{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T23:49:58Z","timestamp":1777506598261,"version":"3.51.4"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T00:00:00Z","timestamp":1670889600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T00:00:00Z","timestamp":1670889600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Traumatic cervical spine injuries (TCSI) are rare injuries. With increasing age the incidence of TCSI is on the rise. TCSI and traumatic brain injury (TBI) are often associated. Both TCSI and TBI are allocated to the Abbreviated Injury Scale (AIS) head region. However, the nature and outcome of these injuries are potentially different. Therefore, the aim of this study was to investigate the epidemiology, demographics and outcome of severely injured patients with severe TCSI, and compare them with polytrauma patients with severe TBI in the strict sense. Consecutive polytrauma patients aged\u2009\u2265\u200915\u00a0years with AIShead\u2009\u2265\u20093 who were admitted to a level-1 trauma center Intensive Care Unit (ICU) from 2013 to 2021 were included. Demographics, treatment, and outcome parameters were analyzed for patients who had AIShead\u2009\u2265\u20093 based on TCSI and compared to patients with AIShead\u2009\u2265\u20093 based on proper TBI. Data on follow-up were collected for TCSI patients. Two hundred eighty-four polytrauma patients (68% male, Injury Severity Score (ISS) 33) with AIShead\u2009\u2265\u20093 were included; Thirty-one patients (11%) had AIShead\u2009\u2265\u20093 based on TCSI whereas 253 (89%) had AIShead\u2009\u2265\u20093 based on TBI. TCSI patients had lower systolic blood pressure in the Emergency Department (ED) and stayed longer in ICU than TBI patients. There was no difference in morbidity and mortality rates. TCSI patients died due to high cervical spine injuries or respiratory insufficiency, whereas TBI patients died primarily due to TBI. TCSI was mainly located at C2, and 58% had associated spinal cord injury. Median follow-up time was 22\u00a0months. Twenty-two percent had improvement of the spinal cord injury, and 10% died during follow-up. In this study the incidence of severe TCSI in polytrauma was much lower than TBI. Cause of death in TCSI was different compared to TBI demonstrating that AIShead based on TCSI is a different entity than based on TBI. In order to avoid data misinterpretation injuries to the cervical spine should be distinguished from TBI in morbidity and mortality analysis.<\/jats:p>","DOI":"10.1038\/s41598-022-25809-8","type":"journal-article","created":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T13:03:44Z","timestamp":1670936624000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Polytrauma patients with severe cervical spine injuries are different than with severe TBI despite similar AIS scores"],"prefix":"10.1038","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1166-0990","authenticated-orcid":false,"given":"Karlijn J. P.","family":"van Wessem","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Menco J. S.","family":"Niemeyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8385-1801","authenticated-orcid":false,"given":"Luke P. H.","family":"Leenen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,12,13]]},"reference":[{"key":"25809_CR1","doi-asserted-by":"publisher","first-page":"e427","DOI":"10.1016\/j.wneu.2017.11.011","volume":"110","author":"PG Passias","year":"2018","unstructured":"Passias, P. G. et al. Traumatic fractures of the cervical spine: Analysis of changes in incidence, cause, concurrent injuries, and complications among 488,262 patients from 2005 to 2013. World Neurosurg. 110, e427\u2013e437. https:\/\/doi.org\/10.1016\/j.wneu.2017.11.011 (2018).","journal-title":"World Neurosurg."},{"issue":"4","key":"25809_CR2","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1016\/j.injury.2011.06.022","volume":"43","author":"JL Clayton","year":"2012","unstructured":"Clayton, J. L. et al. Risk factors for cervical spine injury. Injury 43(4), 431\u2013435 (2012).","journal-title":"Injury"},{"issue":"5","key":"25809_CR3","doi-asserted-by":"publisher","first-page":"E10","DOI":"10.3171\/FOC.2008.25.11.E10","volume":"25","author":"AH Milby","year":"2008","unstructured":"Milby, A. H., Halpern, C. H., Guo, W. & Stein, S. C. Prevalence of cervical spinal injury in trauma. Neurosurg. Focus 25(5), E10. https:\/\/doi.org\/10.3171\/FOC.2008.25.11.E10 (2008).","journal-title":"Neurosurg. Focus"},{"issue":"1","key":"25809_CR4","doi-asserted-by":"publisher","first-page":"19985","DOI":"10.1038\/s41598-021-99484-6","volume":"11","author":"D Jochems","year":"2021","unstructured":"Jochems, D. et al. Incidence, causes and consequences of moderate and severe traumatic brain injury as determined by abbreviated injury score in the Netherlands. Sci. Rep. 11(1), 19985. https:\/\/doi.org\/10.1038\/s41598-021-99484-6 (2021).","journal-title":"Sci. Rep."},{"issue":"9","key":"25809_CR5","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1016\/j.injury.2018.05.012","volume":"49","author":"D Jochems","year":"2018","unstructured":"Jochems, D., Leenen, L. P. H., Hietbrink, F., Houwert, R. M. & van Wessem, K. J. P. Increased reduction in exsanguination rates leaves brain injury as the only major cause of death in blunt trauma. Injury 49(9), 1661\u20131667 (2018).","journal-title":"Injury"},{"issue":"1","key":"25809_CR6","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s40621-022-00374-w","volume":"9","author":"NC Utheim","year":"2022","unstructured":"Utheim, N. C. et al. Epidemiology of traumatic cervical spinal fractures in a general Norwegian population. Inj. Epidemiol. 9(1), 10. https:\/\/doi.org\/10.1186\/s40621-022-00374-w (2022).","journal-title":"Inj. Epidemiol."},{"issue":"1","key":"25809_CR7","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s10143-018-0988-3","volume":"43","author":"MJ Pandrich","year":"2020","unstructured":"Pandrich, M. J. & Demetriades, A. K. Prevalence of concomitant traumatic cranio-spinal injury: A systematic review and meta-analysis. Neurosurg. Rev. 43(1), 69\u201377 (2020).","journal-title":"Neurosurg. Rev."},{"issue":"1","key":"25809_CR8","doi-asserted-by":"publisher","first-page":"2321","DOI":"10.4102\/sajr.v26i1.2321","volume":"26","author":"P Hlwatika","year":"2022","unstructured":"Hlwatika, P. & Hardcastle, T. C. Concurrent cranial and cervical spine injuries by associated injury mechanisms in traumatic brain injury patients. S. Afr. J. Radiol. 26(1), 2321. https:\/\/doi.org\/10.4102\/sajr.v26i1.2321 (2022).","journal-title":"S. Afr. J. Radiol."},{"key":"25809_CR9","doi-asserted-by":"publisher","unstructured":"Thesleff, T., Kataja, A., \u00d6hman, J. & Luoto, T. M. Head injuries and the risk of concurrent cervical spine fractures. Acta Neurochir. (Wien) 159(5), 907\u2013914. https:\/\/doi.org\/10.1007\/s00701-017-3133-0 (2017). Erratum in: Acta Neurochir. (Wien) 159(5), 915\u2013916 (2017).","DOI":"10.1007\/s00701-017-3133-0"},{"issue":"4","key":"25809_CR10","doi-asserted-by":"publisher","first-page":"252","DOI":"10.4103\/0974-2700.120365","volume":"6","author":"T Fujii","year":"2013","unstructured":"Fujii, T., Faul, M. & Sasser, S. Risk factors for cervical spine injury among patients with traumatic brain injury. J. Emerg. Trauma Shock 6(4), 252\u2013258 (2013).","journal-title":"J. Emerg. Trauma Shock"},{"issue":"1","key":"25809_CR11","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1080\/10790268.2017.1357105","volume":"42","author":"S Sikka","year":"2019","unstructured":"Sikka, S. et al. Inconsistencies with screening for traumatic brain injury in spinal cord injury across the continuum of care. J. Spinal Cord. Med. 42(1), 51\u201356 (2019).","journal-title":"J. Spinal Cord. Med."},{"issue":"7","key":"25809_CR12","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.3390\/jpm12071108","volume":"12","author":"AD Valbuena Valecillos","year":"2022","unstructured":"Valbuena Valecillos, A. D., Gater, D. R. & Alvarez, G. Concomitant brain injury and spinal cord injury management strategies: A narrative review. J. Pers. Med. 12(7), 1108. https:\/\/doi.org\/10.3390\/jpm12071108 (2022).","journal-title":"J. Pers. Med."},{"key":"25809_CR13","volume-title":"The Abbreviated Injury Scale-2005 Revision, Update 2008","author":"AAAM","year":"2008","unstructured":"AAAM. The Abbreviated Injury Scale-2005 Revision, Update 2008 (AAAM, 2008)."},{"issue":"11","key":"25809_CR14","doi-asserted-by":"publisher","first-page":"2677","DOI":"10.1007\/s00268-015-3162-x","volume":"39","author":"AC Gunning","year":"2015","unstructured":"Gunning, A. C. et al. Demographic patterns and outcomes of patients in level-1 trauma centers in three international trauma systems. World J. Surg. 39(11), 2677\u20132684 (2015).","journal-title":"World J. Surg."},{"issue":"3","key":"25809_CR15","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1097\/TA.0b013e31827a6e69","volume":"74","author":"DC Dewar","year":"2013","unstructured":"Dewar, D. C., Tarrant, S. M., King, K. L. & Balogh, Z. J. Changes in the epidemiology and prediction of multiple-organ failure after injury. J. Trauma Acute Care Surg. 74(3), 774\u2013779 (2013).","journal-title":"J. Trauma Acute Care Surg."},{"key":"25809_CR16","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1097\/TA.0000000000000406","volume":"77","author":"DC Dewar","year":"2014","unstructured":"Dewar, D. C. et al. Comparison of postinjury multiple-organ failure scoring systems: Denver versus sequential organ failure assessment. J. Trauma Acute Care Surg. 77, 624\u2013629 (2014).","journal-title":"J. Trauma Acute Care Surg."},{"issue":"5","key":"25809_CR17","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1097\/TA.0000000000000453","volume":"77","author":"HC Pape","year":"2014","unstructured":"Pape, H. C. et al. The definition of polytrauma revisited: An international consensus process and proposal of the new \u201cBerlin definition\u201d. J. Trauma Acute Care Surg. 77(5), 780\u2013786 (2014).","journal-title":"J. Trauma Acute Care Surg."},{"key":"25809_CR18","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1001\/archsurg.1994.01420250051006","volume":"129","author":"A Sauaia","year":"1994","unstructured":"Sauaia, A., Moore, F. A. & Moore, E. E. Early predictors of postinjury multiple organ failure. Arch. Surg. 129, 39\u201345 (1994).","journal-title":"Arch. Surg."},{"issue":"23","key":"25809_CR19","first-page":"2526","volume":"307","author":"VM Ranieri","year":"2012","unstructured":"Ranieri, V. M. et al. Acute respiratory distress syndrome: The Berlin definition. JAMA 307(23), 2526\u20132533 (2012).","journal-title":"JAMA"},{"key":"25809_CR20","volume-title":"International Standards for Neurological and Functional Classification of Spinal Cord Injury-Revised 2000","author":"American Spinal Injury Association\/International Medical Society of Paraplegia","year":"2002","unstructured":"American Spinal Injury Association\/International Medical Society of Paraplegia. International Standards for Neurological and Functional Classification of Spinal Cord Injury-Revised 2000 (ASIA, 2002)."},{"issue":"8","key":"25809_CR21","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1038\/sj.sc.3100878","volume":"37","author":"VS Prasad","year":"1999","unstructured":"Prasad, V. S., Schwartz, A., Bhutani, R., Sharkey, P. W. & Schwartz, M. L. Characteristics of injuries to the cervical spine and spinal cord in polytrauma patient population: Experience from a regional trauma unit. Spinal Cord. 37(8), 560\u2013568 (1999).","journal-title":"Spinal Cord."},{"issue":"5","key":"25809_CR22","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1007\/s00068-007-7124-3","volume":"33","author":"H Laurer","year":"2007","unstructured":"Laurer, H. et al. Distribution of spinal and associated injuries in multiple trauma patients. Eur. J. Trauma Emerg. Surg. 33(5), 476\u2013481 (2007).","journal-title":"Eur. J. Trauma Emerg. Surg."},{"issue":"1","key":"25809_CR23","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1007\/s00701-021-05029-1","volume":"164","author":"RK Hackenberg","year":"2022","unstructured":"Hackenberg, R. K. et al. Cervical spine injuries requiring surgery in a Level I trauma centre in a major German city. Acta Neurochir. (Wien) 164(1), 35\u201341 (2022).","journal-title":"Acta Neurochir. (Wien)"},{"issue":"4","key":"25809_CR24","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1016\/j.injury.2022.01.009","volume":"53","author":"M Niemeyer","year":"2022","unstructured":"Niemeyer, M. et al. Mortality in polytrauma patients with moderate to severe TBI on par with isolated TBI patients: TBI as last frontier in polytrauma patients. Injury 53(4), 1443\u20131448 (2022).","journal-title":"Injury"},{"key":"25809_CR25","doi-asserted-by":"publisher","DOI":"10.3171\/2018.10.SPINE1880","author":"M Khorasanizadeh","year":"2019","unstructured":"Khorasanizadeh, M. et al. Neurological recovery following traumatic spinal cord injury: A systematic review and meta-analysis. J. Neurosurg. Spine. https:\/\/doi.org\/10.3171\/2018.10.SPINE1880 (2019).","journal-title":"J. Neurosurg. Spine."},{"key":"25809_CR26","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/3769418","author":"D Jochems","year":"2018","unstructured":"Jochems, D. et al. Outcome in patients with isolated moderate to severe traumatic brain injury. Crit. Care Res. Pract. https:\/\/doi.org\/10.1155\/2018\/3769418 (2018).","journal-title":"Crit. Care Res. Pract."},{"issue":"4","key":"25809_CR27","doi-asserted-by":"publisher","first-page":"632","DOI":"10.3171\/2021.7.SPINE21537","volume":"36","author":"CY Adegeest","year":"2021","unstructured":"Adegeest, C. Y. et al. Influence of severity and level of injury on the occurrence of complications during the subacute and chronic stage of traumatic spinal cord injury: A systematic review. J. Neurosurg. Spine 36(4), 632\u2013652 (2021).","journal-title":"J. Neurosurg. Spine"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-25809-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-25809-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-25809-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T13:19:48Z","timestamp":1670937588000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-25809-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,13]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["25809"],"URL":"https:\/\/doi.org\/10.1038\/s41598-022-25809-8","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,13]]},"assertion":[{"value":"14 June 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 December 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 December 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"21538"}}