Development of a Novel Risk Stratification Score to Predict 30-Day Mortality in Cervical Trauma Patients: CLAAD Score

Miguel A Cartagena-Reyes; Eric Solomon; Juan Silva Aponte; Aditya Joshi; Micheal Raad; Hamid Hassanzadeh; Amit Jain

doi:10.1097/BSD.0000000000001596

Development of a Novel Risk Stratification Score to Predict 30-Day Mortality in Cervical Trauma Patients: CLAAD Score

Clin Spine Surg. 2024 Mar 11. doi: 10.1097/BSD.0000000000001596. Online ahead of print.

Authors

Miguel A Cartagena-Reyes¹, Eric Solomon, Juan Silva Aponte, Aditya Joshi, Micheal Raad, Hamid Hassanzadeh, Amit Jain

Affiliation

¹ Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.

PMID: 38490969
DOI: 10.1097/BSD.0000000000001596

Abstract

Study design: Case control.

Objective: Traumatic cervical spine injuries are associated with a substantial risk of mortality. The aim of this study is to develop a novel mortality prediction model for patients with cervical trauma who require operative treatment.

Summary of background data: Patients with cervical spine trauma have a high risk of postoperative complications and mortality. There are few reliable systems that can accurately predict mortality after surgery for cervical spine trauma, and those that do exist are typically not specific to cervical trauma.

Materials and methods: The National Surgical Quality Improvement Program (NSQIP) database was used to identify patients undergoing surgery for cervical spine trauma. Univariate analyses were performed to identify variables associated with mortality. Variables that were found to be significant in the univariate models were compiled into a multivariable model. The final model was compared with the American Society of Anesthesiologists (ASA), a modified Charlson comorbidity index (mCCI), and the 5-factor modified frailty index (mFI-5) in respect to predicting 30-day mortality after cervical trauma. The score was then externally validated using the Nationwide Inpatient Sample (NIS) database.

Results: Fifty-five (6.7%) of 822 patients did not survive 30 days after surgery. The final multivariable logistic regression model consisted of the following variables: circumferential fusion "C." long "L" fusion (more than 4 levels), anemia "A," age over 60 "A," and dialysis "D." The risk of mortality increased with increasing CLAAD score, with mortality rates of 0.9%, 3.1%, 7.4%, 22.7%, and 14.3% for scores of 0, 1, 2, 3, and 4, respectively. The CLAAD model had an AUC of 0.73 for predicting mortality after cervical trauma.

Conclusions: The CLAAD score is a simple and effective system that can help identify patients at risk of increased mortality within 30 days of cervical trauma.

Level of evidence: Level III.