Enhancing life expectancy: A ‘damaged neck’ does not need to be a terminal prognosis for the aged.
Trauma Surg Acute Care Open. 2018;three(1):e000174
Authors: Godat LN, Kobayashi LM, Chang DC, Coimbra R
Background: Aged sufferers with cervical backbone fractures require optimum care. Remedy with a cervical collar or halo as a substitute of surgical fixation might enhance mortality. This investigation intends to explain the life expectancy after damage and consider the affect of surgical intervention on mortality.
Strategies: Sufferers ?65 years, with traumatic cervical backbone fractures with out twine damage have been recognized within the 1995-2009 California Workplace of Statewide Well being and Planning database. These with halo placement or surgical backbone fixation have been recognized. Major consequence was loss of life, studied on the preliminary admission, 30?days, 1?yr, and the complete research interval. Univariate and multivariate regressions have been carried out to establish predictors of loss of life. Kaplan-Meier survival curves have been used to explain life expectancy after damage.
Outcomes: 10?938 sufferers have been recognized. Mortality charge was 10% throughout the preliminary admission, 28% at 1?yr and 50% throughout the complete research interval. A halo was positioned in 14% of sufferers and 12% underwent surgical fixation. Mortality charges throughout the preliminary admission have been 11% for sufferers with out an intervention, 7% with halo placement and 6% with surgical fixation; at 1?yr, these elevated to 30%, 26% and 19%, respectively. At 1?yr, multiple in 4 sufferers above 75 years of age will die.At 1?yr backbone fixation, feminine gender and admission to a trauma heart predicted a decrease danger of loss of life at 1?yr (OR zero.59, zero.68;?p<zero.001 and OR zero.89; p=zero.02,?respectively). Having a complication, fall mechanism, and traumatic mind damage (OR 1.84, 1.33, 1.37;?p<zero.001,?respectively) have been predictors of a better danger of loss of life. Halo use had no affect on loss of life at 1?yr (OR zero.98; p=zero.77).
Dialogue: Mortality charges after cervical backbone fracture within the aged is excessive. Surgical fixation is related to improved survival; remaining true after adjusting for age and comorbidities; suggesting that surgical fixation might enhance outcomes within the aged.
Degree of proof: Degree IV.
PMID: 29766142 [PubMed]