Early predictors of outcome in spine trauma patients

Spine trauma is a complex field with significant global variation in practice. The acute management of spine trauma is assisted partly by spine trauma treatment algorithms. The majority of existing algorithms classifies and recommends treatment for spine injuries but do not take into account the overall clinical state of the patient. This thesis focuses on the identification of these factors through the delineation of early risk factors predictive of spine trauma mortality, poor functional outcome and suboptimal health status. The methodology of this thesis is the development and pilot of a spine trauma registry minimum dataset utilizing a multidisciplinary modified Delphi approach. The minimum dataset was utilized to gather information with regards to demographics, clinical status factors, polytrauma severity, spine injury characteristics and both patient- and physician reported outcomes. The thesis shows that spine trauma patients are not dissimilar to general trauma patients in terms of mortality predictors. Irreversible predictors of poor outcome identified were the elderly, multiple comorbidities, severe polytrauma, moderate and severe traumatic brain injury and thoracic spine injuries. Reversible predictors of poor outcome identified were the coagulopathy, hypoxia and haemodynamic instability. A clinical status factor may be used as a modifier to all spine trauma treatment algorithms with the purpose of assessing medical stability and suitability for decompressive and reconstructive spine trauma operative procedures. Critically ill trauma patients with spine injuries and irreversible adjusted spine trauma poor outcome predictive variables should have their definitive spine surgery deferred until the they show evidence of survival from their general trauma injuries, in particular, severe traumatic brain injury. Critically ill trauma patients with spine injuries and reversible adjusted spine trauma poor outcome predictive variables should also have their definitive spine surgery deferred until their risk factors have been treated adequately.