The incidence and impact of 'Tandem Neurotrauma'

Xiaoyu Yang; Benjamin M Davies; Jonathan P Coles; David K Menon; Daniel J Stubbs; Aref-Ali Gharooni; Wunna Aung; Michelle L Starkey; Douglas Hay; Fahim Anwar; Ivan S Timofeev; Adel Helmy; Virginia F J Newcombe; Mark R N Kotter; Peter J A Hutchinson

doi:10.1016/j.bas.2023.102702

The incidence and impact of 'Tandem Neurotrauma'

Brain Spine. 2023 Oct 21:3:102702. doi: 10.1016/j.bas.2023.102702. eCollection 2023.

Authors

Xiaoyu Yang^{1

2}, Benjamin M Davies¹, Jonathan P Coles³, David K Menon³, Daniel J Stubbs³, Aref-Ali Gharooni¹, Wunna Aung⁴, Michelle L Starkey¹, Douglas Hay¹, Fahim Anwar⁵, Ivan S Timofeev¹, Adel Helmy¹, Virginia F J Newcombe³, Mark R N Kotter^{1

6}, Peter J A Hutchinson¹

Affiliations

¹ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
² Department of Neurosurgery, Leiden University Medical Centre, Leiden, the Netherlands.
³ Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
⁴ The Golden Jubilee Spinal Cord Injury Centre, James Cook University Hospital, Middlesbrough, United Kingdom.
⁵ Department of Rehabilitation Medicine, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom.
⁶ Anne McLaren Laboratory for Regenerative Medicine, Welcome Trust MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom.

Abstract

Introduction: The epidemiology and prognosis of the isolated traumatic brain injury (TBI) and spinal cord injury (SCI) are well studied. However, the knowledge of the impact of concurrent neurotrauma is very limited.

Research questions: To characterize the longitudinal incidence of concurrent TBI and SCI and to investigate their combined impact on clinical care and outcomes, compared to a comparative but isolated SCI or TBI.

Materials and methods: Data from 167,793 patients in the Trauma Audit and Research Network (TARN) registry collected in England and Wales between 2008 and 2018 were analysed. Tandem neurotrauma was defined as patients with concurrent TBI and SCI. The patient with isolated TBI or SCI was matched to the patient with tandem neurotrauma using propensity scores.

Results: The incidence of tandem neurotrauma increased tenfold between 2008 and 2018, from 0.21 to 2.21 per 100,000 person-years. Patients in the tandem neurotrauma group were more likely to require multiple surgeries, ICU admission, longer ICU and hospital LOS, higher 30-day mortality, and were more likely to be transferred to acute hospitals and rehabilitation or suffer death at discharge, compared to patients with isolated TBI. Likewise, individuals with tandem neurotrauma compared to those with isolated SCI had a higher tendency to receive more than one surgery, ICU admission, longer LOS for ICU and higher mortality either at 30-day follow-up or at discharge.

Discussion and conclusions: The incidence of tandem neurotrauma has increased steadily during the past decade. Its occurrence leads to greater mortality and care requirements, particularly when compared to TBI alone. Further investigations are warranted to improve outcomes in tandem neurotrauma.

Keywords: Incidence; Mortality; Neurotrauma; Rehabilitation; Spinal cord injury; Traumatic brain injury.