Irwin Zareth N, Arthur Melanie, Mullins Richard J, Hart Robert A
Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland 97201, USA.
Spine (Phila Pa 1976). 2004 Apr 1;29(7):796-802. doi: 10.1097/01.brs.0000119400.92204.b5.
Retrospective cohort analysis of hospital discharge and mortality data for spinal fracture and spinal cord injury patients in a single state from 1990 to 1995.
Population-based review of preinjury patient factors, injury and treatment patterns, and in-hospital versus 60-day mortality in adult and geriatric spinal injury patients.
While population-based analyses of hospitalized injured patients indicate that geriatric patients are at higher risk for adverse outcome, less is known about the specific subset of patients with spinal fracture and spinal cord injury. A specific knowledge gap exists regarding factors that influence survival after hospital discharge of spine-injured patients.
Patients with cervical, thoracic, or lumbar spinal fracture were identified by ICD-9-CM discharge diagnosis codes. Age, gender, preexisting conditions, and injury severity were determined, and patients were divided into adult (ages 16-64 years; n = 6,029) and geriatric (ages >or=65 years; n = 3,973) groups. In-hospital and 60-day mortality rates and odds ratios of 60-day mortality were calculated relative to patient and injury characteristics, level of treating hospital, and surgical treatment.
Increased 60-day mortality was associated with preexisting medical conditions, increased injury severity, and paralysis but reduced with surgical treatment. Geriatric patients had fewer cervical injures, lower force injuries, less severe overall injuries, decreased paralysis, increased preexisting conditions, decreased treatment at level 1 and 2 treatment centers, and decreased odds of surgical treatment. Geriatric patients also had increased 60-day versus in-hospital mortality and increased mortality associated with cervical spine injury.
Differences exist in preinjury patient factors, injury and treatment patterns, and mortality between adult and geriatric patients following spinal injuries. The increased 60-day versus in-hospital mortality for the geriatric population suggests that 60-day mortality may be a better measure of outcome for these patients. While the possibility of selection bias exists, both geriatricand adult patients had reduced 60-day mortality associated with surgical intervention.
对1990年至1995年单个州脊柱骨折和脊髓损伤患者的出院及死亡率数据进行回顾性队列分析。
基于人群对成年和老年脊柱损伤患者伤前的患者因素、损伤及治疗模式以及住院期间与60天死亡率进行评估。
虽然对住院受伤患者的基于人群的分析表明老年患者出现不良结局的风险更高，但对于脊柱骨折和脊髓损伤患者这一特定亚组的了解较少。在影响脊柱损伤患者出院后生存的因素方面存在特定的知识空白。
通过ICD-9-CM出院诊断编码识别颈椎、胸椎或腰椎骨折患者。确定年龄、性别、既往疾病和损伤严重程度，并将患者分为成年组（16至64岁；n = 6029）和老年组（年龄≥65岁；n = 3973）。计算相对于患者和损伤特征、治疗医院级别及手术治疗的住院期间和60天死亡率以及60天死亡率的比值比。
60天死亡率增加与既往疾病、损伤严重程度增加和瘫痪相关，但手术治疗可降低死亡率。老年患者颈椎损伤较少、致伤力较低、总体损伤较轻、瘫痪减少、既往疾病增加、在1级和2级治疗中心接受治疗减少以及手术治疗的几率降低。老年患者60天死亡率相对于住院期间死亡率也有所增加，且与颈椎损伤相关的死亡率增加。
成年和老年脊柱损伤患者在伤前患者因素、损伤及治疗模式以及死亡率方面存在差异。老年人群60天死亡率相对于住院期间死亡率增加表明，60天死亡率可能是这些患者结局的更好衡量指标。虽然存在选择偏倚的可能性，但老年和成年患者与手术干预相关的60天死亡率均有所降低。
