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Buwaider A, El-Hajj VG, Blixt S, Nilsson G, MacDowall A, Gerdhem P, Edström E, Elmi-Terander A. Predictors of Early Mortality Following Surgical or Non-surgical Treatment of Subaxial Cervical Spine Fractures: A Retrospective Nationwide Registry Study. Spine J 2024:S1529-9430(24)00297-3. [PMID: 38909908 DOI: 10.1016/j.spinee.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Traumatic subaxial cervical spine fractures are a significant public health concern due to their association with spinal cord injuries (SCI). Despite being mostly caused by low-energy trauma, these fractures significantly contribute to morbidity and mortality. Currently, research regarding early mortality based on the choice of treatment following these fractures is limited. Identifying predictors of early mortality may aid in postoperative patient monitoring and improve outcomes. PURPOSE This study aimed to identify predictors of 30-days, 90-days, and one-year mortality in adults treated for subaxial fractures. STUDY DESIGN A retrospective review of the nationwide Swedish Fracture Register (SFR). PATIENT SAMPLE All adult patients in the SFR who underwent treatment for a subaxial cervical fracture (n = 1,963). OUTCOME MEASURES Analyzed variables included age, sex, injury mechanism, neurological function, fracture characteristics, and treatment type. The primary endpoints were 30-days, 90-days, and one-year mortality. METHODS 1,963 patients in the SFR, treated for subaxial cervical fractures between 2013 to 2021, were analyzed. Surgical procedures included anterior, posterior, or anteroposterior approaches. Non-surgical treatment included collar treatment or medical examinations without intervention. Stepwise regression and Cox regression analysis were used to determine predictors. Model performance was tested using the area under the receiver operating characteristic curve (AUC). RESULTS 620 patients underwent surgery and 1,343 received non-surgical treatment. Surgical cases had primarily translation fractures, with 323 (52%) displaying no neurological deficits. Mortality rates at 30 days, 90 days, and one year were 22/620 (3.5%), 35/620 (5.6%), and 53/620 (8.5%), respectively. Age and SCI were predictors of mortality. Non-surgically treated patients mostly had compression fracture, with 1,214 (90%) experiencing no neurological deficits. Mortality rates at 30 days, 90 days, and one year were 41/1,343 (3.1%), 71/1,343 (5.3%), and 118/1,343 (8.7%). Age, male sex, SCI and fractures occurring at the C3 or C6 levels were predictors of mortality. An intact neurological function was a positive predictor of survival among non-surgically treated patients (AUC > 0.78). CONCLUSIONS Age and SCI emerged as significant predictors of early mortality in both surgically and non-surgically treated patients. An intact neurological function served as a protective factor against early mortality in non-surgically treated patients. Fractures at C3 or C6 vertebrae may impact mortality.
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Affiliation(s)
- Ali Buwaider
- Department of Clinical Neuroscience, Karolinska Institutet, Eugeniavägen 6, Elite Hotel Carolina Tower, 4(th) floor, ME Neurokirurgi, 17164, Stockholm, Sweden
| | - Victor Gabriel El-Hajj
- Department of Clinical Neuroscience, Karolinska Institutet, Eugeniavägen 6, Elite Hotel Carolina Tower, 4(th) floor, ME Neurokirurgi, 17164, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Löwenströms väg 1, 194 89, Upplands Väsby, Sweden
| | - Simon Blixt
- Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen, Enheten för ortopedi och teknologi K54, 14186, Stockholm, Sweden
| | - Gunnar Nilsson
- Capio Spine Center Stockholm, Löwenströmska Hospital, Löwenströms väg 1, 194 89, Upplands Väsby, Sweden
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden; Department of Orthopedics and Hand surgery, Uppsala University Hospital, Akademiska sjukhuset, 751 85, Uppsala, Sweden
| | - Paul Gerdhem
- Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen, Enheten för ortopedi och teknologi K54, 14186, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden; Department of Orthopedics and Hand surgery, Uppsala University Hospital, Akademiska sjukhuset, 751 85, Uppsala, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Eugeniavägen 6, Elite Hotel Carolina Tower, 4(th) floor, ME Neurokirurgi, 17164, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Löwenströms väg 1, 194 89, Upplands Väsby, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Eugeniavägen 6, Elite Hotel Carolina Tower, 4(th) floor, ME Neurokirurgi, 17164, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Löwenströms väg 1, 194 89, Upplands Väsby, Sweden; Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden.
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Yokota K, Sakai H, Kawano O, Morishita Y, Masuda M, Hayashi T, Kubota K, Ideta R, Ariji Y, Koga R, Murai S, Ifuku R, Uemura M, Kishimoto J, Watanabe H, Nakashima Y, Maeda T. Changing trends in traumatic spinal cord injury in an aging society: Epidemiology of 1152 cases over 15 years from a single center in Japan. PLoS One 2024; 19:e0298836. [PMID: 38753862 PMCID: PMC11098516 DOI: 10.1371/journal.pone.0298836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/30/2024] [Indexed: 05/18/2024] Open
Abstract
Traumatic spinal cord injury (TSCI) causes an insult to the central nervous system, often resulting in devastating temporary or permanent neurological impairment and disability, which places a substantial financial burden on the health-care system. This study aimed to clarify the up-to-date epidemiology and demographics of patients with TSCI treated at the largest SCI center in Japan. Data on all patients admitted to the Spinal Injuries Center with TSCI between May 2005 and December 2021 were prospectively collected using a customized, locally designed SCI database named the Japan Single Center Study for Spinal Cord Injury Database (JSSCI-DB). A total of 1152 patients were identified from the database. The study period was divided into the four- or five-year periods of 2005-2009, 2010-2013, 2014-2017, and 2018-2021 to facilitate the observation of general trends over time. Our results revealed a statistically significant increasing trend in age at injury. Since 2014, the average age of injury has increased to exceed 60 years. The most frequent spinal level affected by the injury was high cervical (C1-C4: 45.8%), followed by low cervical (C5-C8: 26.4%). Incomplete tetraplegia was the most common cause or etiology category of TSCI, accounting for 48.4% of cases. As the number of injuries among the elderly has increased, the injury mechanisms have shifted from high-fall trauma and traffic accidents to falls on level surfaces and downstairs. Incomplete tetraplegia in the elderly due to upper cervical TSCI has also increased over time. The percentage of injured patients with an etiology linked to alcohol use ranged from 13.2% (2005-2008) to 19% (2014-2017). Given that Japan has one of the highest aging populations in the world, epidemiological studies in this country will be very helpful in determining health insurance and medical costs and deciding strategies for the prevention and treatment of TSCI in future aging populations worldwide.
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Affiliation(s)
- Kazuya Yokota
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashiku, Fukuoka, Japan
| | - Hiroaki Sakai
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Osamu Kawano
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Yuichiro Morishita
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Muneaki Masuda
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Tetsuo Hayashi
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Kensuke Kubota
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Ryosuke Ideta
- Department of Rehabilitation Medicine, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Yuto Ariji
- Department of Rehabilitation Medicine, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Ryuichiro Koga
- Department of Rehabilitation Medicine, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Satoshi Murai
- Department of Rehabilitation Medicine, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Ryusei Ifuku
- Department of Rehabilitation Medicine, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Masatoshi Uemura
- Department of Rehabilitation Medicine, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Junji Kishimoto
- Center for Clinical and Translational Research, Graduate School of Medical Sciences, Kyushu University, Higashiku, Fukuoka, Japan
| | - Hiroko Watanabe
- Center for Clinical and Translational Research, Graduate School of Medical Sciences, Kyushu University, Higashiku, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashiku, Fukuoka, Japan
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center, Iizuka, Fukuoka, Japan
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Sawada Y, Isshiki Y, Ichikawa Y, Fukushima K, Aramaki Y, Kawano K, Mori M, Oshima K. The Significance of the Treatment for Elderly Severe Trauma Patients Who Required Intensive Care. Cureus 2023; 15:e39110. [PMID: 37378219 PMCID: PMC10292122 DOI: 10.7759/cureus.39110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Purpose Elderly trauma patients have a higher risk of severe disability and death, and this outcome burden in elderly trauma patients must be addressed in countries in which the population is aging. The clarification of the unique clinical features of elderly people who have experienced trauma is important. The purpose of this study is to evaluate the significance of the treatment for elderly severe trauma patients based on the prognosis and total hospital cost. Methods Trauma patients transferred to our emergency department (ED) and admitted to our intensive care unit (ICU) directly or through emergency surgery between January 2013 and December 2019 were examined. We divided patients into three groups: <65 years old (Group Y); 65-79 years old (Group M); and ≥80 years old (Group E). We compared the pre- and post-trauma American Society of Anesthesiology Physical Status (ASA-PS) score and the Katz Activities of Daily Living (ADL) questionnaire at arrival among the three groups. In addition, the duration of ICU and hospital stays, hospital mortality, and total treatment costs were compared. Results There were 1,652 patients admitted to ICU through the ED from January 2013 to December 2019. Of those patients, 197 trauma patients were analyzed. There was no significant difference in injury severity scores between the groups. Significant differences in both the ASA-PS and Katz-ADL scores in posttrauma status were observed among the three groups (posttrauma ASA-PS, 2.0 (2.0, 2.8) in Group Y, 3.0 (2.0, 3.0) in Group M, 3.0 (3.0, 3.0) in Group E, p < 0.001*, posttrauma Katz-ADL, 10.0 (3.3, 12.0) in Group Y, 5.5 (2.0, 10.0) in Group M, 2.0 (0.5, 4.0) in Group E, p < 0.001). The duration of both ICU and hospital stay was significantly longer in Group E compared to the other groups (ICU stay, 4.0 (3.0, 6.5) days in Group Y, 4.0 (3.0, 9.8) days in Group M, 6.5 (3.0, 15.3) days, p = 0.006, hospital stay, 16.9 (8.6, 33.0) days in Group Y, 26.7 (12.0, 51.8) days in Group M, 32.5 (12.8, 51.5) days in Group E, p = 0.005). ICU and hospital mortality were highest in Group E compared with the other groups, but the differences were not significant. Finally, the total hospital cost in Group E was significantly higher than the other groups. Conclusions In elderly trauma patients who required intensive care, PS and ADL in posttrauma status were worse, ICU and hospital stays were longer, and ICU and hospital mortality were higher compared with younger patients. In addition, medical costs were greater in elderly patients. It is supposed that the therapeutic effect observed in young trauma patients cannot be expected in elderly trauma patients.
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Affiliation(s)
- Yusuke Sawada
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Yuta Isshiki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Yumi Ichikawa
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Kazunori Fukushima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Yuto Aramaki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Kei Kawano
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Mizuki Mori
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN
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