Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures

Joshua Baxter,Radcliffe Lisk,Thang Sieu Han,David Fluck,Ahmad Osmani,Keefai Yeong,Jonathan Robin,Christopher Henry Fry

doi:10.1007/s11739-020-02567-x

Abstract

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.

Highlights

Hip fracture is a disabling condition affecting many older individuals worldwide, with incidence rates being greatest among high income countries, those further from the equator [1]
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
Most patients came from their own home (81.3%), followed by residential/ nursing care (12.0%) and rehabilitation (6.7%). 102 (7.5%) patients were admitted with cervical fractures with mean age of 82.7 years (SD ± 9.8) and 1257 (350 men, 907 women) patients admitted with hip fractures with mean age of 83.9 years (SD ± 8.6)

Summary

Introduction

Hip fracture is a disabling condition affecting many older individuals worldwide, with incidence rates being greatest among high income countries, those further from the equator [1]. The estimated lifetime risk of a hip fracture is 23% in European women and 11% in European men [2]. In 1990, the global number of hip fractures was 1.26 million. Because of the steep rise in the rates of hip fractures with age and the growing ageing population, their number is expected to rise to 4.5 million by 2050 [3]. Hip fracture is a prognostic indicator of mortality and disability. The mean cost for an index hospitalisation has been estimated to be over US $10,000, and health and social care costs almost $44,000 at 1 year [6]

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Conclusion