EPIDEMIOLOGIA DAS FRATURAS VERTEBRAIS AVALIADAS NO IOT-FMUSP DE 2019 A 2022

GABANA, EDELVAN; FREITAS, MATHEUS TRINDADE BRUXELAS DE; MARCON, RAPHAEL MARTUS; CRISTANTE, ALEXANDRE FOGAçA; BARROS FILHO, TARCíSIO ELOY PESSOA DE

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ORIGINAL ARTICLE: Trauma • Coluna/Columna 22 (4) • 2023 • https://doi.org/10.1590/S1808-185120222204273511 copiar

EPIDEMIOLOGIA DAS FRATURAS VERTEBRAIS AVALIADAS NO IOT-FMUSP DE 2019 A 2022

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivos:

Determinar o perfil epidemiológico dos pacientes com fraturas na coluna vertebral encaminhados para avaliação pelo Grupo de Coluna do IOT-HCFMUSP entre 2019 e 2022. Avaliar o efeito da Pandemia de Covid-19 sobre esse perfil epidemiológico.

Métodos:

Foram analisados retrospectivamente os prontuários dos pacientes com fratura na coluna encaminhados pela Central de Regulação de Ofertas e Serviços de Saúde (CROSS) de São Paulo ao Grupo de Coluna do IOT-HCFMUSP entre os anos de 2019 e 2022. Foi comparado o perfil epidemiológico entre o período pré-pandemia Covid-19 e o período de pandemia Covid-19 até dezembro de 2022 na cidade de São Paulo.

Resultados:

Analisou-se o prontuário médico de 427 pacientes entre março de 2019 e dezembro de 2022. No período o sexo masculino correspondeu a 71,9% dos casos, a média da idade foi de 46,7 anos. Queda de altura foi o mecanismo de trauma mais frequente (63,7%), seguido de acidentes de motocicleta (14,3%). A ausência de déficit neurológico ocorreu em 76,8% dos casos, bem como a região mais lesada foi a lombar (39,3%). Houveram mudanças no perfil epidemiológico durante a pandemia de Covid 19 em relação à pré-pandemia. Conclusões: Observado predomínio do sexo masculino de meia idade, além do mecanismo de trauma de queda de altura, bem como ausência de déficit neurológico a avaliação inicial. A região lombar e cervical foram os locais mais frequentes de lesão. O período pandêmico interferiu no perfil epidemiológico apresentado e nos intervalos de tempo entre a lesão e a avaliação no IOT-HCFMUSP. Nível de Evidência IV; Série de Casos.

Descritores:
Traumatismos da Coluna Vertebral; Traumas Medulares; Epidemiologia; Fraturas da Coluna Vertebral; COVID-19; Pandemia por COVID-19

Characteristics	n = 427	n (%)
Sex	Male	307 (71.9)
Sex	Female	120 (28.1)
Age (Years)	Mean(SD)		46.7 (18.4)
	Median (P25-P75)		47 (32-60)
	Minimum and Maximum		9-95
Mechanism of trauma	Falls from heights	272 (63.7)
	Motorcycle accidents	61 (14.3)
	Car accidents	38 (8.9)
	Bicycle accidents	9 (2.1)
	Firearm injuries	9 (2.1)
	Shallow water diving	9 (2.1)
	Pedestrian accidents	14 (3.3)
	Direct trauma	15 (3.5)
Region injured	Lumbar	168 (39.3)
	Cervical	159 (37.2)
	Thoracic	70 (16.4)
	Cervical and Thoracic	14 (3.3)
	Thoracic and Lumbar	13 (3.0)
	Sacral	2 (0.5)
	Cervical, Thoracic, and lumbar	1 (0.2)
Neurological deficits	No	328 (76.8)
Neurological deficits	Present	99 (23.2)
Frankel score	A	23 (5.4)
	B	6 (1.4)
	C	24 (5.6)
	D	47 (11.0)
	E	327 (76.6)
Treatment instituted	Conservatively	295 (69.1)
Treatment instituted	Surgically	132 (30.9)
Time interval between injury and admission to IOT-HCFMUSP (days)	Mean(SD)		29.8 (31.2)
	Median (P25-P75)		20 (10-40)
	Minimum and Maximum		0-300
Time interval between admission and surgery (days)	Mean(SD)		8.0 (6.6)
	Median (P25-P75)		6 (4-9)
	Minimum and Maximum		1-44

Characteristics	n = 427	Pre-pandemic n = 121, n (%)	Pandemic n = 306, n (%)	p Value
Sex	Male	87 (71.9)	220 (71.9)	0.999¹ 1 Pearson’s chi-squared test;
Sex	Female	34 (28.1)	86 (28.1)	0.999¹ 1 Pearson’s chi-squared test;
Age (Years)	Mean(SD)	45.0 (19.9)	47.4 (17.7)	0.158³ 3 The Mann-Whitney test.
Age (Years)	Median (P25-P75)	45 (29-61)	48 (34-60)	0.158³ 3 The Mann-Whitney test.
Mechanism of trauma	Falls from heights	73 (60.3)	199 (65.0)	0.009² 2 Fisher’s exact test;
	Motorcycle accidents	25 (20.7)	36 (11.8)
	Car accidents	6 (5.0)	32 (10.5)
	Bicycle accidents	0	9 (2.9)
	Firearm injuries	6 (5.0)	3 (1.0)
	Shallow water diving	2 (1.7)	7 (2.3)
	Pedestrian accidents	5 (4.1)	9 (2.9)
	Direct trauma	4 (3.3)	11 (3.6)
Region injured	Lumbar	48 (39.7)	120 (39.2)	0.261² 2 Fisher’s exact test;
	Cervical	40 (33.1)	119 (38.9)
	Thoracic	19 (15.7)	51 (16.7)
	Cervical and Thoracic	7 (5.8)	7 (2.3)
	Thoracic and Lumbar	6 (5.0)	7 (2.3)
	Sacral	1 (0.8)	1 (0.3)
	Cervical, Thoracic, and lumbar	0	1 (0.3)
Neurological deficits	No	92 (76.0)	236 (77.1)	0.810¹ 1 Pearson’s chi-squared test;
Neurological deficits	Present	39 (24.0)	70 (22.9)	0.810¹ 1 Pearson’s chi-squared test;
Frankel score	A	10 (8.3)	13 (4.2)	0.149¹ 1 Pearson’s chi-squared test;
	B	1 (0.8)	5 (1.6)
	C	3 (2.5)	21 (6.9)
	D	16 (13.2)	31 (10.1)
	E	91 (75.2)	236 (77.1)
Treatment instituted	Conservatively	90 (74.4)	205 (67.0)	0.137¹ 1 Pearson’s chi-squared test;
Treatment instituted	Surgically	31 (25.6)	101 (33.0)	0.137¹ 1 Pearson’s chi-squared test;
Time interval between injury and admission to IOT-HCFMUSP (days)	Mean(SD)	40.5 (37.3)	25.5 (27.4)	<0.001³ 3 The Mann-Whitney test.
	Median (P25-P75)	35 (18-51)	17 (9-30)	<0.001³ 3 The Mann-Whitney test.
Time interval between admission and surgery (days)	Mean(SD)	8.3 (4.8)	7.9 (7.0)	0.182³ 3 The Mann-Whitney test.
Time interval between admission and surgery (days)	Median (P25-P75)	7 (5-10)	6 (4-9)	0.182³ 3 The Mann-Whitney test.

Characteristics	n = 429	Pre-pandemic n = 121, n (%)	Pandemic 1 n= 84, n (%)	Pandemic 2 n = 222, n (%)	p Value
Sex	Male	87 (71.9)	67 (79.8)	153 (68.9)	0.170¹ 1 Pearson’s chi-squared test;
Sex	Female	34 (28.1)	17 (20.2)	69 (31.1)	0.170¹ 1 Pearson’s chi-squared test;
Age (Years)	Mean(SD)	45.0 (19.9)	45.0 (17.9)	48.3 (17.5)	0.133³ 3 The Kruskal-Wallis test
Age (Years)	Median (P25-P75)	45 (29-61)	45 (28-59)	48 (35-60)	0.133³ 3 The Kruskal-Wallis test
Mechanism of trauma	Falls from heights	73 (60.3)	50 (58.8)	149 (67.1)	0.007² 2 Fisher’s exact test;
	Motorcycle accidents	25 (20.7)	14 (16.7)	22 (9.9)
	Car accidents	6 (5.0)	8 (9.5)	24 (10.8)
	Bicycle accidents	0	1 (1.2)	8 (3.6)
	Firearm injuries	6 (5.0)	1 (1.2)	2 (0.9)
	Shallow water diving	2 (1.7)	5 (6.0)	2 (0.9)
	Pedestrian accidents	5 (4.1)	2 (2.4)	7 (3.2)
	Direct trauma	4 (3.3)	3 (3.6)	8 (3.6)
Region injured	Lumbar	48 (39.7)	31 (36.9)	89 (40.1)	0.636² 2 Fisher’s exact test;
	Cervical	40 (33.1)	36 (42.9)	83 (37.4)
	Thoracic	19 (15.7)	13 (15.5)	38 (17.1)
	Cervical and Thoracic	7 (5.8)	1 (1.2)	6 (2.7)
	Thoracic and Lumbar	6 (5.0)	3 (3.6)	4 (1.8)
	Sacral	1 (0.8)	0	1 (0.5)
	Cervical, Thoracic, and lumbar	0	0	1 (0.5)
Neurological deficits	No	92 (76.0)	64 (76.2)	172 (77.5)	0.944¹ 1 Pearson’s chi-squared test;
Neurological deficits	Present	39 (24.0)	20 (23.8)	50 (22.5)	0.944¹ 1 Pearson’s chi-squared test;
Frankel score	A	10 (8.3)	4 (4.8)	9 (4.1)	0.067² 2 Fisher’s exact test;
	B	1 (0.8)	4 (4.8)	1 (0.5)
	C	3 (2.5)	6 (7.1)	15 (6.8)
	D	16 (13.2)	6 (7.1)	25 (11.3)
	E	91 (75.2)	64 (76.2)	172 (77.5)
Treatment instituted	Conservatively	90 (74.4)	50 (59.5)	155 (69.8)	0.073¹ 1 Pearson’s chi-squared test;
Treatment instituted	Surgically	31 (25.6)	34 (40.5)	67 (30.2)	0.073¹ 1 Pearson’s chi-squared test;
Time interval between injury and admission to IOT-HCFMUSP (days)	Mean(SD)	40.5 (37.3)	19.0 (21.0)	28.0 (29.1)	<0.001³ 3 The Kruskal-Wallis test
	Median (P25-P75)	35 (18-51)	12 (6-23)	18 (11-32)	<0.001³ 3 The Kruskal-Wallis test
Time interval between admission and surgery (days)	Mean(SD)	8.3 (4.8)	6.7 (6.3)	8.5 (7.4)	0.094³ 3 The Kruskal-Wallis test
Time interval between admission and surgery (days)	Median (P25-P75)	7 (5-10)	5 (4-7)	6 (4-9)	0.094³ 3 The Kruskal-Wallis test

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[1] Reviewed by: Murilo Daher