TY - JOUR
T1 - Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures
AU - Baxter, Joshua
AU - Fry, Chris H
AU - Han, Thang S
AU - et al.
PY - 2020/11/26
Y1 - 2020/11/26
N2 - 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.
AB - 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.
KW - geriatrics
KW - pressure ulcers
KW - Length of stay
KW - mortality
KW - discharge destination
U2 - 10.1007/s11739-020-02567-x
DO - 10.1007/s11739-020-02567-x
M3 - Article (Academic Journal)
C2 - 33244651
SN - 1828-0447
JO - Internal and emergency medicine
JF - Internal and emergency medicine
ER -