Mortality and complications in elderly patients with cervical spine injuries

To assess the complications and mortality in elderly individuals with cervical spine injuries.

This retrospective observational study was conducted in a tertiary care hospital in a rural area in Japan. Data sets from the trauma registry (January 2011 to March 2018) were analyzed. Patients with cervical spine injury were divided into those aged ≥ 65 years (group Y) and > 65 years (group E). We then analyzed age, sex, 30-day mortality, hospital stay, level of cervical spine injury, presence of cervical vertebral fracture, perioperative complications (pneumonia, urinary tract infection, and severe bedsore), neurological deficit (Frankel classification), Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS).

We evaluated a total of 398 patients; among them, 177 were included in group Y and 221 in group E. The assessed parameters were as follows: age (group Y/E; 48.7/75.9 years), men (78.0/72.3%), 30-day mortality (8.5/10.0%, p = 0.159), hospital stay (17.2/19.1 days, p = 0.36), level of cervical spine injury (C1 [5.7/4.5%], C2 [12.4/15.8%], C3 [10.2/17.2%], C4 [14.1/16.3%], C5 [26.6/22.2%], C6 [22.0/12.2%], and C7 [11.3/10.9%]), vertebral fracture (56.6/61.9%), central cord syndrome (36.2/33%), operation (18.6/13.1%), pneumonia (6.8/11.8%, p = 0.077), urinary tract infection (4.0/6.3%, p = 0.26), severe bedsore (0/1.8%, p = 0.068), Frankel classification (grade A [5.7/6.3%], grade B [6.8/7.7%], grade C [24.9/28.5%], grade D [17.5/11.8%], and grade E [34.5/33.9%]), mean AIS score in the cervical spine (3.3/3.5, p = 0.04), and mean ISS (23.2/22.2, p = 0.38). C3 injuries tended to be higher in group E.

Mortality and morbidity associated with cervical spine injuries did not differ between younger and older patients. Nevertheless, vigilance is required for the detection of C3 injury in elderly individuals.