Frontiers in Neurology (Aug 2022)

Concomitant spine trauma in patients with traumatic brain injury: Patient characteristics and outcomes

  • Lennart Riemann,
  • Obada T. Alhalabi,
  • Andreas W. Unterberg,
  • Alexander Younsi,
  • The CENTER-TBI investigators and participants,
  • Cecilia Åkerlund,
  • Krisztina Amrein,
  • Nada Andelic,
  • Lasse Andreassen,
  • Audny Anke,
  • Anna Antoni,
  • Gérard Audibert,
  • Philippe Azouvi,
  • Maria Luisa Azzolini,
  • Ronald Bartels,
  • Pál Barzó,
  • Romuald Beauvais,
  • Ronny Beer,
  • Bo-Michael Bellander,
  • Antonio Belli,
  • Habib Benali,
  • Maurizio Berardino,
  • Luigi Beretta,
  • Morten Blaabjerg,
  • Peter Bragge,
  • Alexandra Brazinova,
  • Vibeke Brinck,
  • Joanne Brooker,
  • Camilla Brorsson,
  • Andras Buki,
  • Monika Bullinger,
  • Manuel Cabeleira,
  • Alessio Caccioppola,
  • Emiliana Calappi ,
  • Maria Rosa Calvi,
  • Peter Cameron,
  • Guillermo Carbayo Lozano,
  • Marco Carbonara,
  • Simona Cavallo,
  • Giorgio Chevallard,
  • Arturo Chieregato,
  • Giuseppe Citerio,
  • Hans Clusmann,
  • Mark Coburn,
  • Jonathan Coles,
  • Jamie D. Cooper,
  • Marta Correia,
  • Amra Cović,
  • Nicola Curry,
  • Endre Czeiter,
  • Marek Czosnyka,
  • Claire Dahyot-Fizelier,
  • Paul Dark,
  • Helen Dawes,
  • Véronique De Keyser,
  • Vincent Degos,
  • Francesco Della Corte,
  • Hugo den Boogert,
  • Bart Depreitere,
  • Ðula Ðilvesi,
  • Abhishek Dixit,
  • Emma Donoghue,
  • Jens Dreier,
  • Guy-Loup Dulière,
  • Ari Ercole,
  • Patrick Esser,
  • Erzsébet Ezer,
  • Martin Fabricius,
  • Valery L. Feigin,
  • Kelly Foks,
  • Shirin Frisvold,
  • Alex Furmanov,
  • Pablo Gagliardo,
  • Damien Galanaud,
  • Dashiell Gantner,
  • Guoyi Gao,
  • Pradeep George,
  • Alexandre Ghuysen,
  • Lelde Giga,
  • Ben Glocker,
  • Jagoš Golubovic,
  • Pedro A. Gomez,
  • Johannes Gratz,
  • Benjamin Gravesteijn,
  • Francesca Grossi,
  • Russell L. Gruen,
  • Deepak Gupta,
  • Juanita A. Haagsma,
  • Iain Haitsma,
  • Raimund Helbok,
  • Eirik Helseth,
  • Lindsay Horton ,
  • Jilske Huijben,
  • Peter J. Hutchinson,
  • Bram Jacobs,
  • Stefan Jankowski,
  • Mike Jarrett,
  • Ji-yao Jiang,
  • Faye Johnson,
  • Kelly Jones,
  • Mladen Karan,
  • Angelos G. Kolias,
  • Erwin Kompanje,
  • Daniel Kondziella,
  • Evgenios Kornaropoulos,
  • Lars-Owe Koskinen,
  • Noémi Kovács,
  • Ana Kowark,
  • Alfonso Lagares,
  • Linda Lanyon,
  • Steven Laureys,
  • Fiona Lecky,
  • Didier Ledoux,
  • Rolf Lefering,
  • Valerie Legrand,
  • Aurelie Lejeune,
  • Leon Levi,
  • Roger Lightfoot,
  • Hester Lingsma,
  • Andrew I.R. Maas,
  • Ana M. Castaño-León,
  • Marc Maegele,
  • Marek Majdan,
  • Alex Manara,
  • Geoffrey Manley,
  • Costanza Martino,
  • Hugues Maréchal,
  • Julia Mattern,
  • Catherine McMahon,
  • Béla Melegh,
  • David Menon,
  • Tomas Menovsky,
  • Ana Mikolic,
  • Benoit Misset,
  • Visakh Muraleedharan,
  • Lynnette Murray,
  • Ancuta Negru,
  • David Nelson,
  • Virginia Newcombe,
  • Daan Nieboer,
  • József Nyirádi,
  • Otesile Olubukola,
  • Matej Oresic,
  • Fabrizio Ortolano,
  • Aarno Palotie,
  • Paul M. Parizel,
  • Jean-François Payen,
  • Natascha Perera,
  • Vincent Perlbarg,
  • Paolo Persona,
  • Wilco Peul,
  • Anna Piippo-Karjalainen,
  • Matti Pirinen,
  • Dana Pisica,
  • Horia Ples,
  • Suzanne Polinder,
  • Inigo Pomposo,
  • Jussi P. Posti ,
  • Louis Puybasset,
  • Andreea Radoi ,
  • Arminas Ragauskas,
  • Rahul Raj,
  • Malinka Rambadagalla,
  • Isabel Retel Helmrich,
  • Jonathan Rhodes,
  • Sylvia Richardson,
  • Sophie Richter,
  • Samuli Ripatti,
  • Saulius Rocka,
  • Cecilie Roe,
  • Olav Roise,
  • Jonathan Rosand,
  • Jeffrey V. Rosenfeld,
  • Christina Rosenlund,
  • Guy Rosenthal,
  • Rolf Rossaint,
  • Sandra Rossi,
  • Daniel Rueckert,
  • Martin Rusnák,
  • Juan Sahuquillo,
  • Oliver Sakowitz,
  • Renan Sanchez-Porras,
  • Janos Sandor,
  • Nadine Schäfer,
  • Silke Schmidt,
  • Herbert Schoechl,
  • Guus Schoonman,
  • Rico Frederik Schou,
  • Elisabeth Schwendenwein,
  • Charlie Sewalt,
  • Ranjit D. Singh,
  • Toril Skandsen,
  • Peter Smielewski,
  • Abayomi Sorinola,
  • Emmanuel Stamatakis,
  • Simon Stanworth,
  • Robert Stevens,
  • William Stewart,
  • Ewout W. Steyerberg,
  • Nino Stocchetti,
  • Nina Sundström,
  • Riikka Takala,
  • Viktória Tamás,
  • Tomas Tamosuitis,
  • Mark Steven Taylor,
  • Braden Te Ao,
  • Olli Tenovuo,
  • Alice Theadom,
  • Matt Thomas,
  • Dick Tibboel,
  • Marjolein Timmers,
  • Christos Tolias,
  • Tony Trapani,
  • Cristina Maria Tudora,
  • Andreas Unterberg,
  • Peter Vajkoczy ,
  • Shirley Vallance,
  • Egils Valeinis,
  • Zoltán Vámos,
  • Mathieu van der Jagt,
  • Gregory Van der Steen,
  • Joukje van der Naalt,
  • Jeroen T.J.M. van Dijck,
  • Inge A. van Erp,
  • Thomas A. van Essen,
  • Wim Van Hecke,
  • Caroline van Heugten,
  • Dominique Van Praag,
  • Ernest van Veen,
  • Thijs Vande Vyvere,
  • Roel P. J. van Wijk,
  • Alessia Vargiolu,
  • Emmanuel Vega,
  • Kimberley Velt,
  • Jan Verheyden,
  • Paul M. Vespa,
  • Anne Vik,
  • Rimantas Vilcinis,
  • Victor Volovici,
  • Nicole von Steinbüchel,
  • Daphne Voormolen,
  • Petar Vulekovic,
  • Kevin K.W. Wang,
  • Daniel Whitehouse,
  • Eveline Wiegers,
  • Guy Williams,
  • Lindsay Wilson,
  • Stefan Winzeck,
  • Stefan Wolf,
  • Zhihui Yang,
  • Peter Ylén,
  • Alexander Younsi,
  • Frederick A. Zeiler,
  • Veronika Zelinkova,
  • Agate Ziverte,
  • Tommaso Zoerle

DOI
https://doi.org/10.3389/fneur.2022.861688
Journal volume & issue
Vol. 13

Abstract

Read online

ObjectiveSpine injury is highly prevalent in patients with poly-trauma, but data on the co-occurrence of spine trauma in patients with traumatic brain injury (TBI) are scarce. In this study, we used the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) database to assess the prevalence, characteristics, and outcomes of patients with TBI and a concurrent traumatic spinal injury (TSI).MethodsData from the European multi-center CENTER-TBI study were analyzed. Adult patients with TBI (≥18 years) presenting with a concomitant, isolated TSI of at least serious severity (Abbreviated Injury Scale; AIS ≥3) were included. For outcome analysis, comparison groups of TBI patients with TSI and systemic injuries (non-isolated TSI) and without TSI were created using propensity score matching. Rates of mortality, unfavorable outcomes (Glasgow Outcome Scale Extended; GOSe < 5), and full recovery (GOSe 7–8) of all patients and separately for patients with only mild TBI (mTBI) were compared between groups at 6-month follow-up.ResultsA total of 164 (4%) of the 4,254 CENTER-TBI core study patients suffered from a concomitant isolated TSI. The median age was 53 [interquartile range (IQR): 37–66] years and 71% of patients were men. mTBI was documented in 62% of cases, followed by severe TBI (26%), and spine injuries were mostly cervical (63%) or thoracic (31%). Surgical spine stabilization was performed in 19% of cases and 57% of patients were admitted to the ICU. Mortality at 6 months was 11% and only 36% of patients regained full recovery. There were no significant differences in the 6-month rates of mortality, unfavorable outcomes, or full recovery between TBI patients with and without concomitant isolated TSI. However, concomitant non-isolated TSI was associated with an unfavorable outcome and a higher mortality. In patients with mTBI, a negative association with full recovery could be observed for both concomitant isolated and non-isolated TSI.ConclusionRates of mortality, unfavorable outcomes, and full recovery in TBI patients with and without concomitant, isolated TSIs were comparable after 6 months. However, in patients with mTBI, concomitant TSI was a negative predictor for a full recovery. These findings might indicate that patients with moderate to severe TBI do not necessarily exhibit worse outcomes when having a concomitant TSI, whereas patients with mTBI might be more affected.

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