Risk Factors for Early Mortality in Older Patients with Traumatic Cervical Spine Injuries—A Multicenter Retrospective Study of 1512 Cases

J. Clin. Med., 2023 · DOI: 10.3390/jcm12020708 · Published: January 16, 2023

Simple Explanation

This study investigates factors leading to early death in elderly individuals who have suffered traumatic cervical spine injuries. It examines data from 78 hospitals over a decade. The research identified that older age, being male, having a cervical spine fracture, complete motor paralysis, and chronic kidney disease significantly increase the risk of early mortality in this patient group. For those undergoing surgery, the study found that older age, complete motor paralysis, pre-existing cardiac disease, and intraoperative complications were key factors contributing to early mortality.

Study Duration

2010 to 2020

Participants

1512 patients aged ≥65 years

Evidence Level

Not specified

Key Findings

1
Older age, male sex, cervical spine fracture, complete motor paralysis, and chronic kidney disease were identified as independent risk factors for early mortality in older patients with traumatic cervical spine injuries.
2
Complete motor paralysis resulted in an 8.4-fold-higher risk of early mortality, highlighting the significant impact of spinal cord injury severity on survival.
3
Intraoperative complications and pre-existing cardiac disease were identified as independent risk factors for early mortality in patients undergoing surgical treatment.

Research Summary

This multicenter retrospective study aimed to identify predictors of early mortality after traumatic cervical spine injuries in older individuals, analyzing data from 1512 patients across 78 institutions between 2010 and 2020. The study found that older age, male sex, cervical spine fracture, complete motor paralysis, and chronic kidney disease were independent risk factors for early mortality. A subgroup analysis of patients undergoing surgical treatment revealed that older age, complete motor paralysis, cardiac disease, and intraoperative complications were significant risk factors for early mortality.

Practical Implications

Risk Stratification

Identify high-risk patients based on age, sex, injury type, neurological status, and pre-existing conditions to tailor treatment plans and allocate resources effectively.

Surgical Planning

Minimize intraoperative complications through careful surgical planning, advanced imaging evaluation, and strategies to manage pre-existing conditions like cardiac disease.

Conservative Management

Implement proactive measures to prevent complications associated with long-term bed rest and cervical orthosis in patients undergoing conservative treatment, focusing on respiratory and cardiovascular support.

Study Limitations

1
Retrospective multicenter study design leading to potential missing data and variations in treatment strategies between institutions.
2
Exclusion of deaths before hospital transport or in the emergency room, potentially underestimating early mortality.
3
Small number of early mortalities, which may limit the generalizability of the conclusions.

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