Age and Other Risk Factors Influencing Long-Term Mortality in Patients With Traumatic Cervical Spine Fracture

Abstract

Objective: To identify clinical or demographic variables that influence long-term mortality, as well as in-hospital mortality, with a particular focus on the effects of age.

Summary and background data: Cervical spine fractures with or without spinal cord injury (SCI) disproportionately impact the elderly who constitute an increasing percentage of the US population.

Methods: We analyzed data collected for 10 years at a state-designated level I trauma center to identify variables that influenced in-hospital and long-term mortality among elderly patients with traumatic cervical spine fracture with or without SCI. Acute in-hospital mortality was determined from hospital records and long-term mortality within the study period (2003-2013) was determined from the National Death Index. Univariate and multivariate regression analyses were used to identify factors influencing survival.

Results: Data from patients (N = 632) with cervical spine fractures were analyzed, the majority (66%) of whom were geriatric (older than age 64). Most patients (62%) had a mild/moderate injury severity score (ISS; median, interquartile range: 6, 5). Patients with SCI had significantly longer lengths of stay (14.1 days), days on a ventilator (3.5 days), and higher ISS (14.9) than patients without SCI (P < .0001 for all). Falls were the leading mechanism of injury for patients older than age 64. Univariate analysis identified that long-term survival decreased significantly for all patients older than age 65 (hazard ratio [HR]: 1.07; P < .0001). Multivariate analysis demonstrated age (HR: 1.08; P < .0001), gender (HR: 1.60; P < .0007), and SCI status (HR: 1.45, P < .02) significantly influenced survival during the study period.

Conclusion: This study identified age, gender, and SCI status as significant variables for this study population influencing long-term survival among patients with cervical spine fractures. Our results support the growing notion that cervical spine injuries in geriatric patients with trauma may warrant additional research.

Keywords: cervical spine; fracture; geriatric; mortality; spinal cord injury; spine.

Figure 1.

Consort diagram of the study population. A. Stratification of patients with cervical spine fracture in study cohort. B. Stratification of patients with cervical spine fracture by spinal cord injury status. C. Number of patients whose survival was followed over time by years.

Figure 2.

Clinical features of patients with and without spinal cord injury. A, Age at acute hospitalization admission. B, Injury severity score (ISS) at acute hospitalization admission. C, Length of stay during acute hospitalization. D, Days on ventilator during acute hospitalization.

Figure 3.

Survival of patients with and without SCI stratified by age group for descriptive purposes, data was binned according to age group, as designated in the figure. Kaplan-Meier curves analyzed by Cox regression show survival probability in months. Shaded regions indicate 95% Hall-Wellner confidence bands. A. Patients younger than age 65. Logrank p=0.4239. B. Patients age 65-85. Logrank p=0.0980. C. Patients older than age 85. Logrank p=0.01113.