Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013

doi:10.1016/j.wneu.2017.11.011

World Neurosurgery

Volume 110, February 2018, Pages e427-e437

https://doi.org/10.1016/j.wneu.2017.11.011 Get rights and content

Objective

The causes and epidemiology of traumatic cervical spine fracture have not been described with sufficient power or recency. Our goal is to describe demographics, incidence, cause, spinal cord injuries (SCIs), concurrent injuries, treatments, and complications of traumatic cervical spine fractures.

Methods

A retrospective review was carried out of the Nationwide Inpatient Sample. International Classification of Disease, Ninth Revision E-codes identified trauma cases from 2005 to 2013. Patients with cervical fracture were isolated. Demographics, incidence, cause, fracture levels, concurrent injuries, surgical procedures, and complications were analyzed. t tests elucidated significance for continuous variables and χ² for categorical variables. Level of significance was P < 0.05.

Results

A total of 488,262 patients were isolated (age, 55.96 years; male, 60.0%; white, 77.5%). Incidence (2005, 4.1% vs. 2013, 5.4%), Charlson Comorbidity Index (2005, 0.6150 vs. 2013, 1.1178), and total charges (2005, $71,228.60 vs. 2013, $108,119.29) have increased since 2005, whereas length of stay decreased (2005, 9.22 vs. 2013, 7.86) (all P < 0.05). The most common causes were motor vehicle accident (29.3%), falls (23.7%), and pedestrian accidents (15.7%). The most frequent fracture types were closed at C2 (32.0%) and C7 (20.9%). Concurrent injury rates have significantly increased since 2005 (2005, 62.3% vs. 2013, 67.6%). Common concurrent injuries included fractures to the rib/sternum/larynx/trachea (19.6%). Overall fusion rates have increased since 2005 (2005, 15.7% vs. 2013, 18.0%), whereas decompressions and halo insertion rates have decreased (all P < 0.05). SCIs have significantly decreased since 2005, except for upper cervical central cord syndrome. Complication rates have significantly increased since 2005 (2005, 31.6% vs. 2013, 36.2%). Common complications included anemia (7.7%), mortality (6.6%), and acute respiratory distress syndrome (6.6%).

Conclusions

Incidence, complications, concurrent injuries, and fusions have increased since 2005. Length of stay, SCIs, decompressions, and halo insertions have decreased. Indicated trends should guide future research in management guidelines.

Introduction

Within the past decade, there has been an increasing societal awareness toward knowledge and prevention of traumatic injuries. This awareness has been facilitated by increased efforts of both local and national governments toward improving public health, specifically development of outreach programs, preventive medicine, and greater traffic law enforcement.1, 2 Traumatic fractures of the cervical spine are rare but often result in significant morbidity and death. The mortality for patients with a traumatic spinal cord injury (SCI) is markedly high, with rates ranging from 4% to 16.2% within 30 days of admission and from 21.7% to 32.3% within 1 year from admission.3, 4, 5 Surgically treated patients have been reported to have lower mortality compared with nonsurgically treated patients.³ The most common injury sites are typically at C2 and C5 levels.3, 6, 7 The most prevalent mechanisms of injury described in the literature are typically motor vehicle accidents (MVAs) and/or falls.6, 7, 8

There is a paucity of recent and sufficiently powered epidemiologic data concerning traumatic cervical spinal fractures, but previous studies from Canada, China, and Norway found the annual incidence of traumatic cervical spine fractures to be 64/100,000, 65/100,000, and 15/100,000 admissions, respectively. Associated SCI is also a major threat with cervical fracture, in that patients with SCIs have been reported to have increased length of stay (LOS), charges, and adverse outcomes compared with fractures without SCIs.⁹ There is generally a higher prevalence of cervical fracture among males, and significant predictors of cervical fracture have been determined in previous studies to be pelvic fracture, pelvic fracture combined with a fall and/or concurrent head injury, injury severity score >15, and being older than 40 years.5, 6, 10, 11

The increase of public interest, and lack of sufficiently powered studies regarding traumatic cervical spine fractures, poses the need for more recent and complete data to accurately assess national trends and the full scope of etiologic and epidemiologic variables. Our study aims to retrospectively review and describe the annual incidence, cause, surgical treatment, extent of SCI, complications, and concurrent injuries between 2005 and 2013, using the National (Nationwide) Inpatient Sample (NIS).

Section snippets

Data Source

The NIS is 1 part of a family of databases developed through a federal-state-industry partnership, and sponsored by the Agency for Healthcare Research and Quality, for the Healthcare Cost and Utilization Project (HCUP). HCUP are used to inform health care decision making at the national, state, and community levels. The NIS is the largest available all-payer database for U.S. inpatient care and includes data approximating 8 million discharges from 1000 hospitals annually. Forty-five states are

Demographics

A total of 9,822,757 trauma discharges were identified, of which 488,262 were coded as having cervical fractures. The incidence of cervical fracture has increased since 2005 (2005, 4.1% vs. 2013, 5.4%; P < 0.001) with an overall incidence of 5.0% (Figure 1, Table 1). The average age of patients with cervical fracture has increased since 2005 (2005, 51.41 vs. 2013, 59.13; P < 0.001), with an overall average of 55.96 years. The overall average LOS was 8.63 days, and CCI has significantly

Discussion

Traumatic cervical fractures, although rare, are significant causes of morbidity and mortality. Improving health care services have increased the emphasis of injury prevention and management strategies for cervical spine trauma.1, 2, 13 The literature is sparse regarding sufficiently powered, comprehensive reports describing the epidemiology, cause, morbidity, and management of traumatic cervical spine fractures. There are even fewer reports showing temporal trends of these elements.

Our study

Conclusions

This study characterizes the causes and epidemiology of traumatic cervical spine fractures. Using the NIS inpatient database, trends in incidence, causes, surgical procedures, SCIs, concurrent injuries, and complications between 2005 and 2013 are described. Incidence, CCI, total hospital charges, fusion rates, complication rates, and concurrent injury rates have all significantly increased since 2005, whereas LOS, rates of associated SCIs, decompressions, and halo traction device insertions

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: Conflict of interest statement: P.G.P., consulting for Spinewave and Medicrea; M.G., consulting for Paradigm Spine and speaking/teaching for Stryker Spine; and V.L., stock ownership in Nemaris Inc. and speaking/teaching for Medicrea, MSD, DePuy Spine Synthes, and Nemaris Inc.

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Original ArticleTraumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Data Source

Demographics

Discussion

Conclusions

J Safety Res

Injury

Orthop Clin North Am

J Pediatr Surg

Adolescent motor vehicle crash prevention through a trauma centered-based intervention program

J Trauma Acute Care Surg

C2 Vertebral Fractures in the Medicare population: incidence, outcomes, and costs

J Bone Joint Surg Am

Morbidity and mortality associated with surgery of traumatic C2 fractures in octogenarians

Neurosurgery

Incidence of traumatic cervical spine fractures in the Norwegian population: a national registry study

Scand J Trauma Resusc Emerg Med

Epidemiology of traumatic cervical spinal fractures and risk factors for traumatic cervical spinal cord injury in China

J Spinal Disord Tech

Traumatic upper cervical spinal fractures in teaching hospitals of China over 13 years

Medicine (Baltimore)

Original Article
Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013