In-Hospital Mortality for the Elderly with Acute Traumatic Spinal Cord Injury

JOURNAL OF NEUROTRAUMA, 2020 · DOI: 10.1089/neu.2019.6912 · Published: November 1, 2020

Simple Explanation

This study examines in-hospital mortality rates for elderly patients (65+) who have suffered a traumatic spinal cord injury (tSCI). The research explores factors that predict mortality in both surgical and non-surgical patients. The study found that age, comorbidities, neurological injury severity, and ventilation status are significant predictors of in-hospital mortality following surgery. The probability of dying within 50 days post-surgery increases significantly with these factors. For non-surgical patients, age and neurological injury severity were significant predictors of in-hospital mortality. Older patients and those with more severe injuries had a higher probability of dying in the hospital.

Study Duration

2004 to 2017

Participants

1340 elderly patients (≥ 65 years of age) with traumatic spinal cord injury

Evidence Level

Not specified

Key Findings

1
In the surgical group, the odds of dying within 50 days post-surgery are six times higher for patients 77 years of age or older compared to those aged 65-76.
2
Patients with AIS A (complete) neurological injury have five times higher odds of dying compared to those with AIS B, C, or D (incomplete) injuries.
3
Ventilator-dependent patients have seven times higher odds of dying compared to those who are not ventilator-dependent.

Research Summary

This study analyzed data from 1340 elderly patients with tSCI to identify risk factors associated with in-hospital mortality in surgical and non-surgical patients. The study found that age, comorbidities, neurological injury severity, and ventilation status are significant predictors of mortality in surgical patients. Age and neurological injury severity were significant in non-surgical patients. The findings can be used to inform clinical decision-making and discussions with patients and their families regarding the aggressiveness of management and likelihood of survival.

Practical Implications

Clinical Decision Making

The identified predictors of mortality can help clinicians make more informed decisions about the aggressiveness of treatment for elderly tSCI patients.

Patient and Family Communication

The study provides data to facilitate discussions with patients and families about prognosis and goals of management.

Resource Allocation

Understanding the factors associated with mortality can help allocate resources more effectively in the care of elderly tSCI patients.

Study Limitations

1
Surgical data were missing on 24% of patients, leading to potential bias.
2
Limited data availability on injury factors including ISS and AOSpine classification might have underestimated the role of multiple traumas on outcome.
3
In-hospital mortality rates do not include pre-hospital deaths, because of lack of data availability.

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