@article{ref1,
title="Analysis of cervical spine injuries in the elderly from 2001-2010 using a nationwide database: increasing incidence, overall mortality and inpatient hospital charges",
journal="World neurosurgery",
year="2018",
author="Asemota, Anthony O. and Ahmed, A. Karim and Purvis, Taylor E. and Passias, Peter G. and Goodwin, C. Rory and Sciubba, Daniel M.",
volume="120",
number="",
pages="e114-e130",
abstract="BACKGROUND: Cervical spine (C-spine) injuries cause significant morbidity and mortality among the elderly. Although the population of older-adults ≥65 years in the US is expanding, estimates of the burden and outcome of C-spine injury are lacking. <br><br>METHODS: The Nationwide Inpatient Sample 2001-2010 was analyzed. International Classification of Diseases codes identified patients with isolated C-spine fractures (ICF) and C-spine fractures with spinal cord injury (CSCI). Annual admission and mortality rates were calculated using US-Census data. <br><br>RESULTS: A total of 167,278 older-adults were included. Median age was 81 years (IQR=74-86). Most patients were female (54.9%), had Medicare coverage (77.6%), treated in teaching hospitals (63.2%), and falls were the leading injury-mechanism (51.2%). ICF occurred in 91.3%, while CSCI occurred in 8.7% (p<0.001). ICF was more common in ≥85 year-olds and CSCI in 65-69 year-olds (p<0.001). The most common injured C-spine level in ICF was C2-level (47.6%, p<0.001), and in CSCI was C1-C4 level (4.5%, p<0.001). Overall, 15.8% underwent C-spine surgery. Hospitalization rates increased from 26/100,000 in 2001 to 68/100,000 in 2010 (∼167% change, p<0.001). Correspondingly, overall mortality increased from 3/100,000 in 2001 to 6/100,000 in 2010, p<0.001. In-hospital mortality was 11.3%, was strongly associated with increasing age and CSCI (p<0.001). <br><br>CONCLUSIONS: In summary, C-spine fractures among US older-adults constitute a significant healthcare burden. ICF occur commonly, C2-vertebra fractures are most frequent, while CSCI are linked to increased hospital-resource utilization and worse outcomes. The incidence of C-spine fractures and mortality more than doubled over the past decade; however, proportional in-hospital mortality is decreasing.<br><br>Copyright © 2018. Published by Elsevier Inc.<p /> <p>Language: en</p>",
language="en",
issn="1878-8750",
doi="10.1016/j.wneu.2018.07.228",
url="http://dx.doi.org/10.1016/j.wneu.2018.07.228"
}