Objective

To assess the outcome measures used in studies investigating cervical spine fractures in adults, with or without associated spinal cord injury, to inform development of a core outcome set.

Methods

Medline, Embase and Scopus were searched for relevant studies until May 28, 2022, without a historic limit on study date. Study characteristics, population characteristics and outcomes reported were extracted and analyzed.

Results

Our literature search identified 536 studies that met criteria for inclusion, involving 393,266 patients. Most studies were single center (87.3%), retrospective studies (88.9%) and involved a median of 40 patients (range 6–167,278). Treatments assessed included: surgery (55.2%), conservative (6.2%), halo immobilization (4.9%), or a mixture (33.2%). Median study duration was 84 months (range 3–564 months); the timing of clinical and/or radiological follow-up assessment after injury was reported in 56.7%. There was significant heterogeneity in outcomes used, with 79 different reported outcomes measures. Differences in use were identified between smaller/larger, retro-/prospective and single/multicenter cohorts. Over time, the use of radiological outcomes has declined with greater emphasis on patient-reported outcome measures (PROMs). Studies of conservative management were more likely to detail PROMs and mortality, whereas surgical studies reported Frankel/ASIA grade, radiological fusion, complication rates, duration of hospital stay and re-operation rates more frequently. In studies assessing the elderly population (> 65 years), use of PROMs, mortality, hospital stay and discharge destination were more common, whereas fusion was reported less often. Response rates for outcome assessments were lower in studies assessing elderly patients, and studies using PROMs.

Conclusions

We have classified the various outcome measures used for patients with cervical spine fractures based on the COMET outcome taxonomy. We also described the contexts in which different outcomes are more commonly employed to help guide decision-making when designing future research endeavors.

中文翻译：

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系统评价确定用于评估成人颈椎骨折的结果测量

客观的

评估在调查成人颈椎骨折（伴或不伴脊髓损伤）的研究中使用的结果测量，以告知核心结果集的开发。

方法

在 Medline、Embase 和 Scopus 中搜索相关研究，直到 2022 年 5 月 28 日，没有研究日期的历史限制。提取和分析报告的研究特征、人群特征和结果。

结果

我们的文献检索确定了 536 项符合纳入标准的研究，涉及 393,266 名患者。大多数研究是单中心 (87.3%)、回顾性研究 (88.9%)，涉及的患者中位数为 40 人（范围 6–167,278）。评估的治疗包括：手术 (55.2%)、保守治疗 (6.2%)、光晕固定 (4.9%) 或混合治疗 (33.2%)。中位研究持续时间为 84 个月（范围 3-564 个月）；56.7% 报告了受伤后进行临床和/或放射学随访评估的时间。使用的结果存在显着异质性，报告了 79 种不同的结果测量值。在较小/较大、回顾性/前瞻性和单中心/多中心队列之间确定了使用差异。随着时间的推移，放射学结果的使用已经减少，更加强调患者报告的结果测量（PROM）。保守治疗的研究更有可能详细说明 PROM 和死亡率，而手术研究更频繁地报告 Frankel/ASIA 分级、放射学融合、并发症发生率、住院时间和再手术率。在评估老年人口（> 65 岁）的研究中，PROM 的使用、死亡率、住院时间和出院目的地更为常见，而融合的报道较少。在评估老年患者的研究和使用 PROM 的研究中，结果评估的反应率较低。住院和出院目的地更为常见，而融合的报道较少。在评估老年患者的研究和使用 PROM 的研究中，结果评估的反应率较低。住院和出院目的地更为常见，而融合的报道较少。在评估老年患者的研究和使用 PROM 的研究中，结果评估的反应率较低。

结论

我们根据 COMET 结果分类法对用于颈椎骨折患者的各种结果测量进行了分类。我们还描述了在设计未来研究工作时更常采用不同结果来帮助指导决策的背景。