Older patients may have more in-hospital mortality after traumatic spinal cord injuries
Despite having less severe spinal cord injuries than their younger counterparts, older patients with traumatic spinal cord injuries have longer hospital stays, more in-hospital mortality and waited longer for surgery, according to study findings.
Researchers identified 1,440 patients with traumatic spinal cord injuries for the study cohort, with 167 patients aged 70 or older at the time of the initial injury. The study’s primary outcome was to determine the rate of acute surgical treatment. As such, the researchers used bivariate and multivariate regression models to evaluate patient- and injury-related factors that were associated with the need for surgical treatment and the timing of surgery once patients arrived at the treatment center.
Results showed older patients were significantly more likely to be injured by falling, with 83.1 per cent of older patients sustaining injuries from a fall, compared with 37.4 per cent of younger patients. Patients in the older cohort were also more likely to sustain a cervical injury compared with patients in the younger cohort, according to the researchers. Additionally, older patients averaged 35 days in the hospital after their injury, compared with 28 days for younger patients.
Overall, older patients tended to have less severe injuries when compared with the injuries of the younger patients, with 58.2 per cent of patients having a score less than 25 on the injury severity scale, compared with 39.1 per cent of patients in the younger group. The researchers also found that older patients took longer to admit themselves to a hospital and waited longer to have surgery when compared with the younger cohort.
The researchers concluded more information is needed before guideline changes can be recommended for spinal cord injuries in older patients, much like guidelines recommendations for fragility fractures of the hip.
Ahn, H., Bailey, C.S., Rivers, C.S., (2015) Effect of older age on treatment decisions and outcomes among patients with traumatic spinal cord injury. CMAJ. doi:10.1503/cmaj.150085.