247. Predicting mortality following traumatic cervical spinal cord injury in the elderly

Autor: Sean D. Christie, Nathan Evaniew, Dilnur Kurban, Charles G. Fisher, Daniel Banaszek, Christopher S. Bailey, Michael G. Fehlings, Tom Inglis, Eve C. Tsai, Brian K. Kwon, Vanessa K. Noonan
Rok vydání: 2019
Předmět:
Zdroj: The Spine Journal. 19:S121
ISSN: 1529-9430
Popis: BACKGROUND CONTEXT As the incidence of traumatic spinal cord injury (tSCI) in the elderly rises, clinicians are frequently faced with difficult decisions regarding the goals of management and the need to discuss prognosis with the patient and their families. Traumatic spinal cord injury can have potentially devastating consequences, particularly in an elderly population. PURPOSE The objectives of this study were to determine the specific factors associated with mortality in the elderly following tSCI and develop a simple clinical tool to predict mortality in the acute setting. STUDY DESIGN/SETTING A single quaternary spinal referral center. PATIENT SAMPLE All patients from our prospectively collected database with traumatic SCI aged >65 years, from 2007-2014. OUTCOME MEASURES The main outcome measure was in-hospital mortality with data also collected on patient demographics, injury factors and treatment course. METHODS Prospectively collected data of all elderly patients (≥65 years) within the national Rick Hansen SCI registry from 2004 to 2017 were analyzed using bivariate and multivariate analyses to determine what factors were associated with in-hospital patient mortality. RESULTS A total of 1,382 patients were divided into three groups: 65-69 years, 70-74 years and ≥75 years of age. Overall in-hospital mortality was 15.8% with 218 deaths. The factors associated with mortality included age, injury severity (AIS grade), level of injury, and ISS. Mortality rates were highest in the most elderly (65-69 yrs 7.8%, 70-74yrs 10.6%, ≥75yrs 24%). Those with AIS A injuries had a mortality of 30.6% (OR 6.0, p 25 was strongly associated with mortality (p 25 were twice as likely to die in hospital. Of the survivors, only 37% were discharged home. CONCLUSIONS Increasing age, level of injury and AIS grade are strongly associated with mortality in elderly tSCI patients. Using these factors, we can establish a tool for predicting in-patient mortality that may help surgeons with decision-making around goals of management and with communication of prognosis to patients and their families. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
Databáze: OpenAIRE
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