Tee et al identified predictors for functional disability after spinal trauma. These can help to identify a patient who may benefit from more aggressive management. The authors are from The Alfred and National Trauma Research Institute in Melbourne.
Patient selection: spine trauma
Outcome: Glasgow Outcome Scale at 1 year of 4 or less
Predictors for functional disability present within the first 48 hours:
(1) hypotension, with systolic blood pressure < 100 mm Hg (odds ratio 1.98)
(2) hyperglycemia, with blood glucose >= 8 mmol/L (odds ratio 1.67)
(3) moderate or severe brain trauma (odds ratio 5.88)
cumulative product of the odds ratios =
= PRODUCT(odds ratios for the 3 predictors)
Interpretation:
• minimum cumulative odds ratio: 1
• maximum cumulative odds ratio: 19.4
• The higher the cumulative odds the greater the risk for functional disability.
In the study 92% of disabled and 94% of GOS 5 patients had intact neurologic status. A higher prevalence of significant spinal cord injury might give different results.
