Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

Abstract

BACKGROUND CONTEXT Frailty is a relatively new medical concept defined as decreased physiologic reserve and vulnerability to hospitalization. Little is known of frailty's role in traumatic odontoid fractures (C2fx), regarding mechanisms-of-traumatic-injury (MOI) and susceptibility to multiple fxs. PURPOSE Investigate the relationship between patient frailty status and traumatic MOIs. STUDY DESIGN/SETTING Retrospective review of a single-center C2fx database. PATIENT SAMPLE A total of 70 odontoid fx patients. OUTCOME MEASURES Modified frailty index (mFI), serum blood lab test results, concurrent injury rates. METHODS C2fx Patients>=65y/o with an adult traumatic odontoid fx were included. Age, gender, race, charlson comorbidity score (CCI), modified frailty index (mFI, scored from 0-1; [pre-frail 0] [frail>=0.2]) and injury mechanisms were assessed. ANOVA analysis determined differences in mFI among varying MOIs (falls, low speed MVA, high speed MVA, pedestrian vs. car). Logistic regression models (covariates: age, gender, CCI, lymphocyte count, frailty) determined the odds of being injured by a traumatic fall, as well as concurrent injury risk in patients with traumatic falls. RESULTS A total of 70 patients were included (mean age: 80.6±8.5; gender: 60%F; 88% European, 10% Maori/Pacific, 1.4% Asian; CCI 5.3±2.2; mFI 0.21±0.15). The most common MOIs were falls (74.3%), high speed MVAs (17.1%), low speed MVAs (5.7%) and pedestrian versus car (2.9%). Patients with traumatic falls exhibited significantly higher mFI scores (0.25) compared to low speed MVAs (0.16), high speed MVAs (0.08) and pedestrian versus car (0.01) (p=.003). Patients with falls also had lower lymphocyte counts (1.3vs. 2.9vs. 1.5vs. 1.9, p=.033) compared to all MOIs, and higher CCI (5.7vs. 3.0vs. 3.8, p=.018) compared to high speed MVAs and pedestrian versus car accidents. ‘Frail’ patients were at higher risk of being injured via a traumatic fall (OR: 29.167[4.044–210.354], p=.001) (R2: 0.486). Of the patients with traumatic falls (n=52), 16 (30.8%) had cervical concurrent injuries, while 0 patients had noncervical concurrent injuries. mFI was not associated with an increased risk of concurrent cervical spine fractures(p=.612). CONCLUSIONS Patients with traumatic odontoid fx from falls were 29 times more likely to be frail compared to any other MOI. Physicians and patients alike should be aware of the association between elevated frailty scores and odontoid fxs from traumatic falls.