Associated thoracic injury and live hospital discharge after traumatic spinal fracture in Saudi Arabia: a competing-risk secondary cohort analysis

Abstract

Background: Hospital duration after spinal trauma can end in live discharge or death. We examined recorded associated thoracic injury and day-14 live discharge in an openly released Saudi cohort, accounting for in-hospital death.

Methods: A locally frozen plan used 355 adults aged 18–50 years treated during 2005–2016. Fine–Gray regression adjusted for age, sex, spinal cord injury, motor vehicle mechanism and the number of other injured systems. Case-mix-standardized live-discharge probabilities were estimated through day 28, with day 14 primary. Patient bootstraps supplied intervals. Planned sensitivity analyses addressed injury burden, calendar year, missing cord status and contradictory death/follow-up codes; overlap weighting provided an alternative comparison.

Results: 62 patients had associated thoracic injury. Standardized day-14 discharge probabilities were 64.00% without and 52.94% with injury: difference -11.06 percentage points (95% bootstrap interval, -21.29 to -0.30). The subdistribution hazard ratio was 0.69 (0.48–0.99). Excluding two death-coded records with later follow-up codes gave a difference of -11.02 points (-22.32 to 0.06). The overlap-weighted difference was -7.69 points (-20.55 to 5.38). All 4,000 planned bootstrap fits succeeded. Published and released counts differed for several source fields.

Conclusions: Recorded thoracic injury was associated with lower modeled early live-discharge probability in this historical cohort. Alternative weighting and coding sensitivity show important uncertainty. Unmeasured severity, selected completed stays and unresolved source discrepancies prevent causal, treatment or discharge-readiness claims.

Keywords

• spinal trauma
• thoracic injury
• Saudi Arabia
• live discharge
• competing risks
• anesthesiology
• trauma care