Predictors of mortality in the elderly patient with a fracture of the odontoid process

Abstract

Aims Fracture of the odontoid process (OP) in the elderly is associated with mortality rates similar to those of hip fracture. The aim of this study was to identify variables that predict mortality in patients with a fracture of the OP, and to assess whether established hip fracture scoring systems such as the Nottingham Hip Fracture Score (NHFS) or Sernbo Score might also be used as predictors of mortality in these patients. Patients and Methods We conducted a retrospective review of patients aged 65 and over with an acute fracture of the OP from two hospitals. Data collected included demographics, medical history, residence, mobility status, admission blood tests, abbreviated mental test score, presence of other injuries, and head injury. All patients were treated in a semi-rigid cervical orthosis. Univariate and multivariate analysis were undertaken to identify predictors of mortality at 30 days and one year. A total of 82 patients were identified. There were 32 men and 50 women with a mean age of 83.7 years (67 to 100). Results Overall mortality was 14.6% at 30 days and 34.1% at one year. Univariate analysis revealed head injury and the NHFS to be significant predictors of mortality at 30 days and one year. Multivariate analysis showed that head injury is an independent predictor of mortality at 30 days and at one year. The NHFS was an independent predictor of mortality at one year. The presence of other spinal injuries was an independent predictor at 30 days. Following survival analysis, an NHFS score greater than 5 stratified patients into a significantly higher risk group at both 30 days and one year. Conclusion The NHFS may be used to identify high-risk patients with a fracture of the OP. Head injury increases the risk of mortality in patients with a fracture of the OP. This may help to guide multidisciplinary management and to inform patients. This paper provides evidence to suggest that frailty rather than age alone may be important as a predictor of mortality in elderly patients with a fracture of the odontoid process. Cite this article: Bone Joint J 2019;101-B:253–259.

Lessons of the month 1: Polytrauma in a geriatric patient resulting in reactivation of cytomegalovirus infection and secondary cold agglutinin disease-induced haemolytic anaemia

“…1 Odontoid peg fractures have an overall mortality of 14.6% at 30 days and 34.1% at 1 year. 2 A separate study suggests that geriatric polytrauma has an overall mortality as high as 65%, with patients who suffer major blood loss (Hb <8 g/dL) having a mortality three times higher than those with moderate or minor blood loss (Hb ≥8 g/dL). 3 Cryoglobulinaemia accounts for nearly 25% of autoimmune haemolytic anaemia 4 and is important to rule out in cases of suspected haemolytic anaemia.…”

Which frailty scales for patients with adult spinal deformity are feasible and adequate? A systematic review

“…Seventeen studies reported predictive and/or construct validity of eight scales (Table 4). The largest AUC and correlation coefficients of the reported predictive validity was 0.704 (moderate accuracy) [59] and 0.400 (medium strength) respectively [63], suggesting that all other scales were considered to have low accuracy and weak correlation regardless of domain of spinal disorders.…”

Spine Trauma

“…Approximately 59% of C2 fractures involve the odontoid process [3,4]. Mortality of C2 fractures in patients 65 years and older is substantial-approximately 15% at 30 days and 34% and 1 year [5]. The most common mechanism is motor vehicle accident, but in older patients even low energy trauma can result in odontoid process fractures [5].…”

“…Mortality of C2 fractures in patients 65 years and older is substantial-approximately 15% at 30 days and 34% and 1 year [5]. The most common mechanism is motor vehicle accident, but in older patients even low energy trauma can result in odontoid process fractures [5]. There are three types of odontoid fractures as classified by Anderson and D'Alonzo (Fig.…”