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

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.

A multicenter study of 1-year mortality and walking capacity after spinal fusion surgery for cervical fracture in elderly patients

“…Based on our results, in patients treated surgically, a poor general condition with a greater number of comorbidities was considered to result in an increase in postoperative complications or poor postoperative recovery, and hence an increased mortality risk. Previously, a neurological de cit has been linked to mortality after a cervical fracture in the elderly [1-3, 6, 13] and mortality has been correlated with the severity of a neurological de cit [13,14]. The results of our study supported the same nding.…”

A New Scale for Predicting the Risk of In-hospital Mortality in Patients With Traumatic Spinal Cord Injury

“…Previous studies have reported several predictors of mortality in TSCI, such as age, neurological level, severity of neurological deficits, comorbidities, presence of other injuries, and ventilation status (7,(14)(15)(16)(17). However, the sample sizes of most studies did not yield convincing findings, and their long time span involving changes in treatment may have affected the analysis.…”

Development of a machine learning algorithm for predicting in-hospital and 1-year mortality after traumatic spinal cord injury

“…comorbidities) and care practices (e.g. surgery, ventilation) influence mortality risk in the elderly [45]. Future work should consider developing additional algorithms and tools to provide a more precise prediction during the patient's admission for these factors and consider other outcomes (e.g.…”