Abstract
Introduction
The AOSpine Knowledge Forum Trauma initiated a project to develop and validate universal disease-specific outcome instruments for adult spine trauma patients. Besides a patient reported outcome measure, the objective is to develop and validate a clinician reported outcome (AOSpine CROST) for this specific patient population. The AOSpine CROST is needed to formalize the most relevant clinical and radiological assessment parameters as a simple, reliable and quick to administer tool that is completed by the treating surgeons, and enables them to evaluate and predict the clinical and functional outcomes of spine trauma patients on the short term (3 months-2 years) and long term (≥2 years) time periods post-trauma, independent of the patient reported outcome. To identify relevant parameters, 2 separate surveys were conducted.
Material and Methods
The 2 international cross-sectional web-based surveys were conducted among highly experienced spine surgeons from the 5 AOSpine International world regions, consisting of members of AOSpine International and International Spinal Cord Society (ISCoS). The first survey focused on identifying relevant parameters for the thoracic and lumbar spine (TL-survey), the second survey on the subaxial cervical spine (C-survey). Participants were asked to give their opinion on the relevance of a compilation of parameters on a 5-point scale. Those parameters were based on a systematic review, the recently developed AOSpine Subaxial Cervical Spine and Thoracolumbar Spine Injury Classification Systems, as well as expert interviews. In total, 16 parameters were included in the TL-survey, and 21 in the C-survey. Furthermore, participants were asked to indicate the age that may have an influence on patients' outcome. The responses were analyzed using descriptive statistics, frequency analysis and Kruskal-Wallis test.
Results
Out of the 279 invited spinal surgeons, 118 (42.3%) participated in the TL-survey and 108 (38.7%) in the C-survey. Combining the results of both surveys, 5 parameters were identified as relevant by at least 70% of the participants for all spine regions and time periods post-trauma. Neurological status was identified as the most relevant parameter. In contrast, 5 parameters were not deemed relevant. Pain and mobility of the spine were more relevant for the thoracolumbar- and lumbar spine region, while 3 parameters were more relevant for the cervical spine. Five parameters were identified as relevant for the short term, while bony fusion was the only identified parameter for the long term. The identified missing parameter was bone quality. No large differences were observed for the age that may have an influence on patients' outcome (mean range: 50.1–58.2 years). Only minor differences were observed in the response patterns between the world regions, or spine surgeons' degree of experience.
Conclusion
These studies identified clinical and radiological assessment parameters considered as most relevant by a worldwide panel of highly experienced spine surgeons to evaluate and predict outcomes of spine trauma patients. After formalizing these parameters and conducting pilot tests, a final version of the AOSpine CROST has been developed, consisting of 10 items. Once subjected to further validation, the AOSpine CROST will be a helpful tool in research and clinical practice.