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

Background Traumatic spinal cord injury is one of the most disastrous and devastating health burdens all over the world with a high mortality rate. The present study aimed to evaluate the predictors of in-hospital and six-month mortality in these patients. Methods The electronic medical records of 87 consecutive patients with acute complete traumatic quadriplegia were reviewed to extract clinical, radiological, and laboratory data. Simple and multiple logistic regression models were used to estimate crude and adjusted odds with 95% confidence interval (CI) ratios for the predictors of in-hospital mortality and six-month mortality. Results There were 48 males and the mean age was 38.67 ± 12.81; in-hospital and six-month mortality were 21.84% and 11.76%, respectively. Traffic road accidents (67.8%) and falls (12.6%) were the most common causes of injury. The univariate analysis demonstrated advanced age, level of injury, late surgery or no surgical intervention, the lack of methylprednisolone therapy, a higher Charlson comorbidity index, the Injury Severity Score, and the presence of respiratory failure or bradycardia on admission were predictors of in-hospital mortality ( p < 0.05). In the final multiple logistic regression model, the level of injury (OR = 0.02 (0.001,0.35), p = 0.008) and the presence of respiratory failure (OR = 2.37 (0.03,13.88), p = 0.024) were the only predictors of in-hospital mortality. The univariate model showed that the level of injury, respiratory failure on admission, and the Injury Severity Score were the predictors of six-month mortality; however, the level of injury was the only predictor of the six-month mortality (OR = 1.12 (0.99, 1.27), p = 0.028) according to the multiple logistic regression model. Conclusions Several factors could affect in-hospital and six-month mortality in patients with traumatic spinal cord injury. Our findings demonstrated the level of injury and respiratory failure on admission as independent predictors of in-hospital mortality in these patients. Furthermore, the level of injury was the only independent predictor of six-month mortality in the present study.

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Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury

Neurosurgical FOCUS ◽

10.3171/2018.12.focus18555 ◽

2019 ◽

Vol 46 (3) ◽

pp. E3 ◽

Cited By ~ 3

Author(s):

Darryl Lau ◽

Cecilia L. Dalle Ore ◽

Phiroz E. Tarapore ◽

Michael Huang ◽

Geoffrey Manley ◽

...

Keyword(s):

Intensive Care Unit ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Intensive Care ◽

Elderly Patients ◽

The Elderly ◽

Mortality Rates ◽

Traumatic Spinal Cord Injury ◽

Younger Patients ◽

Cord Injury

OBJECTIVEThe elderly are a growing subpopulation within traumatic spinal cord injury (SCI) patients. Studies have reported high morbidity and mortality rates in elderly patients who undergo surgery for SCI. In this study, the authors compare the perioperative outcomes of surgically managed elderly SCI patients with those of a younger cohort and those reported in the literature.METHODSData on a consecutive series of adult traumatic SCI patients surgically managed at a single institution in the period from 2007 to 2017 were retrospectively reviewed. The cohort was divided into two groups based on age: younger than 70 years and 70 years or older. Assessed outcomes included complications, in-hospital mortality, intensive care unit (ICU) stay, hospital length of stay (LOS), disposition, and neurological status.RESULTSA total of 106 patients were included in the study: 83 young and 23 elderly. The two groups were similar in terms of imaging features (cord hemorrhage and fracture), operative technique, and American Spinal Injury Association Impairment Scale (AIS) grade. The elderly had a significantly higher proportion of cervical SCIs (95.7% vs 71.1%, p = 0.047). There were no significant differences between the young and the elderly in terms of the ICU stay (13.1 vs 13.3 days, respectively, p = 0.948) and hospital LOS (23.3 vs 21.7 days, p = 0.793). Elderly patients experienced significantly higher complication (73.9% vs 43.4%, p = 0.010) and mortality (13.0% vs 1.2%, p = 0.008) rates; in other words, the elderly patients had 1.7 times and 10.8 times the rate of complications and mortality, respectively, than the younger patients. No elderly patients were discharged home (0.0% vs 18.1%, p = 0.029). Discharge AIS grade and AIS grade change were similar between the groups.CONCLUSIONSElderly patients had higher complication and mortality rates than those in younger patients and were less likely to be discharged home. However, it does seem that mortality rates have improved compared to those in prior historical reports.

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Up-regulation of glial cell line-derived neurotrophic factor (GDNF) following traumatic spinal cord injury

Neuroscience Research ◽

10.1016/s0168-0102(00)81546-1 ◽

2000 ◽

Vol 38 ◽

pp. S117

Author(s):

K Kiuchi

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cell Line ◽

Glial Cell ◽

Neurotrophic Factor ◽

Traumatic Spinal Cord Injury ◽

Cord Injury

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Surgical Decompression and Methylprednisolone in the Treatment of Traumatic Spinal Cord Injury - What are the Evidences? Review of the Literature

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0034-1382247 ◽

2014 ◽

Vol 75 (S 01) ◽

Author(s):

Toma Spiriev ◽

Lili Laleva ◽

Y. Enchev

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Decompression ◽

Traumatic Spinal Cord Injury ◽

Review Of The Literature ◽

Cord Injury

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Neurological Recovery in Traumatic Spinal Cord Injury Patient with Delayed Surgical Intervention

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.112 ◽

2018 ◽

Vol 1 (2) ◽

pp. 34

Author(s):

Mochamad Targib Alatas

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Intervention ◽

Case Series ◽

Spinal Cord Injury Patient ◽

Traumatic Spinal Cord Injury ◽

Best Interest ◽

Score Improvement ◽

Cord Injury ◽

Injury Patient

Early surgical treatment for traumatic spinal cord injury (SCI) patients has been proven to yield better improvement on neurological state, and widely practiced among surgeons in this field. However, it is not always affordable in every clinical setting. It is undeniable that surgery for chronic SCI has more challenges as the malunion of vertebral bones might have initiated, thus requires more complex operating techniques. In this case series, we report 7 patients with traumatic SCI whose surgical intervention is delayed due to several reasons. Initial motoric scores vary from 0 to 3, all have their interval periods supervised between outpatient clinic visits. On follow up they demonstrate significant neurological development defined by at least 2 grades motoric score improvement. Physical rehabilitation also began before surgery was conducted. These results should encourage surgeons to keep striving for the patient’s best interest, even when the injury has taken place weeks or even months before surgery is feasible because clinical improvement for these patients is not impossible.

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