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Clinical Research
DOI: 10.1016/j.neucie.2020.06.001
Available online 29 October 2020
Clinical characteristics and prognosis of spinal cord injury in individuals over 75 years old
Características clínicas y pronóstico de la lesión medular traumática en pacientes mayores de 75 años
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Rubén Mora-Bogaa,
Corresponding author
ruben.mora.boga@sergas.es

Corresponding author.
, Eva Canosa-Hermidaa, Iris Toral-Guisasolaa, Vanessa Balboa-Barreiroc, Sebastián Salvador-de la Barreraa, María Elena Ferreiro-Velascoa, Antonio Rodríguez-Sotilloa,b, Antonio Montoto-Marquésa,b
a Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
b Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, Spain
c Unidad de Estadística y Epidemiología Clínica, Spanish Clinical Research Network (SCReN), Complexo Hospitalario Universitario, A Coruña (CHUAC), A Coruña, Spain
Received 26 January 2020. Accepted 22 June 2020
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Figures (1)
Tables (5)
Table 1. Demographic characteristics and comorbidities by age group.
Table 2. Aetiology of traumatic spinal cord injury.
Table 3. Characteristics of spinal cord injury on admission by age group.
Table 4. Care during hospitalisation for acute traumatic spinal cord injury.
Table 5. Analysis of the risk factors for death in patients over 75 years with traumatic spinal cord injury.
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Abstract
Objective

To analyze the incidence and characteristics of traumatic spinal cord injury (SCI) in geriatric population of Galicia (Spain), hospital management and functional prognosis

Methods

Comparative retrospective study. Patients admitted with acute traumatic SCI during the time period between January 2010 and December 2016 were included. Two groups established: The elderly over and under 75 years of age, with the latter acting as a control group.

Results

379 patients were studied (27.2% ≥75 years). The main etiology in the >75 years group were falls: 80.6%. There were 65.7% who presented incomplete spinal cord injuries with mean motor index (MI) of 44.9/100. Upon discharge, 90.8% were dependent. Hospital mortality was 34.9%. Those >75 years suffered from more cervical injuries (74.8 vs. 51.2%, p < 0.001), longer delay in diagnosis (31.1% vs. 9.2%, p < 0.001) and higher hospital mortality (34.9% vs. 3.2%, p < 0.001). Fewer surgical interventions were performed, with a longer delay. Percentages for admission into ICU, mechanical ventilation and performing a tracheostomy proved to be similar. There were no significant differences found in the evolution according to the ASIA scale or the MI.

Conclusions

1) The frequency of traumatic SCI in the elderly in Galicia is high. 2) Neurological evolution is similar to younger patients but the level of dependence is higher. 3) The level of care provided is similar in both groups, except for the surgical indication. 4) Hospital mortality is high.

Keywords:
Traumatic spinal cord injury
Falls
Geriatric patient
Prognosis
Resumen
Objetivos

Analizar la incidencia y características de la lesión medular (LM) traumática en la población geriátrica de Galicia (España), el manejo hospitalario y el pronóstico vital y funcional.

Material y métodos

Estudio comparativo retrospectivo. Se incluyen los pacientes ingresados por LM traumática aguda entre enero de 2010 y diciembre de 2016. Se establecen dos grupos: mayores y menores de 75 años, actuando los últimos como grupo control.

Resultados

Recogidos 379 pacientes (27,2% ≥75 años). La etiología más frecuente en el grupo ≥75 años fueron las caídas: 80,6%. El 65,7% presentaban lesiones medulares incompletas con un índice motor (IM) medio de 44,9/100. Al alta el 90,8% eran dependientes, precisando silla de ruedas el 53,8%. La mortalidad hospitalaria fue del 34,9%. En comparación con el grupo control, los pacientes mayores sufrieron más lesiones cervicales (74,8 vs 51,2%, p < 0,001), mayor retraso diagnóstico (31,1% vs 9,2%, p < 0,001) y mortalidad hospitalaria (34,9% vs 3,2%, p < 0,001). Se realizaron menos intervenciones quirúrgicas y con mayor demora. Los porcentajes de ingreso en UCI, ventilación mecánica y realización de traqueostomía fueron similares. No se encontraron diferencias significativas en cuanto a evolución neurológica según la escala ASIA (American Spinal Injury Association) (p = 0,46) o el IM (p = 0,48).

Conclusiones

1) La frecuencia de LM traumática en ancianos en Galicia es elevada. 2) La evolución neurológica medida por el ASIA es similar a pacientes más jóvenes, si bien el nivel de dependencia al alta es mayor. 3) El nivel de cuidados hospitalarios es similar en ambos grupos salvo por la indicación quirúrgica. 4) La mortalidad hospitalaria es alta.

Palabras clave:
Lesión medular traumática
Caídas
Paciente geriátrico
Pronóstico

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