Independent Predictors of Survival After Traumatic Atlanto-Occipital Dissociation

Background Atlanto-occipital dissociation (AOD) occurs when the skull base is forcibly separated from the vertebral column. Existing literature on AOD is sparse and risk factors for mortality are unknown. This study determined independent predictors of survival after AOD. Methods Patients who sustained AOD were identified from the NTDB (2007-2014). Those arriving without signs of life or with missing mortality data were excluded. Study groups were defined as patients who survived to hospital discharge vs patients who died in hospital. Demographics, injury data, interventions, and outcomes were compared between groups using univariate analysis. Multivariate logistic regression was used to determine independent predictors of survival. Results After applying exclusion criteria, 1489 patients (0.05). Patients who survived had a median hospital LOS of 5 days [IQR 1-14] and ICU LOS of 1 day [IQR 0-7]. The most common discharge destination was home (n=395, 26%). Conclusions Traumatic AOD is not uniformly fatal, with 78% of patients who arrive alive to hospital surviving to discharge. When death occurs, it is typically within the first 23 hours. Lower ISS and higher GCS on admission independently predict survival, while time to neurosurgical intervention does not. Survivors have a short hospital stay and are commonly discharged home. This study suggests that AOD among patients who arrive alive to hospital may not be as devastating as previously considered. Level of Evidence III Study Type Prognostic and Epidemiological Address for Correspondence and Reprints: Kenji Inaba, MD, FRCSC, FACS, Division of Trauma and Surgical Critical Care, LAC + USC Medical Center, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA 90033, E-mail: kinaba@surgery.usc.edu Conflict of Interest The authors have no conflicts of interest or disclosures of funding to declare. Presentations The results of this study were presented at the Trauma Association of Canada (TAC) Annual Meeting in Toronto, Canada on February 22-23, 2018. © 2018 Lippincott Williams & Wilkins, Inc.

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