (11.4)	46 (12.4)	8 (2.2)	169 (45.7)
Gender, n (%)
Male	45 (12.2)	41 (11.1)	54 (14.6)	78 (21.1)	82 (22.2)	21 (5.7)	321 (86.7)
Female	5 (1.4)	11 (3.0)	4 (1.1)	11 (3.0)	16 (4.3)	2 (0.5)	49 (13.2)
Underlying diseases*, n (%)
Yes	16 (4.3)	15 (4.1)	20 (5.4)	43 (11.6)	30 (8.1)	9 (2.4)	133 (35.9)
No	34 (9.2)	37 (10.0)	38 (10.3)	46 (12.4)	68 (18.4)	14 (3.8)	237 (64.1)
Education level, n (%)
Illiterate	2 (0.5)	4 (1.1)	1 (0.3)	8 (2.2)	8 (2.2)	0 (0)	23 (6.2)
Elementary school	17 (4.6)	17 (4.6)	19 (5.1)	34 (9.2)	39 (10.5)	9 (2.4)	135 (36.5)
Middle school	23 (6.2)	20 (5.4)	30 (8.1)	27 (7.3)	35 (9.5)	10 (2.7)	145 (39.2)
High school	4 (1.1)	5 (1.4)	4 (1.1)	10 (2.7)	12 (3.2)	0 (0)	35 (9.5)
College degree and above	4 (1.1)	6 (1.6)	4 (1.1)	10 (2.7)	4 (1.1)	4 (1.1)	32 (8.6)
Occupation, n (%)
Peasant	20 (5.4)	18 (4.9)	18 (4.9)	35 (9.5)	42 (11.4)	7 (1.9)	140 (37.8)
Laborer	20 (5.4)	14 (3.8)	27 (7.3)	31 (8.4)	31 (8.4)	10 (2.7)	133 (35.9)
Drivers	1 (0.3)	4 (1.1)	1 (0.3)	1 (0.3)	3 (0.8)	0 (0)	10 (2.7)
Office-worker	1 (0.3)	2 (0.5)	1 (0.3)	10 (2.7)	2 (0.5)	0 (0)	16 (4.3)
Civil servant	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.3)	1 (0.3)
Students	0 (0)	1 (0.3)	1 (0.3)	1 (0.3)	1 (0.3)	0 (0)	4 (1.1)
Retired	3 (0.8)	5 (1.4)	7 (1.9)	4 (1.1)	10 (2.7)	2 (0.5)	31 (8.4)
Teachers	0 (0)	1 (0.3)	0 (0)	1 (0.3)	0 (0)	0 (0)	2 (0.5)
Others	5 (1.4)	7 (1.9)	3 (0.8)	6 (1.6)	9 (2.4)	3 (0.8)	33 (8.9)
APACHE II, median (IQR)	8.0 (6.0, 11.0)	7.5 (5.0, 12.0)	8.0 (6.0, 11.0)	8.0 (6.0, 11.0)	8.0 (5.0, 10.3)	9.0 (5.0, 11.0)	11.0 (7.8, 11.0)
Etiology, n (%)
Traffic accidents	22 (5.9)	21 (5.7)	19 (5.1)	32 (8.6)	31 (8.4)	10 (2.7)	135 (36.5)
Falls from a low place	0 (0)	3 (0.8)	5 (1.4)	10 (2.7)	13 (3.5)	5 (1.4)	36 (9.7)
Falls from a high place	25 (6.8)	23 (6.2)	29 (7.8)	41 (11.1)	47 (12.7)	7 (1.9)	172 (46.5)
Objects fall from a high place	1 (0.3)	5 (1.4)	5 (1.4)	6 (1.6)	7 (1.9)	1 (0.3)	25 (6.8)
Assault	2 (0.5)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	2 (0.5)
Injury segments, n (%)
Cervical	44 (11.9)	46 (12.4)	45 (12.2)	72 (19.5)	80 (21.6)	21 (5.7)	308 (83.2)
Thoracic	5 (1.4)	4 (1.1)	5 (1.4)	12 (3.2)	13 (3.5)	2 (0.5)	41 (11.1)
Lumbar	1 (0.3)	2 (0.5)	8 (2.2)	5 91.4)	5 (1.4)	23 (6.2)	21 (5.7)
Sacral	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
ASIA grade, n (%)
A	11 (3.0)	17 (4.6)	21 (5.7)	31 (8.4)	26 (7.0)	9 (2.4)	115 (31.1)
B	2 (0.5)	0 (0)	0 (0)	4 (1.1)	3 (0.8)	0 (0)	9 (2.4)
C	10 (2.7)	14 (3.8)	17 (4.6)	23 (6.2)	23 (6.2)	10 (2.7)	97 (26.2)
D	27 (7.3)	21 (5.7)	20 (5.4)	31 (8.4)	46 (12.4)	4 (1.1)	149 (40.3)
Severity of injury, n (%)
Complete tetraplegia	9 (2.4)	13 (3.5)	15 (4.1)	22 (5.9)	16 (4.3)	7 (1.9)	82 (22.2)
Incomplete tetraplegia	35 (9.5)	33 (8.9)	31 (8.4)	50 (13.5)	63 (17.0)	14 (3.8)	226 (61.1)
Complete paraplegia	4 (1.1)	4 (1.1)	6 (1.6)	12 (3.2)	12 (3.2)	2 (0.5)	40 (10.8)
Incomplete paraplegia	2 (0.5)	2 (0.5)	6 (1.6)	5 (1.4)	7 (1.9)	0 (0)	22 (5.9)
ISS, n (%)
≤15	13 (3.5)	9 (2.4)	9 (2.4)	9 (2.4)	16 (4.3)	5 (1.4)	61 (16.5)
16-25	13 (3.5)	9 (2.4)	8 (2.2)	22 (5.9)	27 (7.3)	8 (2.2)	87 (23.5)
> 25	24 (6.5)	34 (9.2)	41 (11.1)	58 (15.7)	55 (14.9)	10 (2.7)	222 (60)
Treatment strategy, n (%)
Surgical treatment	35 (9.5)	46 (12.4)	50 (13.5)	70 (18.9)	79 (21.4)	18 (4.9)	72 (19.5)
Conservative treatment	15 (4.1)	6 (1.6)	8 (2.2)	19 (5.1)	19 (5.1)	5 (1.4)	298 (80.5)
Concomitant injury*, n (%)
Yes	49 (13.2)	50 (13.5)	56 (15.1)	89 (24.1)	97 (26.2)	21 (5.7)	362 (97.8)
No	1 (0.3)	2 (0.5)	2 (0.5)	0 (0)	1 (0.3)	2 (0.5)	8 (2.2)
Complication*, n (%)
Yes	31 (8.4)	32 (8.6)	33 (8.9)	56 (15.1)	59 (15.9)	14 (3.8)	255 (60.8)
No	19 (5.1)	20 (5.4)	25 (6.8)	33 (8.9)	39 (10.5)	9 (2.4)	145 (39.2)
ICU LOS, d, median (IQR)	13.0 (3.0, 18.0)	10.0 (4.3, 15.5)	7.0 (4.0, 12.3)	5.0 (2.0, 10.0)	4.0 (2.0, 7.3)	5.0 (2.0, 8.0)	6.0 (3.0, 12.0)
Hospital LOS, d, median (IQR)	16.0 (11.8, 21.3)	14.5 (10.0, 20.8)	12.0 (9.0, 16.3)	10.0 (6.5, 14.0)	9 (6.0, 14.0)	10.0 (6.0, 14.0)	12.0 (8.0, 17.0)

Table 1.

Figure 2.

Table 2.

Table 3.

Demographic and clinical characteristics of 370 TSCI patients with or without VTE

Characteristics	VTE (n=93)	Non-VTE (n=277)	P-value
Age, years, n (%)			0.002
18-30	1 (1.1)	20 (7.2)
31-45	8 (8.6)	43 (15.5)
46-60	37 (39.8)	118 (42.6)
61-75	43 (46.2)	82 (29.6)
>75	14 (5.1)	4 (4.3)
BMI, kg/m², median (IQR)	23.0 (20.7, 25.4)	22.7 (20.8, 24.5)	0.393
Smoking history, n (%)			0.041
Yes	59 (63.4)	142 (51.3)
No	34 (36.6)	135 (48.7)
Gender, n (%)			0.241
Male	84 (90.3)	237 (85.6)
Female	9 (9.7)	40 (14.4)
Underlying diseases, n (%)
Hypertension	22 (23.7)	64 (23.1)	0.913
Diabetes	6 (6.5)	27 (9.7)	0.335
Cardiovascular disease	4 (4.3)	6 (2.2)	0.272
Respiratory disease	1 (1.1)	8 (2.9)	0.326
Ankylosing spondylitis	4 (4.3)	11 (4.0)	0.889
Others	3 (3.2)	17 (6.1)	0.283
Etiology, n (%)			0.358
Traffic accidents	30 (32.3)	105 (37.9)
Falls from a low place	9 (9.7)	27 (9.7)
Falls from a high place	48 (51.6)	124 (44.8)
Objects fall from a high place	5 (5.4)	20 (7.2)
Assault	1 (1.1)	1(0.4)
Grading of VTE risk*, n (%)			0.045
Low risk (0-1)	0 (0)	3 (1.1)
Medium risk (2)	0 (0)	7 (2.5)
High risk (3-4)	3 (3.2)	15 (5.4)
Extremely high risk (≥5)	90 (96.8)	252 (91.0)
ISS, n (%)			0.302
≤15	12 (12.9)	49 (17.7)
16-25	22 (23.7)	65 (23.5)
>25	59 (63.4)	163 (58.8)
Injury segments, n (%)			0.125
Cervical	80 (86.0)	228 (82.3)
Thoracic	12 (12.9)	29 (10.5)
Lumbar	1 (1.1)	20 (7.2)
Sacral	0 (0)	0 (0)
ASIA grade, n (%)			0.243
A	31 (33.3)	84 (30.3)
B	3 (3.2)	6 (2.2)
C	29 (31.2)	68 (24.5)
D	30 (32.3)	119 (43.0)
Severity of the injury, n (%)			0.176
Complete tetraplegia	22 (23.7)	60 (21.7)
Incomplete tetraplegia	59 (63.4)	167 (60.3)
Complete paraplegia	10 (10.8)	30 (10.8)
Incomplete paraplegia	2 (2.2)	20 (7.2)
Surgical treatment, n (%)			0.215
Yes	79 (84.9)	219 (79.1)
No	14 (15.1)	58 (20.9)
Mechanical ventilation, n (%)			<0.001
Yes	25 (26.9)	152 (54.9)
No	68 (73.1)	125 (45.1)
Physical VTE prophylaxis, n (%)			0.776
Yes	81 (87.1)	238 (85.9)
No	12 (12.9)	39 (14.1)
Chemical VTE prophylaxis, n (%)			<0.001
Yes	29 (31.2)	145 (52.3)
No	64 (68.8)	132 (47.7)
Concomitant injury, n (%)			0.098
Yes	93 (100)	269 (97.1)
No	0 (0)	8 (2.9)

Table 3.

Table 4.

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Treatment of TSCI	Status on discharge
Treatment of TSCI	Cure	Improve	Unchange	Deterioration
Surgical treatment	2 (0.7)	42 (14.1)	210 (70.5)	44 (14.8)
Conservative treatment	1 (1.4)	8 (11.1)	50 (69.4)	13 (18.1)
Total	3 (0.8)	50 (13.5)	260 (70.3)	57 (15.4)

Factors	B	Wald	OR	95%CI	P-value
Age	0.543	9.011	1.721	1.207-2.454	0.003
Smoking history	0.307	1.012	1.359	0.748-2.469	0.314
Mechanical ventilation	1.232	15.956	3.427	1.873-6.271	<0.001
Grade of VTE risk (Caprini score)	0.357	0.825	1.429	0.825-2.474	0.203
Non-use of chemical VTE prophylaxis	-1.173	16.794	2.986	1.749-5.099	<0.001