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Affiliation
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Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, NSW, Australia; Prince of Wales Clinical School, UNSW, NSW, Australia. |
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Abstract
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BACKGROUND CONTEXT: Traumatic spinal injuries are often associated with both long-term disability, higher frequency of hospital readmissions and high medical costs for individuals of all ages. Age differences in terms of injury profile and health outcomes among those who sustain a spinal cord injury have been identified. However, factors that may influence health outcomes among those with a spinal injury have not been extensively examined at a population-level.
PURPOSE: To describe the characteristics of traumatic spinal injury, identify factors predictive of mortality; and estimate the cost of hospital treatment for younger and older people. STUDY DESIGN/SETTING: A population-based retrospective epidemiological study of using linked hospitalisation and mortality records during 1 January 2010 to 30 June 2014 in New South Wales, Australia. PATIENT SAMPLE: 13,429 hospitalisations. OUTCOME MEASURES: Mortality within 30 and 90 days of hospitalisation, hospital length of stay (LOS), and hospitalisation costs.
METHODS: Hospitalisations with a principal diagnosis of spinal cord injury or spinal fractures were used to identify traumatic spinal injuries. Age-standardised incidence rates were calculated and negative binomial regression was used to examine statistical significant changes over time. Cox proportional hazard regression was used to examine the effect of risk factors on survival at 90-days.
RESULTS: There were 13,429 hospitalisations, with 52.4% of individuals aged ≥65 years. The hospitalisation rates for individuals aged ≤64 years and ≥65 years were both estimated to significantly increase per year by 3.3% (95%CI 0.97-5.79, p<0.006) and 3.3% (95%CI 1.02-5.71, p=0.005), respectively. For individuals aged ≥65 years there were a higher proportion of females injured, comorbid conditions, injuries following a fall in the home or aged care facility, a longer hospital LOS, unplanned hospital admissions and deaths than individual aged ≤64 years. The average cost per index hospitalisation was AUD$23,808 for individuals aged ≤64 years and AUD$31,187 for individuals aged ≥65 years with a total estimated cost of AUD$371 million. Mortality risk at 90-days was increased for individuals who had one or more comorbidities, a higher injury severity score and if their injury occurred in the home or an aged care facility.
CONCLUSION: Spinal injury is represents a substantial cost and results in debilitating injuries, particularly for older individuals. Spinal injury prevention efforts for older people should focus on the implementation of fall injury prevention, while for younger individuals prevention measures should target road safety.
Copyright © 2017 Elsevier Inc. All rights reserved.
Language: en |