Epidemiology Of Brachial Plexus Injuries In A Multi-Trauma Population: A 10 Year Retrospective Analysis Of A Single Level I Trauma Center
Adnan Prsic, MD; David C Ludwig, DMD; Shane D Morrison, MD; Dennis Kao, MD; Grant O'Keefe, MD
University of Washington, Seattle, WA
The incidence and severity of traumatic brachial plexus injuries (BPI) in the US population is unknown. Canadian data estimates the incidence of traumatic BPI at 1.2% for all patients admitted to a regional trauma facility. The goals for our study were to determine the incidence and the associated injury patterns of traumatic BPI in the US.
Our institution's Level I Medical Center Trauma Registry was queried using the ICD-9/10 code for "injury of brachial plexus". Traumatic cases of BPI from 2005 to 2016 were identified. Patient demographics, survival data, hospital stay, ICU stay as well as injury severity score (ISS) were recorded. Demographic data analysis and correlation of ISS with demographic variables were calculated with significance set at p<0.05.
One hundred fifty-nine subjects presented with brachial plexus injuries during this timeframe, representing 0.26% of all traumatic injuries. Most (82%) were male and the mean age was 34.615.2 years. Most (77%) identified as "White" while 13% identified as "Hispanic" and 5% "Black".
Medicare/Medicaid, private/commercial insurance, and self-pay constituted 30%, 29% and 20% of subjects, respectively. Motorcycle collision (31%), motor vehicle collision (23%), and firearm injuries (13%) were the most common injury mechanisms. Most injuries were blunt trauma (82%). 98 subjects (62%) had ISS between 1 and 26, 51 subjects (32%) had scores between 27 and 47, and 10 subjects (6%) had scores between 48-75. Some (21%) were positive for alcohol while 19% had positive toxicology results. Most (62%) required ICU admission with an average ICU stay of 4.9 days. Overall average hospital stay was 13.6 days. Only 13% were discharged to a rehab facility and two subjects died.
BPI related to motor vehicle collision (MVC) had the highest ISS (3015.0) while those who had a fall had the lowest scores (17.312.4) (p=0.03). Those with blunt trauma had higher ISS than those with penetrating trauma (29.013.3 vs 22.813.1, respectively) (p=0.03). Amongst those with brachial plexus injuries, those who also had abdominal injuries had the highest ISS (36.913.5) while those with external/burns/other trauma had the lowest scores (24.612.9).
Our study represents the first large scale retrospective BPI review of a US based Level I trauma center, illustrating these injuries are rare, but more severe when associated with MVC. Future studies will focus on the review of ISS and abbreviated injury scale (AIS) in recovery of BPI and the creation of a treatment algorithm for those with brachial plexus injuries.
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