Effect of multiple trauma on mortality and neurological recovery after spinal cord or cauda equina injury.

We conducted a retrospective study in which we related the outcome of spinal cord injury to the presence of serious accompanying injuries. From 1974 through 1979, 144 patients with spinal cord trauma were admitted to the Acute Spinal Cord Injury Unit of Sunnybrook Medical Centre, 27 (19%) of whom had other major injuries of Grade 3 or higher according to the Abbreviated Injury Scale. These additional injuries included, among others, cerebral contusion, hemothorax, major intra abdominal bleeding, and femoral fracture. These 27 patients (Group 1) were compared to the 117 patients (Group 2) who had only spinal cord injuries. The two groups were similar in age and sex distribution. The incidence of hypotension on admission was higher in Group 1 (59%) than in Group 2 (7%) (p<0.001). In Group 1, 74% had either complete cord injury or incomplete injury with severe paresis, whereas only 58% of Group 2 had injuries of this magnitude. This difference was even more pronounced at discharge, when 78% of Group 1 were in the complete or severe injury categories, as compared with 52% in Group 2 (p<0.02). The Sunnybrook Cord Injury Recovery Index from admission to discharge was 1.9% in Group 1 and 19.8% in Group 2 (p<0.01), indicating that Group 2 patients had much better recovery. Mortality during hospitalization was 19% in Group 1 and 4% in Group 2 (p<0.01). Our results indicate that patients with spinal cord injury accompanied by other major injuries had more severe initial neurological deficits, poorer neurological recovery, and a higher mortality rate than those with cord injury alone. The higher incidence of hypotension in Group 1 may have played a signifi cant role in the less favorable neurological outcome.