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In-Hospital Mortality for the Elderly with Acute Traumatic Spinal Cord Injury
Tom Inglis1, Dan Banaszek1, Carly S Rivers2
1Department of Orthopaedics, Vancouver Spine Surgery Institute, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Journal of Neurotrauma
|July 9, 2020
Summary
Elderly patients with traumatic spinal cord injury (tSCI) face high in-hospital mortality. Age, comorbidities, injury severity (ASIA Impairment Scale), and ventilation status predict outcomes, informing clinical decisions for older adults with tSCI.
Area of Science:
- Geriatric Medicine
- Neurosurgery
- Traumatology
Background:
- Traumatic spinal cord injury (tSCI) incidence is increasing in elderly populations.
- Clinical management and prognostication for tSCI in older adults present unique challenges.
- Discussions on treatment aggressiveness, recovery potential, and survival are critical.
Purpose of the Study:
- To identify risk factors for in-hospital mortality in elderly surgical and non-surgical tSCI patients.
- To determine predictors of unfavorable outcomes in this demographic.
- To inform clinical decision-making and family discussions regarding tSCI management in the elderly.
Main Methods:
- Analysis of data from the Canadian Rick Hansen SCI Registry (2004-2017).
- Inclusion of elderly patients (≥ 65 years) with tSCI.
- Descriptive analysis and logistic regression to compare survival and mortality groups, identifying significant predictors.
Main Results:
- In-hospital mortality is high among elderly tSCI patients.
- Surgical patients had a longer median time to death (30 days) compared to non-surgical patients (7 days).
- Key predictors of mortality post-surgery include advanced age (≥77 years), comorbidities, severe neurological injury (ASIA Impairment Scale A), and ventilator dependence.
Conclusions:
- Age, comorbidities, neurological injury severity, and ventilation status are significant predictors of in-hospital mortality in elderly tSCI patients.
- A model was developed to estimate the probability of death within 50 days post-surgery.
- Findings support informed clinical decision-making and patient/family counseling regarding tSCI in older adults.
