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Improving life expectancy: A ‘broken neck’ doesn’t have to be a terminal diagnosis for the elderly

BACKGROUND: Elderly patients with cervical spine fractures require optimal care. Treatment with a cervical collar or halo instead of surgical fixation may increase mortality. This investigation intends to describe the life expectancy after injury and evaluate the impact of surgical intervention on m...

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Autores principales: Godat, Laura N, Kobayashi, Leslie M, Chang, David C, Coimbra, Raul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5887759/
https://www.ncbi.nlm.nih.gov/pubmed/29766142
http://dx.doi.org/10.1136/tsaco-2018-000174
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author Godat, Laura N
Kobayashi, Leslie M
Chang, David C
Coimbra, Raul
author_facet Godat, Laura N
Kobayashi, Leslie M
Chang, David C
Coimbra, Raul
author_sort Godat, Laura N
collection PubMed
description BACKGROUND: Elderly patients with cervical spine fractures require optimal care. Treatment with a cervical collar or halo instead of surgical fixation may increase mortality. This investigation intends to describe the life expectancy after injury and evaluate the impact of surgical intervention on mortality. METHODS: Patients ≥65 years, with traumatic cervical spine fractures without cord injury were identified in the 1995–2009 California Office of Statewide Health and Planning database. Those with halo placement or surgical spine fixation were identified. Primary outcome was death, studied at the initial admission, 30 days, 1 year, and the entire study period. Univariate and multivariate regressions were performed to identify predictors of death. Kaplan-Meier survival curves were used to describe life expectancy after injury. RESULTS: 10 938 patients were identified. Mortality rate was 10% during the initial admission, 28% at 1 year and 50% during the entire study period. A halo was placed in 14% of patients and 12% underwent surgical fixation. Mortality rates during the initial admission were 11% for patients without an intervention, 7% with halo placement and 6% with surgical fixation; at 1 year, these increased to 30%, 26% and 19%, respectively. At 1 year, more than one in four patients above 75 years of age will die. At 1 year spine fixation, female gender and admission to a trauma center predicted a lower risk of death at 1 year (OR 0.59, 0.68; p<0.001 and OR 0.89; p=0.02, respectively). Having a complication, fall mechanism, and traumatic brain injury (OR 1.84, 1.33, 1.37; p<0.001, respectively) were predictors of a higher risk of death. Halo use had no impact on death at 1 year (OR 0.98; p=0.77). DISCUSSION: Mortality rates after cervical spine fracture in the elderly is high. Surgical fixation is associated with improved survival; remaining true after adjusting for age and comorbidities; suggesting that surgical fixation may improve outcomes in the elderly. LEVEL OF EVIDENCE: Level IV.
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spelling pubmed-58877592018-05-14 Improving life expectancy: A ‘broken neck’ doesn’t have to be a terminal diagnosis for the elderly Godat, Laura N Kobayashi, Leslie M Chang, David C Coimbra, Raul Trauma Surg Acute Care Open Original Article BACKGROUND: Elderly patients with cervical spine fractures require optimal care. Treatment with a cervical collar or halo instead of surgical fixation may increase mortality. This investigation intends to describe the life expectancy after injury and evaluate the impact of surgical intervention on mortality. METHODS: Patients ≥65 years, with traumatic cervical spine fractures without cord injury were identified in the 1995–2009 California Office of Statewide Health and Planning database. Those with halo placement or surgical spine fixation were identified. Primary outcome was death, studied at the initial admission, 30 days, 1 year, and the entire study period. Univariate and multivariate regressions were performed to identify predictors of death. Kaplan-Meier survival curves were used to describe life expectancy after injury. RESULTS: 10 938 patients were identified. Mortality rate was 10% during the initial admission, 28% at 1 year and 50% during the entire study period. A halo was placed in 14% of patients and 12% underwent surgical fixation. Mortality rates during the initial admission were 11% for patients without an intervention, 7% with halo placement and 6% with surgical fixation; at 1 year, these increased to 30%, 26% and 19%, respectively. At 1 year, more than one in four patients above 75 years of age will die. At 1 year spine fixation, female gender and admission to a trauma center predicted a lower risk of death at 1 year (OR 0.59, 0.68; p<0.001 and OR 0.89; p=0.02, respectively). Having a complication, fall mechanism, and traumatic brain injury (OR 1.84, 1.33, 1.37; p<0.001, respectively) were predictors of a higher risk of death. Halo use had no impact on death at 1 year (OR 0.98; p=0.77). DISCUSSION: Mortality rates after cervical spine fracture in the elderly is high. Surgical fixation is associated with improved survival; remaining true after adjusting for age and comorbidities; suggesting that surgical fixation may improve outcomes in the elderly. LEVEL OF EVIDENCE: Level IV. BMJ Publishing Group 2018-03-20 /pmc/articles/PMC5887759/ /pubmed/29766142 http://dx.doi.org/10.1136/tsaco-2018-000174 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Original Article
Godat, Laura N
Kobayashi, Leslie M
Chang, David C
Coimbra, Raul
Improving life expectancy: A ‘broken neck’ doesn’t have to be a terminal diagnosis for the elderly
title Improving life expectancy: A ‘broken neck’ doesn’t have to be a terminal diagnosis for the elderly
title_full Improving life expectancy: A ‘broken neck’ doesn’t have to be a terminal diagnosis for the elderly
title_fullStr Improving life expectancy: A ‘broken neck’ doesn’t have to be a terminal diagnosis for the elderly
title_full_unstemmed Improving life expectancy: A ‘broken neck’ doesn’t have to be a terminal diagnosis for the elderly
title_short Improving life expectancy: A ‘broken neck’ doesn’t have to be a terminal diagnosis for the elderly
title_sort improving life expectancy: a ‘broken neck’ doesn’t have to be a terminal diagnosis for the elderly
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5887759/
https://www.ncbi.nlm.nih.gov/pubmed/29766142
http://dx.doi.org/10.1136/tsaco-2018-000174
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