The elderly patient with spinal injury: Treat or transfer?

Galinos Barmparas, Zara Cooper, Adil H. Haider, Joaquim M. Havens, Reza Askari, Ali Salim

Research output: Contribution to journalArticle

Abstract

Background The purpose of this investigation was to delineate whether elderly patients with spinal injuries benefit from transfers to higher level trauma centers. Methods Retrospective review of the National Trauma Data Bank 2007 to 2011, including patients > 65 (y) with any spinal fracture and/or spinal cord injury from a blunt mechanism. Patients who were transferred to level I and II centers from other facilities were compared to those admitted and received their definitive treatment at level III or other centers. Results Of 3,313,117 eligible patients, 43,637 (1.3%) met inclusion criteria: 19,588 (44.9%) were transferred to level I-II centers, and 24,049 (55.1%) received definitive treatment at level III or other centers. Most of the patients (95.8%) had a spinal fracture without a spinal cord injury. Transferred patients were more likely to require an intensive care unit admission (48.5% versus 36.0%, P <0.001) and ventilatory support (16.1% versus 13.3%, P <0.001). Mortality for the entire cohort was 7.7% (8.6% versus 7.1%, P <0.001) and significantly higher, at 21.7% for patients with a spinal cord injury (22.3% versus 21.0%, P <0.001). After adjusting for all available covariates, there was no difference in the adjusted mortality between patients transferred to higher level centers and those treated at lower level centers (adjusted odds ratio [95% confidence interval]: 1.05 [0.95-1.17], P = 0.325). Conclusions Transfer of elderly patients with spinal injuries to higher level trauma centers is not associated with improved survival. Future studies should explore the justifications used for these transfers and focus on other outcome measures such as functional status to determine the potential benefit from such practices.

Original languageEnglish (US)
Pages (from-to)58-65
Number of pages8
JournalJournal of Surgical Research
Volume202
Issue number1
DOIs
StatePublished - May 1 2016
Externally publishedYes

Fingerprint

Spinal Injuries
Spinal Cord Injuries
Spinal Fractures
Trauma Centers
Patient Transfer
Mortality
Intensive Care Units
Odds Ratio
Outcome Assessment (Health Care)
Databases
Confidence Intervals
Survival
Wounds and Injuries
Therapeutics

Keywords

  • Elderly
  • Mortality
  • Outcomes
  • Spine injuries
  • Transfers
  • Trauma centers

ASJC Scopus subject areas

  • Surgery

Cite this

Barmparas, G., Cooper, Z., Haider, A. H., Havens, J. M., Askari, R., & Salim, A. (2016). The elderly patient with spinal injury: Treat or transfer? Journal of Surgical Research, 202(1), 58-65. https://doi.org/10.1016/j.jss.2015.12.032

The elderly patient with spinal injury : Treat or transfer? / Barmparas, Galinos; Cooper, Zara; Haider, Adil H.; Havens, Joaquim M.; Askari, Reza; Salim, Ali.

In: Journal of Surgical Research, Vol. 202, No. 1, 01.05.2016, p. 58-65.

Research output: Contribution to journalArticle

Barmparas, G, Cooper, Z, Haider, AH, Havens, JM, Askari, R & Salim, A 2016, 'The elderly patient with spinal injury: Treat or transfer?', Journal of Surgical Research, vol. 202, no. 1, pp. 58-65. https://doi.org/10.1016/j.jss.2015.12.032
Barmparas G, Cooper Z, Haider AH, Havens JM, Askari R, Salim A. The elderly patient with spinal injury: Treat or transfer? Journal of Surgical Research. 2016 May 1;202(1):58-65. https://doi.org/10.1016/j.jss.2015.12.032
Barmparas, Galinos ; Cooper, Zara ; Haider, Adil H. ; Havens, Joaquim M. ; Askari, Reza ; Salim, Ali. / The elderly patient with spinal injury : Treat or transfer?. In: Journal of Surgical Research. 2016 ; Vol. 202, No. 1. pp. 58-65.
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abstract = "Background The purpose of this investigation was to delineate whether elderly patients with spinal injuries benefit from transfers to higher level trauma centers. Methods Retrospective review of the National Trauma Data Bank 2007 to 2011, including patients > 65 (y) with any spinal fracture and/or spinal cord injury from a blunt mechanism. Patients who were transferred to level I and II centers from other facilities were compared to those admitted and received their definitive treatment at level III or other centers. Results Of 3,313,117 eligible patients, 43,637 (1.3{\%}) met inclusion criteria: 19,588 (44.9{\%}) were transferred to level I-II centers, and 24,049 (55.1{\%}) received definitive treatment at level III or other centers. Most of the patients (95.8{\%}) had a spinal fracture without a spinal cord injury. Transferred patients were more likely to require an intensive care unit admission (48.5{\%} versus 36.0{\%}, P <0.001) and ventilatory support (16.1{\%} versus 13.3{\%}, P <0.001). Mortality for the entire cohort was 7.7{\%} (8.6{\%} versus 7.1{\%}, P <0.001) and significantly higher, at 21.7{\%} for patients with a spinal cord injury (22.3{\%} versus 21.0{\%}, P <0.001). After adjusting for all available covariates, there was no difference in the adjusted mortality between patients transferred to higher level centers and those treated at lower level centers (adjusted odds ratio [95{\%} confidence interval]: 1.05 [0.95-1.17], P = 0.325). Conclusions Transfer of elderly patients with spinal injuries to higher level trauma centers is not associated with improved survival. Future studies should explore the justifications used for these transfers and focus on other outcome measures such as functional status to determine the potential benefit from such practices.",
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AU - Askari, Reza

AU - Salim, Ali

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N2 - Background The purpose of this investigation was to delineate whether elderly patients with spinal injuries benefit from transfers to higher level trauma centers. Methods Retrospective review of the National Trauma Data Bank 2007 to 2011, including patients > 65 (y) with any spinal fracture and/or spinal cord injury from a blunt mechanism. Patients who were transferred to level I and II centers from other facilities were compared to those admitted and received their definitive treatment at level III or other centers. Results Of 3,313,117 eligible patients, 43,637 (1.3%) met inclusion criteria: 19,588 (44.9%) were transferred to level I-II centers, and 24,049 (55.1%) received definitive treatment at level III or other centers. Most of the patients (95.8%) had a spinal fracture without a spinal cord injury. Transferred patients were more likely to require an intensive care unit admission (48.5% versus 36.0%, P <0.001) and ventilatory support (16.1% versus 13.3%, P <0.001). Mortality for the entire cohort was 7.7% (8.6% versus 7.1%, P <0.001) and significantly higher, at 21.7% for patients with a spinal cord injury (22.3% versus 21.0%, P <0.001). After adjusting for all available covariates, there was no difference in the adjusted mortality between patients transferred to higher level centers and those treated at lower level centers (adjusted odds ratio [95% confidence interval]: 1.05 [0.95-1.17], P = 0.325). Conclusions Transfer of elderly patients with spinal injuries to higher level trauma centers is not associated with improved survival. Future studies should explore the justifications used for these transfers and focus on other outcome measures such as functional status to determine the potential benefit from such practices.

AB - Background The purpose of this investigation was to delineate whether elderly patients with spinal injuries benefit from transfers to higher level trauma centers. Methods Retrospective review of the National Trauma Data Bank 2007 to 2011, including patients > 65 (y) with any spinal fracture and/or spinal cord injury from a blunt mechanism. Patients who were transferred to level I and II centers from other facilities were compared to those admitted and received their definitive treatment at level III or other centers. Results Of 3,313,117 eligible patients, 43,637 (1.3%) met inclusion criteria: 19,588 (44.9%) were transferred to level I-II centers, and 24,049 (55.1%) received definitive treatment at level III or other centers. Most of the patients (95.8%) had a spinal fracture without a spinal cord injury. Transferred patients were more likely to require an intensive care unit admission (48.5% versus 36.0%, P <0.001) and ventilatory support (16.1% versus 13.3%, P <0.001). Mortality for the entire cohort was 7.7% (8.6% versus 7.1%, P <0.001) and significantly higher, at 21.7% for patients with a spinal cord injury (22.3% versus 21.0%, P <0.001). After adjusting for all available covariates, there was no difference in the adjusted mortality between patients transferred to higher level centers and those treated at lower level centers (adjusted odds ratio [95% confidence interval]: 1.05 [0.95-1.17], P = 0.325). Conclusions Transfer of elderly patients with spinal injuries to higher level trauma centers is not associated with improved survival. Future studies should explore the justifications used for these transfers and focus on other outcome measures such as functional status to determine the potential benefit from such practices.

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