Traumatic spinal cord injury in the elderly: predictors for mortality and functional outcomes

The incidence of traumatic spinal cord injury (tSCI) in the elderly is increasing in the setting of an ageing population. We aim to present and define the clinical course of tSCI in the elderly Australian cohort with this cohort study to identify pertinent predictors for mortality thereby improving risk stratification in this potentially devastating disease.

A review of the prospectively maintained Victorian State Trauma Registry (VSTR) database was performed to identify patients who sustained a tSCI between 2007 and 2021. Patients aged 65 years and older were included. Demographic, treatment, disposition and outcome data were all obtained from the database and supplemented from the patient's medical record as required. A primary outcome of death at 6 months was defined. Secondary outcomes were collated for Extended Glasgow Outcome Score (GOS-E) at 6 months, length of stay in hospital, and discharge disposition.

A total of 169 elderly patients with tSCI were identified, with 168 followed up to completion (mean age 73.5 years, 73.4% male). The majority (52.7%) were secondary to low-impact falls, and 67.5% underwent surgery for their injury. 19.6% (n=33) of the cohort were dead at 6 months. The likelihood of death at 6 months was significantly associated with increasing age [odds ratio (OR) 1.22 per year increase in age; 95% confidence interval (CI): 1.09-1.36; P=0.001], Injury Severity Score (ISS) (OR 1.11 per unit ISS; 95% CI: 1.05-1.18; P=0.001), and complete injuries. The level of injury, surgical management and Charlson Comorbidity Index (CCI) of 1 or greater did not reach significance. Age was also associated with worsening GOS-E at 6 months and prospects of being discharged home, but not with length of stay.

tSCI in the elderly is a challenging condition. Increasing age is significantly associated with increased risk of mortality and poorer GOS-E scores at 6 months.