Subaxial cervical spine injury classification system: is it most appropriate for classifying cervical injury?

The cervical spine injury represents a potential devastating disease with 6% associated in-hospital mortality （lain et al., 2015）. Neurological deterioration ranging from complete spinal cord injury （SCI） to incomplete SCI or single radiculopathy are potential consequences of the blunt trauma over this region. The subaxial cervical spine accounts the vast majority of cervical injuries, making up two thirds of all cervical fractures （Alday, 1996）. Few classifications （Holdsworth, 1970; White et al., 1975; Mien et al., 1982; Denis, 1984; Vaccaro et al., 2007） have been proposed to describe injuries of the cervical spine for several reasons. First, to delineate the best treatment in each case; second, to determinate an accurate neurological prognosis, and third, to establish a standard way to communicate and describe specific characteristics of cervical injuries patterns. Classical systems are primarily descriptive and no single system has gained widespread use, largely because of restrictions in clinical relevance and its complexity.

Reliability and validity of sub-axial injury classification in clinical application

Objective To evaluate the clinical reliability and validity of the sub-axial injury classification (SLIC) system proposed by the Spine Trauma Study Group (STSG) in 2007. Methods Thirty cases of cervical injury were randomly chosen

Orchard Sports Injury and Illness Classification System (OSIICS) Version 15

Background:Sports medicine(injury and illnesses)requires distinct coding systems because the International Classification of Diseases is insuf-ficient for sports medicine coding.The Orchard Sports Injury and Illness Classification System(OSIICS)is one of two sports medicine coding systems recommended by the International Olympic Committee.Regular updates of coding systems are required.Methods:For Version 15,updates for mental health conditions in athletes,sports cardiology,concussion sub-types,infectious diseases,and skin and eye conditions were considered particularly important.Results:Recommended codes were added from a recent International Olympic Committee consensus statement on mental health conditions in athletes.Two landmark sports cardiology papers were used to update a more comprehensive list of sports cardiology codes.Rugby union protocols on head injury assessment were used to create additional concussion codes.Conclusion:It is planned that OSIICS Version 15 will be translated into multiple new languages in a timely fashion to facilitate international accessibility.The large number of recently published sport-specific and discipline-specific consensus statements on athlete surveillance warrant regular updating of OSIICS.

Assessment of load-sharing thoracolumbar injury: A modified scoring system

BACKGROUND Many classification systems of thoracolumbar spinal fractures have been proposed to enhance treatment protocols,but none have achieved universal adoption.AIM To develop a new patient scoring system for cases with thoracolumbar injury classification and severity score(TLICS)=4,namely the load-sharing thoracolumbar injury score(LSTLIS).METHODS Based on thoracolumbar injury classification and severity score,this study proposes the use of the established load-sharing classification(LSC)to develop an improved classification system(LSTLIS).To prove the reliability and reproducibility of LSTLIS,a retrospective analysis for patients with thoracolumbar vertebral fractures has been conducted.RESULTS A total of 102 cases were enrolled in the study.The scoring trend of LSTLIS is roughly similar as the LSC scoring,however,the average deviation based on the former method is relatively smaller than that of the latter.Thus,the robustness of the LSTLIS scoring method is better than that of LSC.LSTLIS can further classify patients with TLICS=4,so as to assess more accurately this particular circumstance,and the majority of LSTLIS recommendations are consistent with actual clinical decisions.LSTLIS is a scoring system that combines LSC and TLICS to compensate for the lack of appropriate inclusion of anterior and middle column compression fractures with TLICS.Following preliminary clinical verification,LSTLIS has greater feasibility and reliability value,is more practical in comprehensively assessing certain clinical circumstances,and has better accuracy with clinically significant guidelines.

New classification of acute bile duct injuries

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Selection of Surgical Approach and Clinical Significance of Lower Cervical Spine Injuries Guided by SLIC Scoring System

Objective: To explore the feasibility and clinical significance of surgical approach selection for cervical spine injury guided by SLIC scoring system. Methods: The clinical data of 75 patients with lower cervical injury surgery from January 2020 to November 2022 were retrospectively analyzed, including 48 males and 27 females. Age: 28 - 65 years old. Causes of injury: 39 cases of traffic accidents, 15 cases of ice and snow sports, 12 cases of falling from high places, 9 cases of heavy objects. There were 12 cases of C3-4, 33 cases of C4-5, 21 cases of C5-6, and 9 cases of C6-7. Time from injury to medical treatment: 4 h - 2 d. Cervical spine X-ray, MRI, MDCT examination and preoperative SLIC score were performed on admission. Anterior approach was performed by subtotal cervical vertebrae resection or discectomy, titanium Cage or cage supported bone grafting and anterior titanium plate fixation. Posterior approach was performed with cervical laminoplasty, lateral mass or pedicle screw fixation and fusion. The combined anterior-posterior operation was performed by the anterior methods+ posterior methods. The time from injury to surgery is 12 h to 3 d. The function before and after operation was evaluated by JOA efficacy evaluation criteria. The correlation between the three surgical approaches and postoperative efficacy and SLIC score was compared. SPSS 22.0 software was used for statistical analysis of the data. Results: In this group of 75 patients, 32 cases of anterior operation, 22 cases of posterior operation and 21 cases of combined operation were followed up for no less than 12 months. There was no significant difference in age, gender, injury cause, injury segment, time from injury to treatment, and time from injury to operation among the three surgical approaches, which were comparable. The SLIC scores of mild, moderate and severe injuries of anterior surgery, posterior surgery and combined anterior and posterior surgery, They were (5.26 ± 1.24, 5.86 ± 1.67, 8.25 ± 0.21), (5.57 ± 1.43, 5.99 ± 1.85, 9.00 ± 0.25), (0, 5.98 ± 0.33, 9.44 ± 0.34), respectively. By comparing the SLIC scores and JOA scores of anterior surgery and posterior surgery, there was no difference in SLIC scores and JOA scores between the two groups for mild and moderate injuries (P > 0.05). However, the JOA scores at 3 months, 6 months and 12 months after surgery were different from those before surgery, and the postoperative efficacy and JOA scores were significantly improved (P & lt;0.05), indicating that the two surgical methods had the same therapeutic effect, that is, anterior or posterior surgery could be used to treat mild or moderate injuries (P > 0.05). There were differences in SLIC scores among the three surgical approaches for severe injury (P 0.05). The postoperative efficacy and JOA score of combined anterior-posterior approach were significantly improved compared with those before operation (P Conclusion: SLIC score not only provides accurate judgment for conservative treatment or surgical treatment of cervical spine injury, but also provides evidence-based medical basis and reference value for the selection of surgical approach and surgical method. According to the SLIC score, the surgical approach is safe and feasible. When the SLIC score is 4 - 7, anterior surgery is selected for type A injury, and posterior surgery is selected for type B injury. When the SLIC score is ≥8, combined anterior-posterior surgery should be selected. It is of great significance for clinical formulation of precision treatment strategy.

Definition and Classification of Acute Kidney Injury:Contributions and Problems in the Clinical Practice

Definition and Classification of Acute Kidney Injury Before the RIFLE classification system of acute renal failure（ARF） was proposed in the Second Conference of Acute Dialysis Quality Initiative （ADQI,an international volunteer organization mainly composed of intensivists and nephrologists in developed countries） in 2002, there were more than 35 diagnostic criteria of ARF in different literatures, which led to confusion in clinical practice and epidemiological investigation.

Prognostic factors and its predictive value in patients with metastatic spinal cancer

BACKGROUND The spine is the most common location of metastatic diseases.Treating a metastatic spinal tumor depends on many factors,including patients’overall health and life expectancy.The present study was conducted to investigate prognostic factors and clinical outcomes in patients with vertebral metastases.AIM To investigate prognostic factors and their predictive value in patients with metastatic spinal cancer.METHODS A retrospective analysis of 109 patients with metastatic spinal cancer was conducted between January 2015 and September 2017.The prognoses and survival were analyzed,and the effects of factors such as clinical features,treatment methods,primary lesions and affected spinal segments on the prognosis of patients with metastatic spinal cancer were discussed.The prognostic value of Frankel spinal cord injury functional classification scale,metastatic spinal cord compression(MSCC),spinal instability neoplastic score(SINS)and the revised Tokuhashi score for prediction of prognosis was explored in patients with metastatic spinal tumors.RESULTS Age,comorbidity of metastasis from elsewhere,treatment methods,the number of spinal tumors,patient’s attitude toward tumors and Karnofsky performance scale score have an effect on the prognosis of patients(all P<0.05).With respect to classification of spinal cord injury,before operation,the proportion of grade B and grade C was higher in the group of patients who died than in the group of patients who survived,and that of grade D and grade E was lower in the group of patients who died than in the group of patients who survived(all P<0.05).At 1 mo after operation,the proportion of grade A,B and C was higher in the group of patients who died than in the group of patients who survived,and that of grade E was lower in patients in the group of patients who died than in the group of patients who survived(all P<0.05).MSCC occurred in four(14.3%)patients in the survival group and 17(21.0%)patients in the death group(P<0.05).All patients suffered from intractable pain,dysfunction in spinal cord and even paralysis.The proportion of SINS score of 1 to 6 points was lower in the death group than in the survival group,and the proportion of SINS score of 7 to 12 points was higher in the death group than in the survival group(all P<0.05).The proportion of revised Tokuhashi score of 0 to 8 points and 9 to 11 points were higher in the death group than in the survival group,and the proportion of revised Tokuhashi score of 12 to 15 points was lower in the death group than in the survival group(all P<0.05).Frankel spinal cord injury functional classification scale,MSCC,SINS and revised Tokuhashi score were important factors influencing the surgical treatment of patients with metastatic spinal cancer(all P<0.05).CONCLUSION Frankel spinal cord injury functional classification scale,MSCC,SINS and revised Tokuhashi score were helpful in predicting the prognosis of patients with metastatic spinal cancer.

Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity?

Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe（moderate and severe） carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.

Impact of hospital type on risk-adjusted,traffic-related 30-day mortality:a population-based registry study

Background:Traffic incidents are still a major contributor to hospital admissions and trauma-related mortality.The aim of this nationwide study was to examine risk-adjusted traffic injury mortality to determine whether hospital type was an independent survival factor.Methods:Data on all patients admitted to Swedish hospitals with traffic-related injuries,based on International Classification of Diseases codes,between 2001 and 2011 were extracted from the Swedish inpatient and cause of death registries.Using the binary outcome measure of death or survival,data were analysed using logistic regression,adjusting for age,sex,comorbidity,severity of injury and hospital type.The severity of injury was established using the International Classification of Diseases Injury Severity Score(ICISS).Results:The final study population consisted of 152,693 hospital admissions.Young individuals(0–25 years of age)were overrepresented,accounting for 41%of traffic-related injuries.Men were overrepresented in all age categories.Fatalities at university hospitals had the lowest mean(SD)ICISS 0.68(0.19).Regional and county hospitals had mean ICISS 0.75(0.15)and 0.77(0.15),respectively,for fatal traffic incidents.The crude overall mortality in the study population was 1193,with a mean ICISS 0.72(0.17).Fatalities at university hospitals had the lowest mean ICISS 0.68(0.19).Regional and county hospitals had mean ICISS 0.75(0.15)and 0.77(0.15),respectively,for fatal traffic incidents.When regional and county hospitals were merged into one group and its risk-adjusted mortality compared with university hospitals,no significant difference was found.A comparison between hospital groups with the most severely injured patients(ICISS0.85)also did not show a significant difference(odds ratio,1.13;95%confidence interval,0.97–1.32).Conclusions:This study shows that,in Sweden,the type of hospital does not influence risk adjusted traffic related mortality,where the most severely injured patients are transported to the university hospitals and centralization of treatment is common.