Prognostic value of mechanism of injury on in-hospital outcomes following cervical fusion in motor vehicle accident-related neck trauma

Introduction: Patients with unstable neck injuries following motor vehicle accident (MVA) cervical spine injuries are often treated with surgical cervical fusion. Postoperative prognosis is highly variable and difficult to predict. Given that MVAs are one of the leading causes of cervical trauma, this study seeks to identify aspects of the mechanism of injury (MOI) that are associated with a complicated postoperative hospital course.

Methods: The National Trauma Dank Bank was queried from 2017-2019 for all adults with nonfatal cervical spine injuries due to MVAs who underwent cervical fusion. Complicated hospital course was defined as length of stay > 14 days (representing the 75% quantile), any hospital complication, or discharge to long-term care or hospice. A multivariable logistic regression model was developed to identify independent predictors of complicated hospital stay.

Results: A total of 8,088 patients meeting the inclusion criteria were identified. Of those, 3,655 experienced a complicated hospital course while 4,433 did not. Following multivariable regression, vehicle intrusion (OR 1.49, CI 1.25-1.79) and victim ejection (OR 1.41 CI 1.08-1.83) were associated with increased complications, while seatbelts (OR 0.81 CI 0.73-0.9) and airbags (OR 0.87, CI 0.78-0.96) associated with fewer complications. In contrast, passenger death in the vehicle compartment was not significant (OR 1.25, CI 0.74-2.09). Additionally, GCS < 13, elderly age, and medical comorbidities were also associated with increased complications.

Conclusion : Vehicle intrusion and victim ejection were MOI-related factors associated with a more complicated hospital course while seatbelts and airbags were associated with a less complicated hospital course. These factors may be useful in goals-of-care discussions, postoperative prognostication, discharge planning, as well as patient/family education. Care must be taken by consulting neurosurgical providers to ascertain this information from emergency department providers, emergency medical services personnel, and accident witnesses whenever possible.