create the summary of the findings "Methods
In this cross-sectional study, we used the data of patients
(n = 986) with TSI admitted to Shahid Beheshti hospital of
KAUMS (from 2014 to 2017). The administrative dataset
of Shahid Beheshti hospital was used for this purpose.
Medical records of patients with spinal trauma were
Original Article
Volume 5, Issue 2, 2019, p. 65-70
Traumatic spine injury in Kashan, Iran
© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution
License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.
Esmaeil Fakharian1
, Zahra Sehat2*, Mojtaba Sehat2
1
Department of Neurosurgery, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
2
Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
Received: 13 April 2019
Accepted: 19 May 2019
Published online: 28 May 2019
*Corresponding author: Zahra
Sehat, Trauma Research Center,
Kashan University of Medical
Sciences, Ghotb-e-Ravandi Blvd.,
Kashan, Iran.
Email: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>
Competing interests: None.
Funding information: None.
Citation: Fakharian E, Sehat Z, Sehat
M. Traumatic spine injury in Kashan,
Iran. Journal of Emergency Practice
and Trauma 2019; 5(2): 65-70. doi:
10.15171/jept.2019.12.
Abstract
Objective: Traumatic spine injuries are seriously important and are associated with
considerable morbidity and mortality. The goal of this study is to determine the epidemiology
of the traumatic spine injuries in Shahid Beheshti Hospital of Kashan University of Medical
Sciences (KAUMS), the main trauma center in Kashan, Iran.
Methods: This cross-sectional study was undertaken on all cases of traumatic spinal injuries
that were admitted to Shahid Beheshti hospital of KAUMS from 2014 to 2017. A checklist was
used to collect demographic characteristics (age, gender, education, marital) and mechanism
of the injury of the spine. According to ICD-10, the level of the injury was detected by
diagnostic tests such as radiologic imaging and magnetic resonance imaging and computed
tomography scans, and also multi-trauma final outcome of the patients with traumatic
spine injury (TSI) and rate of the spinal cord injury (SCI), hospital length of stay and surgery
treatment was investigated.
Results: The number of patients with traumatic spine injuries was 986. Among this batch,
77% were males. The mean age of the patients was 39.5 years. Most injuries occurred in
the age group of 15 to 30 years. Traffic accident was the most common mechanism of the
trauma (35.2%) followed by the falls (26.95%) motorcycle accident (17.9%), assault by a sharp
object or an unspecified object (10.13%) and other reasons (5.6%). The most common site of
injury was in lumbar section (24.41%). Patients with traffic accident injury had the longest
hospitalization. The rate of SCI was 2.63% and the rate of mortality was 2.3%.
Conclusion: The TSI is an important and serious public health problem and a major cause
of disability. Understanding the epidemiology can help us contrive appropriate preventative
measures.
Keywords: Epidemiology, Iran, Kashan, Traumatic Spine Injury
Jept
Open Access http://jept.ir
Publish Free
doi 10.15171/jept.2019.12
Fakharian et al
66 Journal of Emergency Practice and Trauma, 2019, 5(2), 65-70
obtained from the Medical Records Department of the
hospital. All patients’ data remained confidential during
the study.
Shahid Beheshti hospital is a referral teaching hospital in
Kashan. Kashan is a city located in the central part of the
Islamic republic of Iran with a population of about 500 000
and is among the crowded cities of Iran (9). This hospital
is a trauma center which admits injured patients.
We used a checklist to gather data. The checklist included
demographic characteristics (age, gender, education,
marital) and mechanism of injury according to ICD-10.
In addition, it contained other information concerning
the level of injury detected by diagnostic tests (radiologic
imaging, magnetic resonance imaging and computed
tomography scans), multi-trauma, final outcome of
the patients with TSI, the rate of SCI, hospital length of
stay and surgery treatment. Regarding the reliability of
this checklist, we used Cronbach Alpha to estimate the
reliability (Cronbach alpha = 0.76). The statistical analysis
(chi-square in order to investigating the relationship
between variables) was conducted using SPSS software
version 19 (SPSS Inc., Illinois, USA). P<0.05 was
considered as the level of significance. All information
about patients remained confidential during the study
period.
Results
The total number of patients with TSI was 986 in which
77% of them were males (n = 759) and 23% were females
(n = 227). The mean age of patients was 39.05 (SD=0.58)
with a median of 35 years (the minimum age of patients
was 2 and the maximum age was 95). The most frequent of
these injuries occurred in the age group of 15 to 30 years
(P < 0. 004).
Most patients had the education level under diploma (n
= 621 (63%) and 16% of them had a university education
(n = 159). About 33% of patients with TSI were married
(n = 325). Table 1 shows the categorization of age among
patients. For analysis of this data, we used chi-square
test. In occupational survey dealing with job of patients
with TSI, most patients were workers (27.35%, n = 270),
unemployed (25.53%, n=252), housewives (16.21%, n =
160) or students (17.73%, n = 175). Others had another
job or their jobs were not specified. The majority of
traumatic spine injuries happened in spring and summer.
Also, 76.9% of all injury been have happened between
Late spring until the end of September (P<0. 001).
The mechanisms of injuries are described as follows:
car occupant injured in a traffic accident was the most
common mechanism of trauma (35.2%, n = 349), followed
by the falls accident (26.95%, n = 266), motorcycle rider
injured in a traffic accident (17.9%, n = 177), assault
by a sharp object or an unspecified object (10.13%, n
= 100), and other reasons (5.6%, n = 50). (P=0.075).
The mechanisms of injuries in different age groups are
presented in Table 2.
Among patients with TSI (n=987), 30.49 % (n = 301) of
them had multi-trauma and head injuries were the most
common (5.34%; n=53). This type of injury was the
most frequent among other traumatic injuries leading to
hospitalization.
Traumatic spine injuries are categorized into four
anatomic regions including cervical, thoracic, lumbar and
thoracolumbar. As depicted in Table 3, in our study the
most common injury occurred in lumbar section (24.41%;
n = 241). Patients whit Traumatic spine injuries mostly
involved of fracture of lumbar vertebra 23.7% (n = 234)
of total patients studied and 174 cases involved Cervical
section injury (17.62%). In addition, 21.27% (n = 210) of
cases had thoracic vertebra fracture. Sixty-one patients
with TSI had thoracolumbar spine injury (6.18%). Besides,
Table 1. Categorization of age based on sex
Age-group
Sex Total (%) Man Woman
1-5 9 3 12 (1.21)
5-15 36 14 55 (5.58)
15-30 277 24 301 (30.1)
30-45 204 54 258 (25.2)
45-60 143 34 177 (17.3)
60-75 61 30 91 (9.84)
75-95 26 22 48 (4.7)
Total 759 227 986
P < 0. 004.
Table 2. Mechanisms of injuries in age groups
Mechanism Total Car accident Fall Motorcycle Assault Other
Age group
1-5 7 4 0 0 1 12
5-15 23 16 7 2 7 55
15-30 87 46 86 67 15 301
30-45 123 78 40 12 5 258
45-60 65 60 32 12 8 177
60-75 27 39 9 7 9 91
75-95 17 23 3 0 5 48
Total 349 266 177 100 50 987
Percent 35.3% 26.95% 17.9% 10.13% 5.06% 100.0%
P = 0. 075.
Fakharian et al
Journal of Emergency Practice and Trauma, 2019, 5(2), 65-70 67
53.9% of thoracolumbar spine fractures occurred due to
fall and 47.3% occurred due to RTC.
In the current study, the rate of SCI was 2.63% (n = 26)
in which 7 cases had thoracic spinal cord, 16 cases had
cervical spinal cord and 3 cases had thoracolumbar SCI.
Seventeen cases of spinal cord injuries were due to road
traffic accident (RTA) and 4 cases were due to falls and 3
cases result of other mechanisms.
The hospital length of stay for all patients with TSI in
this study was different and dependent upon age, sex,
mechanism and type of injury. Surgery operation had
a significant role for hospital length of stay (P = 0.01).
However, the median duration of hospital stay for all
patients was 4 days (mean = 5.7, minimum = 1 and
maximum = 157).
Patients with traffic accident injury had the longest
hospitalization and the second cause of hospital stay was
related to injury due to fall and assault. Table 4 shows the
duration of hospital stay for different mechanisms of TSI.
Of all patients (n=987), 97.7% (n = 964) survived but
2.3% (n = 23) died in hospital and two patients passed
away later. Patients who sustained spine injury as a result
of car accident had a significantly higher rate of death
than those who were injured due to falling (1.5% vs 0.5%,
P = 0.04) (Table 5).
Among the patients hospitalized due to TSI for more than
24 hours, 424 patients underwent surgery and their injury
was owing to traffic accidents (128). The most common
methods of surgery for these patients are shown in Table 6."