Spinal level and cord involvement in the prediction of sepsis development after vertebral fracture repair for traumatic spinal injury.
Spinal level and cord involvement in the prediction of sepsis development after vertebral fracture repair for traumatic spinal injury.
复制标题
脊髓水平和脊髓受累预测创伤性脊柱损伤椎体骨折修复后脓毒症的发展。
DOI：
10.3171/2021.12.spine21423
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发表时间：
2022-08-01
影响因子：
2.8
通讯作者：
Zaidi, Hasan A.
中科院分区：
文献类型：
--
作者：
Hoffman, Samantha E.;Hauser, Blake M.;Zaki, Mark M.;Gupta, Saksham;Chua, Melissa;Bernstock, Joshua D.;Khawaja, Ayaz M.;Smith, Timothy R.;Zaidi, Hasan A.
尽管了解相关的不良后果，但识别有败血症风险的住院患者仍具有挑战性。我们的目的是描述因创伤性脊柱损伤（TSI）而接受椎体骨折修复术的患者脓毒症的流行病学和临床风险。我们对 2011 年至 2014 年国家创伤数据库编码的 TSI 初次住院期间接受椎体骨折修复的成人进行了回顾性队列分析。在 30,463 名符合资格接受椎体骨折修复的患者中，317 名患者在初次住院期间出现脓毒症。大多数是在机动车事故（63%）或跌倒（28%）后出现的。患脓毒症的患者男性（OR 1.5；95% CI 1.1-1.9）、糖尿病（OR 1.5；95% CI 1.11-2.1）和肥胖（OR 1.9；95% CI 1.4-2.5）的可能性更大。此外，他们出现中度（OR 2.7；95% CI 1.8-4.2）或重度格拉斯哥昏迷量表评分（OR 3.9；95% CI 2.9-5.2）以及伴有腹部损伤（OR 1.9；95% CI 1.5-2.5）但颅骨、胸部或上/下肢损伤的可能性更大受伤。有趣的是，颈椎损伤与脓毒症的发生显着相关（OR 1.4；95% CI 1.1-1.8），但胸椎和腰椎损伤则不然。脊髓损伤（OR 1.9；95% CI 1.5-2.5）也与脓毒症相关，无论程度如何。脓毒症患者的住院时间大约延长了 16 天。他们出院接受康复护理或在家接受康复护理的几率更大（OR 2.4；95% CI 1.8–3.2），死亡或出院到临终关怀医院的几率也更大（OR 6.0；95% CI 4.4–8.1）。在接受椎体骨折修复的患者中，患有颈椎骨折、脊髓损伤、已有合并症和严重伴随损伤的患者发生术后败血症和医院不良处置的风险最高。
Despite understanding the associated adverse outcomes, identifying hospitalized patients at risk for sepsis is challenging. We aimed to characterize the epidemiology and clinical risk of sepsis in patients who have undergone vertebral fracture repair for traumatic spinal injury (TSI). We conducted a retrospective cohort analysis of adults undergoing vertebral fracture repair during initial hospitalization following TSI encoded within the National Trauma Databank from 2011–2014. Of the 30,463 eligible patients undergoing vertebral fracture repair, 317 developed sepsis during initial hospitalization. Most presented following motor vehicle accident (63%) or fall (28%). Patients who developed sepsis had greater odds of being male (OR 1.5; 95% CI 1.1–1.9), having diabetes (OR 1.5; 95% CI 1.11–2.1), and being obese (OR 1.9; 95% CI 1.4–2.5). Additionally, they had greater odds of presenting with moderate (OR 2.7; 95% CI 1.8–4.2) or severe Glasgow Coma Scale scores (OR 3.9; 95% CI 2.9–5.2) and of having concomitant abdominal injuries (OR 1.9; 95% CI 1.5–2.5) but not cranial, thoracic, or upper/lower extremity injuries. Interestingly, cervical spine injury was significantly associated with developing sepsis (OR 1.4; 95% CI 1.1–1.8), but thoracic and lumbar spine injuries were not. Spinal cord injury (OR 1.9; 95% CI 1.5–2.5) was also associated with sepsis regardless of level. Patients with sepsis were hospitalized approximately 16 days longer. They had greater odds of being discharged to rehabilitative care or home with rehabilitative care (OR 2.4; 95% CI 1.8–3.2) and greater odds of death or discharge to hospice (OR 6.0; 95% CI 4.4–8.1). Among patients undergoing vertebral fracture repair, those with cervical spine fractures, spinal cord injuries, pre-existing comorbidities, and severe concomitant injuries are at highest risk for developing postoperative sepsis and experiencing adverse hospital disposition.