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Clinical Research
Uncorrected Proof. Available online 4 October 2024
Mortality risk factors for adult trauma patients treated with halo brace for cervical spine fracture
Factores de riesgo de mortalidad para pacientes adultos con traumatismos tratados con halo ortopédico por fractura de columna cervical
Kim Hoanga,
Corresponding author
khoang7@hs.uci.edu

Corresponding author.
, Jeffrey Santosa, Areg Grigoriana, Lourdes Swenteka, Hansen Bowb, Jeffry Nahmiasa
a University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA
b University of California, Irvine, Department of Neurological Surgery, Orange, California, USA
Article information
Statistics
Tables (4)
Table 1. Demographics and comorbidities of patients undergoing Halo brace for cervical spine fracture stratified by mortality.
Table 2. Injury profile and vital signs for patients undergoing Halo brace for cervical spine fracture stratified by mortality.
Table 3. Outcomes and complications for patients undergoing Halo brace for cervical spine fracture stratified by mortality.
Table 4. Multivariable logistic regression analysis for associated risk of mortality for patients undergoing Halo brace for cervical spine fracture.
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Abstract
Introduction and objectives

Halo braces treat upper cervical spine fractures and serve as the most rigid form of external immobilization. Recently, halo braces have lost favor due to known complications and advances in surgical stabilization. This study aims to determine the contemporary incidence for use of halo braces and identify risk factors associated with mortality in trauma patients undergoing halo brace for cervical spine fractures.

Materials and methods

The 2017–2019 Trauma Quality Improvement Program Database was queried for patients ≥18 years-old with a cervical spine fracture undergoing halo brace. Patients sustaining penetrating trauma and severe torso injuries (abbreviated injury scale >3 for the abdomen or thorax) were excluded. Bivariate and multivariable logistic regression analyses were performed.

Results

From 144,434 patients with a cervical spine fracture, 272 (0.2%) underwent halo brace and 14 (5%) of these died. Those who died were older (73.5 vs. 53 years-old, p = 0.011) and had higher rates of hypertension (78.6% vs 33.1%, p < 0.001) and chronic kidney disease (14.3% vs. 1.2%, p < 0.001). Glasgow Coma Scale ≤8 (46.2% vs. 8.2%, p < 0.001) and cervical spinal cord injury (71.4% vs. 21.3%, p < 0.001) were more common in patients who died. In addition, those who died more often sustained respiratory complications (7.1% vs. 0.4%, p = 0.004) and sepsis (7.1% vs. 0.4%, p = 0.004). On multivariable logistic regression analysis, only Glasgow Coma Scale ≤8 (OR 19.77, 3.04–128.45, p = 0.002) was associated with increased mortality.

Conclusions

Only 5% of cervical spine fracture patients undergoing halo brace died. Respiratory complications and sepsis were more common in those who died. On multivariable analysis only Glasgow Coma Scale ≤8 remained an independent associated risk factor for mortality.

Keywords:
Halo brace
Halo immobilization
Cervical spine fracture
Spine surgery
Spine brace
Resumen
Introducción y objetivos

Los aparatos ortopédicos Halo tratan las fracturas de la columna cervical superior y sirven como la forma más rígida de inmovilización externa. Recientemente, los aparatos de halo han perdido popularidad debido a complicaciones conocidas y avances en la estabilización quirúrgica. Este estudio tiene como objetivo determinar la incidencia contemporánea del uso de aparatos ortopédicos con halo e identificar los factores de riesgo asociados con la mortalidad en pacientes traumatizados sometidos a aparatos ortopédicos con halo por fracturas de la columna cervical.

Materiales y métodos

Se consultó la base de datos del Programa de mejora de la calidad del trauma 2017–2019 para pacientes ≥18 años con una fractura de la columna cervical sometidos a un halo ortopédico. Se excluyeron los pacientes que sufrieron traumatismos penetrantes y lesiones graves del torso (escala de lesión abreviada >3 para el abdomen o el tórax). Se realizaron análisis de regresión logística bivariados y multivariables.

Resultados

De 144,434 pacientes con fractura de columna cervical, 272 (0.2%) fueron sometidos a halo y 14 (5%) de ellos fallecieron. Los que fallecieron eran de mayor edad (73.5 vs. 53 años, p = 0.011) y tenían mayores tasas de hipertensión (78.6% vs. 33.1%, p < 0.001) y enfermedad renal crónica (14.3% vs. 1.2%, p < 0.001). La escala de coma de Glasgow ≤8 (46.2% frente a 8.2%, p < 0.001) y la lesión de la médula espinal cervical (71.4% frente a 21.3%, p < 0.001) fueron más comunes en los pacientes que fallecieron. Además, los que murieron con mayor frecuencia sufrieron complicaciones respiratorias (7.1% frente a 0.4%, p = 0.004) y sepsis (7.1% frente a 0.4%, p = 0.004). En el análisis de regresión logística multivariable, sólo la Escala de Coma de Glasgow ≤8 (OR 19.77, 3.04–128.45, p = 0.002) se asoció con una mayor mortalidad.

Conclusiones

Sólo el 5% de los pacientes con fractura de columna cervical sometidos a halo fallecieron. Las complicaciones respiratorias y la sepsis fueron más comunes en los que murieron. En el análisis multivariable sólo la Escala de Coma de Glasgow ≤8 siguió siendo un factor de riesgo asociado independiente para la mortalidad.

Palabras clave:
Halo ortopédico
Inmovilización de halo
Fractura de la columna cervical
Cirugía de columna
Aparato ortopédico para la columna vertebral

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