Geriatric Trauma Patients With Cervical Spine Fractures due to Ground Level Fall: Five Years Experience in a Level One Trauma Center

Abstract

BackgroundIt has been found that significantly different clinical outcomes occur in trauma patients with different mechanisms of injury. Ground level falls (GLF) are usually considered “minor trauma” with less injury occurred in general. However, it is not uncommon that geriatric trauma patients sustain cervical spine (C-spine) fractures with other associated injuries due to GLF or less. The aim of this study is to determine the injury patterns and the roles of clinical risk factors in these geriatric trauma patients.MethodsData were reviewed from the institutional trauma registry of our local level 1 trauma center. All patients had sustained C-spine fracture(s). Basic clinical characteristics, the distribution of C-spine fracture(s), and mechanism of injury in geriatric patients (65 years or older) were compared with those less than 65 years old. Furthermore, different clinical variables including age, gender, Glasgow coma scale (GCS), blood alcohol level, and co-existing injuries were analyzed by multivariate logistic regression in geriatric trauma patients due to GLF and internally validated by random bootstrapping technique.ResultsFrom 2006 - 2010, a total of 12,805 trauma patients were included in trauma registry, of which 726 (5.67%) had sustained C-spine fracture(s). Among all C-spine fracture patients, 19.15% (139/726) were geriatric patients. Of these geriatric patients 27.34% (38/139) and 53.96% (75/139) had C1 and C2 fractures compared with 13.63% (80/587) and 21.98% (129/587) in young trauma patients (P < 0.001). Of geriatric trauma patients 13.67% (19/139) and 18.71% (26/139) had C6 and C7 fractures compared with 32.03% (188/587) and 41.40% (243/587) in younger ones separately (P < 0.001). Furthermore, 53.96% (75/139) geriatric patients had sustained C-spine fractures due to GLF with more upper C-spine fractures (C1 and C2). Only 3.2% of those had positive blood alcohol levels compared with 52.9% of younger patients (P < 0.001). In addition, 6.34% of geriatric patients due to GLF had intracranial pathology (ICP) which was one of the most common co-injuries with C-spine fractures. Logistic regression analysis showed the adjusted odds ratios of 1.17 (age) and 91.57 (male) in geriatric GLF patients to predict this co-injury pattern of C-spine fracture and ICP.ConclusionGeriatric patients tend to sustain more upper C-spine fractures than non-geriatric patients regardless of the mechanisms. GLF or less not only can cause isolated C-spines fracture(s) but also lead to other significant injuries with ICP as the most common one in geriatric patients. Advanced age and male are two risk factors that can predict this co-injury pattern. In addition, it seems that alcohol plays no role in the cause of GLF in geriatric trauma patients.

Risk factors for ground-level falls differ by sex

“…Organ damage, which is a risk factor for mortality from blunt injury, has been the subject of numerous previous studies, and intracranial hemorrhagic lesions, cervical spinal cord damage, hemothorax, pneumothorax, intra-abdominal organ injury, and leg fractures have been reported to constitute independent risk factors for mortality [2,5,7,14,[21][22][23]. Studies of ground-level falls have also identified high AIS in the head, thoracic, abdominal, pelvic, and leg areas in cases of death [5].…”

Review article: NEXUS criteria to rule out cervical spine injury among older patients: A systematic review

“…In a large retrospective observational study of 12 805 trauma patients, Wang et al . reported that the majority (54.0%) of cervical spine fractures in the elderly were due to falls, whereas, in the non‐geriatric group, transport‐associated accidents accounted for 79.6% of cervical spine fractures …”

“…20 Older patients are also more likely to sustain cervical spine injuries that are clinically unstable, involve more than one vertebral level and occur in the upper cervical spine. 20 The distribution of mechanism of injury also varies between older and younger patients. In a large retrospective observational study of 12 805 trauma patients, Wang et al reported that the majority (54.0%) of cervical spine fractures in the elderly were due to falls, whereas, in the non-geriatric group, transport-associated accidents accounted for 79.6% of cervical spine fractures.…”

“…In a large retrospective observational study of 12 805 trauma patients, Wang et al reported that the majority (54.0%) of cervical spine fractures in the elderly were due to falls, whereas, in the non-geriatric group, transport-associated accidents accounted for 79.6% of cervical spine fractures. 20 Moreover, the elderly are more likely to experience alterations in cognitive, sensory-perceptual and motor abilities, which limit with their ability to contribute to clinical assessment. 21 Health providers will need to adapt and optimise their practices in order to overcome the unique diagnostic challenges of an ageing population.…”

Mortality and Readmission After Cervical Fracture from a Fall in Older Adults: Comparison with Hip Fracture Using National Medicare Data

“…17 One possible explanation is that, because hip fracture is so much more common than cervical fracture after low-impact falls, fall prevention and treatment for osteoporosis may shift the age-specific incidence of hip fracture toward the oldest adults, who are more likely to be women. 18 Not surprisingly, head injury is closely associated with cervical spinal injury, 19 leading to higher ISS in individuals with cervical fracture with and without SCI. After accounting for these differences between groups using propensity score modeling, it was found that, despite being younger, having fewer comorbid illnesses, and being more likely to receive care at teaching hospitals and higher-level trauma hospitals, Medicare beneficiaries who sustained a cervical fracture after a low-impact fall were nearly twice as likely to die within 30 days of their injury as those who sustained a hip fracture.…”