Introduction: The past four decades have seen multiple attempts to define the incidence of concurrent traumatic brain (TBI) and spine or spinal cord injuries (SCI), with reports ranging widely from 16-74%.
Methods: In an effort to more definitively characterize the longitudinal incidence and concurrence rates for TBI and spinal injuries, a retrospective review of the National Inpatient Sample database is presented, spanning the years 1988 to 2008.
Results: While the incidence of TBI has remained relatively stable over this interval (1988: 54,087, 2008: 59,806), the incidence of spinal injuries has steadily increased (1988: 22,281, 2008: 46,941). Moreover, concurrence rates have steadily risen in both directions. Within TBI patients, the incidence of spine injury has risen from 3.7% (1988) to 12.5% (2008); within patients with spine injuries, the incidence of TBI has risen from 9.1% (1988) to 15.9% (2008). Although rates of vertebral injury increased significantly for all regions of the spine, cervical fractures increased the most with a three-fold rise in the general NIS population and a four-fold rise in the TBI population. The incidence of SCI has remained relatively stable over this twenty-year interval and represented 14% of all spine injuries in 1988, but only 8.8% in 2008.
Conclusions: Potential explanations for these trends include more routine use of advanced imaging in trauma screening, improved sensitivity of spinal and cranial imaging, a possible trend toward more violent mechanisms of injury, and improved first responder care leading to greater survival rates in the field. The presence of TBI significantly impacts both the surgical and critical care management of spine injuries; similarly, the presence of vertebral fractures significantly influences the management of TBI. As concurrence rates rise, heightened sensitivity to synchronous injuries must be maintained and management strategies must be adapted to render optimal patient care.
Patient Care: The incidence of concurrent TBI and SCI continues to rise due to multiple factors. As a result, these patients, which were once a small subset, have now become a commonly encountered clinical entity. Our work highlights the needs for elevated clinical suspicion of concurrent injuries and the development of management protocols specific to this growing patient population.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Recognize that there is a steadily increasing incidence of concurrent traumatic brain and spinal cord injuries.
2) Identify the factors contributing to the rise in incidence of concurrent injuries.
3) Discuss the importance of early recognition of synchronous injuries and understand the need for management strategies specific to this patient population.
References: Agency for Healthcare Research and Quality: Healthcare Cost and Utilization Project (HCUP) - Nationwide Inpatient Sample (NIS) in. Rockville, MD. July 2010. March 2011. http://www.hcup-us.ahrq.gov/nisoverview.jsp.
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