Age-based differences in the disability of spine injuries in pediatric and adult motor vehicle crash occupants

Abstract

Objective

The objective was to develop a disability-based metric for quantifying disability rates as a result of motor vehicle crash (MVC) spine injuries and compare functional outcomes between pediatric and adult subgroups.

Methods

Disability rate was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank—Research Data System for the top 95% most frequent Abbreviated Injury Scale (AIS) 3 spine injuries (14 unique injuries). Pediatric (7–18 years), young adult (19–45 years), middle-aged adult (46–65 years), and older adult (66+ years) MVC occupants with FIM scores available and at least one of the 14 spine injuries were included. FIM scores of 1 or 2 at time of discharge were used to define disability and correspond to full functional or modified dependence in self-feeding, locomotion, and/or verbal expression. Disability rate was evaluated on a per injury basis for each AIS 3 spine injury and calculated as the proportion of cases associated with disability (i.e. FIM of 1 or 2) out of the total cases of that particular injury. Disability rates were calculated with and without the exclusion of cases with severe co-injuries (AIS 4+) to minimize bias from additional non-spinal injuries that could have contributed to disability. Associations between adjusted disability rates and existing mortality rates were investigated.

Results

Locomotion impairment alone was the most frequent disability type for the top 14 AIS 3 spine injuries (7 cervical, 4 thoracic, and 3 lumbar) across all age groups and spine regions. Adjusted and unadjusted disability rates ranged from 0-69%. Adjusted disability rates increased with age: 14.8 ± 10% (mean ± SD) in pediatrics to 16.2 ± 6.6% (young adults), 29.2 ± 10.9% (middle-aged adults), and 45.0 ± 12.2% (older adults). Among all adult populations, adjusted mortality and disability rates were positively correlated (R²>0.24), with disability rates consistently greater than corresponding mortality rates.

Conclusions

Older adults had significantly greater disability rates associated with MVC spine injuries across all spinal regions. MVC disability rates for pediatrics were considerably lower. Overall, rates of mortality were significantly lower than rates of disability. The adjusted disability rates developed can supplement existing injury metrics by accounting for age- and location-specific functional implications of MVC spine injuries.

Keywords:

• Automotive
• vertebra
• morbidity
• older adults
• fracture
• functional outcome

Acknowledgments

We thank Samantha Schoell, Andrea Doud, Sheevanie Casimir, and Karan Devane for their assistance with data analysis and review. The authors acknowledge the National Science Foundation (NSF) Center for Child Injury Prevention Studies at the Children’s Hospital of Philadelphia (CHOP) for sponsoring this study and its Industry Advisory Board (IAB) members for their support, valuable input, and advice. This publication was also supported by the National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health and Human Development (K08HD073241), and National Institute on Aging (K25AG058804). The views presented are those of the authors and not necessarily the views of CHOP, the NSF, the IAB members, or the NIH. The content reproduced from the NTDB remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original data, text, tables, or figures.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Preexisting datasets were utilized for the analyses conducted in this study. These included the NASS-CDS datasets (https://www.nhtsa.gov/research-data/national-automotive-sampling-system-nass) from years 2000-2011, which are publicly available, as well as NTDB-RDS (https://www.facs.org/quality-programs/trauma/tqp/center-programs/ntdb) datasets from years 2000-2011. The mortality metrics used are available in the Appendix of a prior publication (Weaver et al. 2013). The final, compiled datasets from these sources are available upon request from the authors.

Additional information

Funding

We thank Samantha Schoell, Andrea Doud, Sheevanie Casimir, and Karan Devane for their assistance with data analysis and review. The authors acknowledge the National Science Foundation (NSF) Center for Child Injury Prevention Studies at the Children’s Hospital of Philadelphia (CHOP) for sponsoring this study and its Industry Advisory Board (IAB) members for their support, valuable input, and advice. This publication was also supported by the National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health and Human Development (K08HD073241), and National Institute on Aging (K25AG058804). The views presented are those of the authors and not necessarily the views of CHOP, the NSF, the IAB members, or the NIH. The content reproduced from the NTDB remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original data, text, tables, or figures.