Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK.
Intern Emerg Med. 2021 Aug;16(5):1207-1213. doi: 10.1007/s11739-020-02567-x. Epub 2020 Nov 26.
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 age of 83.8 years (standard deviation = 8.7) admitted to a National Health Service 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. 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 more likely to associate with acute delirium and pressure ulcers, and for discharge to residency of high level of care, independent of established risk factors.
因颈椎骨折入院的患者在受伤后 30 天内死亡的可能性是髋部骨折患者的两倍。然而，颈椎骨折的治疗指南比髋部骨折的治疗指南要少。我们假设这两种类型的骨折的结果可能不同。我们分析了 2013 年至 2019 年间在英国国民保健系统医院就诊的 1359 名患者（406 名男性，953 名女性），他们的平均年龄为 83.8 岁（标准差=8.7），患有颈椎（7.5%）或髋部骨折（92.5%），年龄相似。通过逐步多变量逻辑回归评估颈椎骨折（以髋部骨折为参照）、住院时间（LOS）、合并症、年龄和性别与结果（急性谵妄、新发压疮和转至疗养院/护理院）之间的关系。无痴呆病史的急性谵妄与颈椎骨折有关：比值比（OR）=2.4，95%置信区间（CI）=1.3-4.7，年龄≥80 岁：OR=3.5（95%CI=1.9-6.4），中风史：OR=1.8（95%CI=1.0-3.1）和缺血性心脏病：OR=1.9（95%CI=1.1-3.6）；压疮与颈椎骨折有关：OR=10.9（95%CI=5.3-22.7），2-3 周 LOS：OR=3.0（95%CI=1.2-7.5）和 LOS≥3 周：OR=4.9，95%CI=2.2-11.0；转至疗养院/护理院与颈椎骨折有关：OR=3.2（95%CI=1.4-7.0），LOS≥3 周：OR=4.4（95%CI=2.5-7.6），痴呆：OR=2.7（95%CI=1.6-4.7），帕金森病：OR=3.4（95%CI=1.3-8.8），年龄≥80 岁：OR=2.7（95%CI=1.3-5.6）。总之，与髋部骨折相比，颈椎骨折更易发生急性谵妄和压疮，且更易转至高级护理院，独立于既定的风险因素。
