[Impact of age on mortality in patients with acute traumatic spinal cord injury requiring intensive care]

Abstract

Objective: To evaluate the impact of age (<or≥65 ans) on hospital mortality in traumatic spinal cord injury requiring intensive care.

Design: Retrospective, monocenter.

Patients and methods: A total of 131 patients greater or equal to 15 years (<65 years, n=109 and ≥65 years, n=22) was analyzed (cervical, n=71; thoracolumbar, n=60), over a 10 years period (1998-2008). The hospital and long-term mortality were studied. The risks factors of death were searched by a uni- and multivariate analysis. Intensive care unit (ICU) discharge and long-term neurological recovery, and long-term functional independence measure (FIM) were assessed.

Results: Hospital mortality was increased in patients greater or equal to 65 years (41% vs 6%, P<0.001) and long term mortality was not different between the two groups (31% vs 12%, P=0.150). The risks factors of death were age (HR=3.44; IC 95%: 1.53-7.72, P=0.028), previous coronary disease (HR=3.64; IC 95%: 1.25-10.65; P=0.018) and fall injury (HR=2.40; IC 95%: 1.15-5.00, P=0.020). Among survivors, incompletes forms (Frankel B, C, D, E) were significantly more frequent in older patients at ICU discharge and long term follow up. At long term, FIM was similar in the two groups except a better sphincter control in patient greater or equal to 65 years.

Conclusion: Mortality rate of older people (≥65 years) were greater than those in younger people, mainly caused by an increased hospital mortality. Among survivors, the neurological recovery was better in patients' greater or equal to 65 years, and was associated with a functional status at least comparable than in the youngest patients.