利用全国性数据库对2001年至2010年老年患者颈椎损伤的分析：发病率、总死亡率及住院费用均呈上升趋势
Analysis of Cervical Spine Injuries in Elderly Patients from 2001 to 2010 Using a Nationwide Database: Increasing Incidence, Overall Mortality, and Inpatient Hospital Charges.
作者信息
Asemota Anthony O, Ahmed A Karim, Purvis Taylor E, Passias Peter G, Goodwin C Rory, Sciubba Daniel M
机构信息
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Division of Spinal Surgery, Department of Orthopaedic Surgery, New York University Medical Center Hospital for Joint Diseases, New York University School of Medicine, New York, New York, USA.
出版信息
World Neurosurg. 2018 Dec;120:e114-e130. doi: 10.1016/j.wneu.2018.07.228. Epub 2018 Aug 2.
BACKGROUND
Cervical spine (C-spine) injuries cause significant morbidity and mortality among elderly patients. Although the population of older-adults ≥65 years in the United States is expanding, estimates of the burden and outcome of C-spine injury are lacking.
METHODS
The Nationwide Inpatient Sample 2001-2010 was analyzed. International Classification of Diseases, Ninth Revision, Clinical Modification 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 U.S. Census data.
RESULTS
A total of 167,278 older adults were included. Median age was 81 years (interquartile range = 74-86). Most patients were female (54.9%), had Medicare coverage (77.6%), were treated in teaching hospitals (63.2%), and had falls as the leading injury mechanism (51.2%). ICF occurred in 91.3%, whereas CSCI occurred in 8.7% (P < 0.001). ICF was more common in ≥85-year-old patients and CSCI in 65- to 69-year-old patients (P < 0.001). The most common injured C-spine level in ICF was the 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).
CONCLUSIONS
In summary, C-spine fractures among U.S. older adults constitute a significant health care burden. ICFs occur commonly, C2-vertebra fractures are most frequent, whereas CSCIs are linked to increased hospital-resource use 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.
背景
颈椎（C 型脊柱）损伤在老年患者中会导致显著的发病率和死亡率。尽管美国 65 岁及以上的老年人口在不断增加，但目前缺乏对 C 型脊柱损伤负担和结局的评估。
方法
对 2001 - 2010 年全国住院患者样本进行分析。使用国际疾病分类第九版临床修订本编码来识别孤立性 C 型脊柱骨折（ICF）患者和伴有脊髓损伤的 C 型脊柱骨折（CSCI）患者。利用美国人口普查数据计算年度住院率和死亡率。
结果
共纳入 167,278 名老年人。中位年龄为 81 岁（四分位间距 = 74 - 86）。大多数患者为女性（54.9%），有医疗保险覆盖（77.6%），在教学医院接受治疗（63.2%），且主要损伤机制为跌倒（51.2%）。ICF 发生率为 91.3%，而 CSCI 发生率为 8.7%（P < 0.001）。ICF 在 85 岁及以上患者中更常见，而 CSCI 在 65 至 69 岁患者中更常见（P < 0.001）。ICF 中最常受伤的 C 型脊柱节段是 C2 节段（47.6%，P < 0.001），CSCI 中是 C1 - C4 节段（4.5%，P < 0.001）。总体而言，15.8%的患者接受了 C 型脊柱手术。住院率从 2001 年的 26/100,000 增加到 2010 年的 68/100,000（变化约 167%，P < 0.001）。相应地，总体死亡率从 2001 年的 3/100,000 增加到 2010 年的 6/100,000，P < 0.001。院内死亡率为 11.3%，与年龄增长和 CSCI 密切相关（P < 0.001）。
结论
总之，美国老年人的 C 型脊柱骨折构成了重大的医疗负担。ICF 常见，C2 椎体骨折最为频繁，而 CSCI 与医院资源使用增加和更差的结局相关。在过去十年中，C 型脊柱骨折的发生率和死亡率增加了一倍多；然而，院内死亡率比例正在下降。
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