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. 2020 Nov 1;37(21):2332-2342.
doi: 10.1089/neu.2019.6912. Epub 2020 Aug 26.

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

Tom Inglis  1 , Dan Banaszek  1 , Carly S Rivers  2 , Dilnur Kurban  2 , Nathan Evaniew  1 , Nader Fallah  2 , Zeina Waheed  2 , Sean Christie  3 , Richard Fox  4 , Jean-Marc Mac Thiong  5 , Karen Ethans  6 , Chester Ho  7 , Angelo Gary Linassi  8 , Henry Ahn  9 , Najmedden Attabib  10 , Christopher S Bailey  11 , Michael G Fehlings  12 , Daryl R Fourney  13 , Jérôme Paquet  14 , Andrea Townson  15 , Eve Tsai  16 , Christiana L Cheng  2 , Vanessa K Noonan  2 , Marcel F Dvorak  1   17 , Brian K Kwon  1   17
Affiliations

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

Tom Inglis et al. J Neurotrauma. .

Abstract

As the incidence of traumatic spinal cord injury (tSCI) in the elderly rises, clinicians are increasingly faced with difficult discussions regarding aggressiveness of management, likelihood of recovery, and survival. Our objective was to outline risk factors associated with in-hospital mortality in elderly surgical and non-surgical patients following tSCI and to determine those unlikely to have a favorable outcome. Data from elderly patients (≥ 65 years of age) in the Canadian Rick Hansen SCI Registry from 2004 to 2017 were analyzed using descriptive analysis. Survival and mortality groups in each of the surgical and non-surgical group were compared to explore factors associated with in-hospital mortality and their impact, using logistical regression. Of 1340 elderly patients, 1018 had surgical data with 826 having had surgery. In the surgical group, the median time to death post-injury was 30 days with 75% dying within 50 days compared with 7 days and 20 days, respectively, in the non-surgical group. Significant predictors for in-hospital mortality following surgery are age, comorbidities, neurological injury severity (American Spinal Injury Association [ASIA] Impairment Scale [AIS]), and ventilation status. The odds of dying 50 days post-surgery are six times higher for patients ≥77 years of age versus those 65-76 years of age, five times higher for those with AIS A versus those with AIS B/C/D, and seven times higher for those who are ventilator dependent. An expected probability of dying within 50 days post-surgery was determined using these results. In-hospital mortality in the elderly after tSCI is high. The trend with age and time to death and the significant predictors of mortality identified in this study can be used to inform clinical decision making and discussions with patients and their families.

Keywords: elderly; mortality; prognosis; surgery; traumatic spinal cord injury.

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Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
Flow and selection of participants for the analysis. RHSCIR, Rick Hansen Spinal Cord Injury Registry; L2, second lumbar spinal vertebra.
FIG. 2.
FIG. 2.
Cumulative percent of participants who died in-hospital for the (a) surgical group and (b) non-surgical group.
FIG. 3.
FIG. 3.
Percent of participants who survived (black) and who died in-hospital (white) by each age year for the (a) surgical group and (b) non-surgical group.
See this image and copyright information in PMC

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