Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures

et al.

Research output: Contribution to journalArticle (Academic Journal)

Abstract

Patients admitted with a cervical fracture are twice as likely to die within 30 days of injury than those with a hip fracture. However, guidelines for the management of cervical fractures are less available than for hip fractures. We hypothesise that outcomes may differ between these types of fractures. We analysed 1359 patients (406 men, 953 women) with mean (±SD) age 83.8 ±8.7 years admitted to an NHS hospital in 2013-2019 with a cervical (7.5%) or hip fracture (92.5%) of similar age. The association of cervical fracture (hip fracture as reference), hospital length of stay (LOS), co-morbidities, age and sex with outcomes (acute delirium, new pressure ulcer, and discharge to residential/nursing care) was assessed by stepwise multivariate logistic regression. The risk of acute delirium without history of dementia was increased with cervical fractures: odds ratio (OR)=2.4, 95% confidence interval (CI)=1.3-4.7, age ≥80 years: OR=3.5 (95%CI=1.9-6.4), history of stroke: OR=1.8 (95%CI=1.0-3.1) and ischaemic heart disease: OR=1.9 (95%CI=1.1-3.6), pressure ulcers was increased with cervical fractures: OR=10.9 (95%CI=5.3-22.7), LOS of 2-3 weeks: OR=3.0 (95%CI=1.2-7.5) and LOS of ≥3 weeks: OR=4.9, 95%CI=2.2-11.0, and discharge to residential/nursing care was increased with cervical fractures: OR=3.2 (95%CI=1.4-7.0), LOS of ≥3 weeks: OR=4.4 (95%CI=2.5-7.6), dementia: OR=2.7 (95%CI=1.6-4.7), Parkinson’s disease: OR=3.4 (95%CI=1.3-8.8), and age ≥80 years: OR=2.7 (95%CI=1.3-5.6). In conclusion, compared with hip fracture, cervical fracture is associated with increased risk for acute delirium and pressure ulcers, and for discharge to residency of high level of care, independent of established risk factors.
Original languageEnglish
JournalInternal and emergency medicine
Publication statusAccepted/In press - 7 Nov 2020

Keywords

  • geriatrics
  • pressure ulcers
  • Length of stay
  • mortality
  • discharge destination

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