Elsevier

Injury

Volume 41, Issue 2, February 2010, Pages 226-230
Injury

Factors that predict poor outcomes in patients with traumatic vertebral body fractures

https://doi.org/10.1016/j.injury.2009.10.019Get rights and content

Abstract

Objective

To identify factors that predict poor patient-reported outcomes in patients with traumatic vertebral body fracture(s) of the thoracic and/or lumbar spine without neurological deficit.

Summary of background data

There is a paucity of information on factors that predict poor patient-reported outcomes in patients with traumatic vertebral body fracture(s) of the thoracic and/or lumbar spine without neurological deficit.

Methods

Patients were identified from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). VOTOR includes all patients with orthopaedic trauma admitted to the two adult Level 1 trauma centres in Victoria, Australia. Patient-reported outcomes and data on possible predictive factors, including demographic details, injury-related and treatment-based factors, were obtained from the VOTOR database. Patient-reported outcomes were measured at 12 months post-injury using the 12-Item Short-Form Health Survey (SF-12), a Numerical Rating Scale (NRS) for pain, global outcome questions and data was collected on return to work or study. For the identification of predictive factors, univariate analyses of outcome vs. each predictor were carried out first, followed by logistic multiple regression.

Results

344 patients were eligible for the study and data were obtained for 264 (76.7%) patients at 12 months follow-up. Patients reported ongoing pain at 12 months post-injury (moderate–severe: 33.5%), disability (70.1%) and inability to return to work or study (23.3%). A number of demographic, injury-related and treatment-based factors were identified as being predictive of poor patient-reported outcomes. Patients who had associated radius fracture(s) were more likely to have moderate to severe disability (odds ratio (OR) = 3.85, 95% confidence interval = 1.30–11.39), a poorer physical health status (OR = 3.73, 1.37–10.12) and moderate to severe pain (OR = 3.23, 1.22–8.56) at 12 months post-injury than patients without radius fracture. Patients who did not receive compensation for work-related or road traffic-related injuries were less likely to report moderate to severe pain (OR = 0.45, 0.23–0.90) or have a poorer mental health status (OR = 0.17, 0.04–0.70) at 12 months post-injury than those who received compensation.

Conclusions

The prognostic factors identified in this study may assist clinicians in the identification of patients requiring more intensive follow-up or additional rehabilitation to ultimately improve patient care.

Introduction

Traumatic vertebral body fractures of the thoracic and/or lumbar spine without neurological deficit are common in trauma patients and predominantly occur in young and previously active individuals in their 20–40 s following road traffic incidents or falls.1, 3, 6, 11, 13, 15, 20, 21, 23, 26, 28 Patients frequently sustain other associated non-spinal injuries1, 11, 15, 16, 21, 24 and outcomes are poor, with many patients reporting ongoing pain, disability, poor physical health and inability to return to work or study.1, 5, 11

Little is known about factors that predict return to work or study, pain, health status and disability at 12 months post-injury in patients with traumatic vertebral body fracture(s) of the thoracic and/or lumbar spine without neurological deficit, including patients with other additional injuries. Previous studies have mostly addressed different injury populations9, 12, 18, 22, 29 with different follow-up durations12, 29 and usually assess a limited number of potential predictors11 or outcome measures.5

It is important that studies address this knowledge deficit as an understanding of the factors that predict poor patient-reported outcomes in this group of patients will assist clinicians in the identification of patients at risk of a poorer prognosis and ultimately facilitate better patient management and care. The objective of this study was to identify factors that predict poor patient-reported outcomes in patients with traumatic vertebral body fracture(s) of the thoracic and/or lumbar spine without neurological deficit, including patients with other additional injuries.

Section snippets

Patients

Patients were identified from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) Phase 1 (August 2003 to August 2004) and 2 (May 2005 to July 2006). VOTOR registers all patients with an orthopaedic and/or spinal injury managed or followed up by an orthopaedic unit at one of the two adult Level 1 trauma centres in Victoria, Australia (the Alfred and Royal Melbourne Hospital). Patients with pathological fracture related to metastatic disease and/or an isolated orthopaedic injury managed

Results

344 patients with acute traumatic vertebral body fracture(s) of the thoracic and/or lumbar spine without neurological deficit were included in the study. Data were obtained from 264 (76.7%) patients at 12 months follow-up. There were no significant differences between patients who were lost to follow-up compared with patients for which follow-up was possible at 12 months post-injury with respect to patient demographics, injury cause or ISS.

The median age was 38 years, with almost 90% of

Discussion

Using a prospective cohort of patients with traumatic vertebral body fractures, we have identified a number of demographic, injury-related and treatment-based factors that are associated with poor patient-reported outcomes.

Although education level was identified as a potential predictor of return to work in a number of studies investigating factors influencing return to work in the general trauma population,19, 22 this association was not identified in the present study for return to work or

Conclusion

In our study, a number of demographic, injury-related and treatment-based factors were identified as being predictive of poor patient-reported outcomes. The findings of this study may: (i) assist clinicians in the identification of patients at risk of poorer prognosis, who may require more intensive follow-up or additional rehabilitation and (ii) assist clinicians in providing better information to patients on their likely prognosis.

Conflict of interest statement

The authors do not have any conflicts of interest, or any financial and personal relationships with other people, or organisations, that could inappropriately influence this work.

Acknowledgments

The authors would like to acknowledge the work of the VOTOR Research Group: Melissa Hart, Owen Williamson, Peter Cameron, Belinda Gabbe and Ann Sutherland.

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