|
Citation
|
Asemota AO, Ahmed AK, Purvis TE, Passias PG, Goodwin CR, Sciubba DM. World Neurosurg. 2018; 120: e114-e130. |
|
Affiliation
|
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: dsciubb1@jhmi.edu. |
|
Abstract
|
BACKGROUND: Cervical spine (C-spine) injuries cause significant morbidity and mortality among the elderly. Although the population of older-adults ≥65 years in the US is expanding, estimates of the burden and outcome of C-spine injury are lacking.
METHODS: The Nationwide Inpatient Sample 2001-2010 was analyzed. International Classification of Diseases codes identified patients with isolated C-spine fractures (ICF) and C-spine fractures with spinal cord injury (CSCI). Annual admission and mortality rates were calculated using US-Census data.
RESULTS: A total of 167,278 older-adults were included. Median age was 81 years (IQR=74-86). Most patients were female (54.9%), had Medicare coverage (77.6%), treated in teaching hospitals (63.2%), and falls were the leading injury-mechanism (51.2%). ICF occurred in 91.3%, while CSCI occurred in 8.7% (p<0.001). ICF was more common in ≥85 year-olds and CSCI in 65-69 year-olds (p<0.001). The most common injured C-spine level in ICF was C2-level (47.6%, p<0.001), and in CSCI was C1-C4 level (4.5%, p<0.001). Overall, 15.8% underwent C-spine surgery. Hospitalization rates increased from 26/100,000 in 2001 to 68/100,000 in 2010 (∼167% change, p<0.001). Correspondingly, overall mortality increased from 3/100,000 in 2001 to 6/100,000 in 2010, p<0.001. In-hospital mortality was 11.3%, was strongly associated with increasing age and CSCI (p<0.001).
CONCLUSIONS: In summary, C-spine fractures among US older-adults constitute a significant healthcare burden. ICF occur commonly, C2-vertebra fractures are most frequent, while CSCI are linked to increased hospital-resource utilization and worse outcomes. The incidence of C-spine fractures and mortality more than doubled over the past decade; however, proportional in-hospital mortality is decreasing.
Copyright © 2018. Published by Elsevier Inc.
Language: en |