Risk factors related to traumatic spinal cord injury outcomes: An analysis of the US National Trauma Data Bank.

Abstract

Introduction: Traumatic spinal cord injuries (TSCIs) are associated with high morbidity rates that can affect motor, sensory, and autonomic function. SCIs commonly result from sports, motor vehicle accidents, and other blunt traumas.

Objective: To determine risk factors for in-hospital mortality, in-hospital complications, and increased length of stay (LOS) following TSCI.

Methods: Data from the United States (US) National Trauma Data Bank (NTDB) from 2017 to 2021 was collected and used to assess risk factors for increased in-hospital mortality, complications, and hospital length of stay. Univariable analysis was completed on the 2017-2018 data. Variable importance was calculated, and a logistic regression was performed using the most important variables. Internal and external validation was completed using a testing cohort and 2020-2021 data.

Results: Spinal fusion was associated with decreased mortality but increased complications and LOS. Increased age and injury severity score was associated with increased mortality, complications, and LOS, while the emergency department Glasgow Coma Score was inversely related to all outcomes. Each model had moderate to high prediction ability based on internal area under the curves (AUCs) ranging from 0.757 to 0.899 and external AUCs between 0.744 and 0.884.

Conclusion: Understanding the factors that contribute to poorer outcomes following TSCI can help inform physicians of best treatment practices and patient prognosis. We highlighted five risk factors that correlate with short-term patient outcomes. Future research will further explore how treatment can impact both short - and long-term outcomes.