Department of Surgery, NYU Langone Health, Bellevue Hospital Center, New York, New York.
Department of Surgery, NYU Langone Health, Bellevue Hospital Center, New York, New York.
J Surg Res. 2020 Sep;253:100-104. doi: 10.1016/j.jss.2020.03.036. Epub 2020 Apr 25.
Osteopenia is common in the elderly, increasing their risk of sustaining cervical fractures after ground level falls (GLFs). We sought to examine the incidence of blunt cerebrovascular injury (BCVI) and subsequent stroke in elderly GLF patients as compared with other higher injury mechanisms.
The Trauma Quality Improvement Program database (2011-2016) was used to identify blunt trauma patients with isolated (other body region abbreviated injury scale <3) cervical spine (C1-C7) fractures. Patients were stratified into three groups: nonelderly patients (<65) with all mechanisms of injury, elderly patients (≥65) with GLF, and elderly patients with all other mechanism of injury. Multivariable logistic regression was used to determine predictors for BCVI, stroke, spinal cord injury, and acute kidney injury.
Seventeen thousand six hundred twenty-eight patients with cervical spine injuries were identified. BCVI was highest in the <65 group (0.8%) and lowest in elderly patients with GLF (0.3%, P = 0.001). When controlling for other factors, elderly patients with GLF were less likely to sustain BCVI (adjusted odds ratio: 0.46, P = 0.03) but had comparable rates of stroke attributable to BCVI (18.2% versus 6.5%, P = 0.184) and comparable rate of acute kidney injury compared with elderly patients with other mechanism of injury.
In elderly patients with isolated cervical spine fracture after GLF, BCVI occurs less frequently but is associated with a comparable rate of stroke as compared with other mechanisms. Low injury mechanism should not preclude BCVI screening in the presence of cervical spine fractures.
骨质疏松症在老年人中很常见，增加了他们在平地跌倒（GLF）后发生颈椎骨折的风险。我们试图研究与其他更高损伤机制相比，老年 GLF 患者中钝性脑血管损伤（BCVI）和随后中风的发生率。
使用创伤质量改进计划数据库（2011-2016 年）来确定孤立性（其他身体区域简略损伤量表 <3）颈椎（C1-C7）骨折的钝性创伤患者。患者分为三组：所有损伤机制的非老年患者（<65 岁），老年患者（≥65 岁）的 GLF，以及老年患者的所有其他损伤机制。多变量逻辑回归用于确定 BCVI、中风、脊髓损伤和急性肾损伤的预测因素。
确定了 17628 例颈椎损伤患者。<65 岁组的 BCVI 最高（0.8%），老年 GLF 患者最低（0.3%，P=0.001）。在控制其他因素后，老年 GLF 患者发生 BCVI 的可能性较小（调整后的优势比：0.46，P=0.03），但归因于 BCVI 的中风率相当（18.2%与 6.5%，P=0.184），与老年患者的其他损伤机制相比，急性肾损伤的发生率相当。
在 GLF 后孤立性颈椎骨折的老年患者中，BCVI 发生频率较低，但与其他机制相比，中风的发生率相当。在存在颈椎骨折的情况下，低损伤机制不应排除 BCVI 筛查。
