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Factors affecting survival of patients in the acute phase of upper cervical spine injuries

  • Trauma Surgery
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Abstract

Introduction

In recent years, on the one hand, the mortality rates of upper cervical spine injuries, such as odontoid fractures, were suggested to be not so high, but on the other hand reported to be significantly high. Furthermore, it has not been well documented the relationship between survival rates and various clinical features in those patients during the acute phase of injury because of few reports. This study aimed to evaluate survival rates and acute-phase clinical features of upper cervical spine injuries.

Methods

We conducted a retrospective review of all patients who were transported to the advanced emergency medical center and underwent computed tomography of the cervical spine at our hospital between January 2006 and December 2015. We excluded the patients who were discovered in a state of cardiopulmonary arrest (CPA) and could not be resuscitated after transportation. Of the 215 consecutive patients with cervical spine injuries, we examined 40 patients (18.6%) diagnosed with upper cervical spine injury (males, 28; females, 12; median age, 58.5 years). Age, sex, mechanism of injury, degree of paralysis, the level of cervical injury, injury severity score (ISS), and incidence of CPA at discovery were evaluated and compared among patients classified into the survival and mortality groups.

Results

The survival rate was 77.5% (31/40 patients). In addition, complete paralysis was observed in 32.5% of patients. The median of ISS was 34.0 points, and 14 patients (35.0%) presented with CPA at discovery. Age, the proportion of patients with complete paralysis, a high ISS, and incidence of CPA at discovery were significantly higher in the mortality group (p = 0.038, p = 0.038, p < 0.001, and p < 0.001, respectively).

Conclusions

Elderly people were more likely to experience upper cervical spine injuries, and their mortality rate was significantly higher than that in injured younger people. In addition, complete paralysis, high ISS, a state of CPA at discovery, was significantly higher in the mortality group.

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Author contributions

Author contributions to the study and manuscript preparation include the following. Conception and design: Morita, Takebayashi. Acquisition of data: Morita, Irifune. Analysis and interpretation of data: all authors. Drafting the article: Morita. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Takebayashi. Administrative/technical/material support: Takebayashi. Study supervision: Yamashita.

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Correspondence to Tomonori Morita.

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Conflict of interest

Tomonori Morita, Tsuneo Takebayashi, Hideto Irifune, Hirofumi Ohnishi, Suguru Hirayama, and Toshihiko Yamashita declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Morita, T., Takebayashi, T., Irifune, H. et al. Factors affecting survival of patients in the acute phase of upper cervical spine injuries. Arch Orthop Trauma Surg 137, 543–548 (2017). https://doi.org/10.1007/s00402-017-2655-5

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