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Early Surgical Decompression and Pulmonary Embolism Risk in Traumatic Cervical Spinal Cord Injury: A Propensity
Samer G Salman1, Rohan A Phadke1, Nathan J Lee2
1School of Medicine, Baylor College of Medicine, Houston, TX, USA.
Insights
Early cervical decompression after traumatic spinal cord injury (SCI) does not increase the risk of in-hospital pulmonary embolism (PE). PE risk should not delay decompression, but mortality differences warrant caution.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Critical Care Medicine
Background:
- Traumatic cervical spinal cord injury (SCI) poses significant risks, including pulmonary embolism (PE).
- The optimal timing for cervical decompression in SCI patients remains a critical clinical question.
Purpose of the Study:
- To investigate the association between early cervical decompression and in-hospital pulmonary embolism (PE) following traumatic cervical spinal cord injury (SCI).
Main Methods:
- Propensity score-matched retrospective cohort study using the National Trauma Data Bank (2019-2024).
- Adults with traumatic cervical SCI undergoing decompression were analyzed, with early decompression defined as within 24 hours.
- 1:1 matching using 30 covariates identified 4,480 balanced pairs for primary outcome analysis of in-hospital PE.
Main Results:
- Early cervical decompression was not associated with a higher risk of detected in-hospital PE (OR 0.97, 95% CI 0.70 to 1.35).
- Robustness analyses, including negative-control outcomes, supported the null finding.
- Early decompression was associated with increased in-hospital mortality (OR 1.54, 95% CI 1.30 to 1.82).
Conclusions:
- Early cervical decompression after traumatic cervical SCI is not linked to an increased incidence of pulmonary embolism.
- Pulmonary embolism risk alone should not be a reason to delay cervical decompression.
- Differential mortality and potential confounding necessitate careful interpretation and prospective validation.
Abstract:
Study DesignPropensity score-matched retrospective cohort study.ObjectivesTo determine whether early cervical decompression is associated with in-hospital pulmonary embolism (PE) after traumatic cervical spinal cord injury (SCI).MethodsAdults with traumatic cervical SCI undergoing coded cervical decompression after direct admission were identified in the National Trauma Data Bank, 2019 to 2024. Early decompression was within 24 hours; delayed decompression was after 24 hours. Patients were matched 1:1 using 30 covariates. The primary outcome was detected in-hospital PE. Robustness analyses included sensitivity, subgroup, landmark, negative-control, competing-risk, clustered-error, bootstrap, and McNemar analyses.ResultsAmong 11,530 decompression-coded patients, matching yielded 4,480 balanced pairs. Early decompression was not associated with detected PE (OR 0.97, 95% CI 0.70 to 1.35; p = 0.868; absolute risk difference -0.04%, 95% CI -0.58% to 0.49%). Robustness analyses supported this null finding, including a null negative-control outcome (OR 1.10, 95% CI 0.75 to 1.62). No subgroup interaction was significant after multiplicity correction. In patients with Injury Severity Score ≥25, PE risk was similar (OR 0.88, 95% CI 0.56 to 1.39). Early decompression was associated with higher in-hospital mortality overall (OR 1.54, 95% CI 1.30 to 1.82), creating potential competing-risk bias.ConclusionsEarly cervical decompression after traumatic cervical SCI was not associated with increased detected in-hospital PE. PE risk alone should not justify delaying otherwise indicated decompression, but differential mortality and residual confounding require cautious interpretation and prospective confirmation.
