@article{ref1,
title="Improving life expectancy: a 'broken neck' doesn't have to be a terminal diagnosis for the elderly",
journal="Trauma surgery and acute care open",
year="2018",
author="Godat, Laura N. and Kobayashi, Leslie M. and Chang, David C. and Coimbra, Raul",
volume="3",
number="1",
pages="e000174-e000174",
abstract="BACKGROUND: Elderly patients with cervical spine fractures require optimal care. Treatment with a cervical collar or halo instead of surgical fixation may increase mortality. This investigation intends to describe the life expectancy after injury and evaluate the impact of surgical intervention on mortality. <br><br>METHODS: Patients ≥65 years, with traumatic cervical spine fractures without cord injury were identified in the 1995-2009 California Office of Statewide Health and Planning database. Those with halo placement or surgical spine fixation were identified. Primary outcome was death, studied at the initial admission, 30 days, 1 year, and the entire study period. Univariate and multivariate regressions were performed to identify predictors of death. Kaplan-Meier survival curves were used to describe life expectancy after injury. <br><br>RESULTS: 10 938 patients were identified. Mortality rate was 10% during the initial admission, 28% at 1 year and 50% during the entire study period. A halo was placed in 14% of patients and 12% underwent surgical fixation. Mortality rates during the initial admission were 11% for patients without an intervention, 7% with halo placement and 6% with surgical fixation; at 1 year, these increased to 30%, 26% and 19%, respectively. At 1 year, more than one in four patients above 75 years of age will die.At 1 year spine fixation, female gender and admission to a trauma center predicted a lower risk of death at 1 year (OR 0.59, 0.68; p<0.001 and OR 0.89; p=0.02, respectively). Having a complication, fall mechanism, and traumatic brain injury (OR 1.84, 1.33, 1.37; p<0.001, respectively) were predictors of a higher risk of death. Halo use had no impact on death at 1 year (OR 0.98; p=0.77). <br><br>DISCUSSION: Mortality rates after cervical spine fracture in the elderly is high. Surgical fixation is associated with improved survival; remaining true after adjusting for age and comorbidities; suggesting that surgical fixation may improve outcomes in the elderly. LEVEL OF EVIDENCE: Level IV.<p /> <p>Language: en</p>",
language="en",
issn="2397-5776",
doi="10.1136/tsaco-2018-000174",
url="http://dx.doi.org/10.1136/tsaco-2018-000174"
}