A Retrospective Analysis of Concomitant Spinal Injuries in the Setting of Polytrauma at a Tertiary Hospital in Singapore

Aims: Polytrauma involving multiple organ systems is a pertinent health concern. Spinal injuries are often observed in polytrauma, with serious consequences to patients’ quality of life and a significant healthcare burden. Due to its complexity, there are limited studies analyzing the population of spinal injuries in polytrauma in Singapore. This study aims to retrospectively evaluate a cohort of polytrauma patients and characterize the relationship between the presence of traumatic spinal injury and clinical outcomes. Methods: A retrospective cohort of patients who presented to the emergency department for multisystem trauma was assembled from a local trauma database at a tertiary hospital in Singapore from January 2012 to June 2020. Variables analyzed were the presence of concomitant spine injury, mechanism of injury, injury severity score (ISS), gender, age, ethnicity, and year of admission. Outcomes were mortality, length of stay, and cost. Results: 1568 patients involved in multisystem trauma were identified for this study. It was observed that 27.2% (n=427) had concomitant spinal injuries, which were most commonly due to falls (83.6%, n=357), followed by vehicular accidents (12.9%, n=55). The percentage of falls as the primary injury mechanism increased from 25.9% in the 21- to 30-year-old age range to 96.4% in the 81- to 90-year-old age range. Meanwhile, the percentage of vehicular accidents as the primary injury mechanism decreased from 67.8% in the 21- to 30-year-old age range to 3.2% in the 81- to 90-year-old age range. Notably, the mortality rate of patients with spine injuries (2.6%, n=416, relative risk 0.17) was significantly lower than that of those without spine involvement (15.1%, n=969, p<0.001), with an adjusted odds ratio for mortality of 0.25 (95% CI (0.11, 0.52), p<0.001). The mean total length of stay was lower in patients with spinal injuries, at 11.8 days (SD 14.6, p<0.001), compared to 16.0 days (SD 28.0) in patients without spinal injuries. The mean total hospital bill was lower in patients with spinal injuries, at 8692 Singapore dollars (SD 13980, p<0.001), compared to 16359 Singapore dollars (SD 30658) in patients without spinal injuries. Conclusions: Spinal injury in the context of polytrauma is not an independent predictor of poorer outcomes, as it has been observed to have lower mortality compared to polytrauma patients without spinal involvement. This may be attributed to the complex nature of polytrauma; previous studies have found that high-energy traumatic injuries tend to be associated with more independent living and mobility than low-energy injuries, with the former having better functional outcomes postinjury. Similarly, patients with spinal cord involvement in polytrauma, which suggests a high-energy injury, may have greater functional demands and subsequently better reserves, thus conferring better survivability.