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Updated: May 5, 2026
Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
Predicting morbidity and mortality after surgery for isolated traumatic spinal injury without spinal cord injury
Ahmad Mohammad Ismail1, Maximilian Peter Forssten, Yang Cao
1From the Department of Orthopedic Surgery (A.M.I., M.P.F., I.I., S.P.F.), Orebro University Hospital; School of Medical Sciences (A.M.I., M.P.F., I.I.), and Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health (Y.C.), Orebro University, Orebro, Sweden; Center of Trauma and Critical Care (B.S.), The George Washington University, Washington, DC; and School of Medical Sciences (S.M.), Orebro University, Orebro, Sweden.
Background:
Traumatic spinal injuries are associated with a high risk of morbidity and mortality. The aim of this study is to investigate which variables best predict adverse outcomes in patients who had surgery for isolated traumatic spinal injury without spinal cord injury.
Methods:
The American College of Surgeons Trauma Quality Improvement Program database was used to identify adult (18 years or older) surgically managed patients with an isolated traumatic spinal injury, without spinal cord injury admitted between 2013 and 2021. An isolated injury was defined as a spine Abbreviated Injury Scale score ≥2 and an Abbreviated Injury Scale score ≤1 in the remaining body regions, as well as corresponding International Classification of Diseases, Ninth and Tenth Revision, codes. The predictive value of demographic, clinical, and comorbidity data was evaluated using logistic regression models and ranked using the permutation importance method.
Results:
A total of 39,457 patients were included in the study, of whom 554 died during hospitalization. The most important variables for predicting in-hospital mortality were age, sex, Glasgow Coma Scale on admission, Orthopedic Frailty Score, and cervical spine injury. The most important variables for predicting complications were age, cervical spine injury, the need for cervical spine surgery, Revised Cardiac Risk Index, and alcohol use disorder. Finally, age, cervical spine injury, sex, Glasgow Coma Scale on admission, and Orthopedic Frailty Score had the highest relative importance when predicting failure to rescue. Models based on the five most important variables for each outcome demonstrated an excellent predictive ability for in-hospital mortality (area under the receiver operating characteristic curve [AUROC], 0.84; 95% confidence interval [CI], 0.82-0.86) and failure to rescue (AUROC [95% CI], 0.86 [0.84-0.87]) as well as an acceptable predictive ability for complications (AUROC [95% CI], 0.72 [0.71-0.73]).
Conclusion:
The most important factors identified to predict mortality, complications, and failure to rescue in traumatic spinal injury patients without spinal cord injury who undergo surgery were patients' age, sex, frailty, cervical spine injury that necessitated surgical intervention, and cardiovascular risk.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
