title: Cervical spine fractures in patients 65 years or older: a 3-year experience at a level I trauma center.
abstract: BACKGROUND
  Cervical spine fractures in the elderly carry a mortality as high as 26%. We reviewed our experience to define the level of injury, prevalence of neurologic deficits, treatments employed, and the correlation between patients' pre- and posthospital residences. Also, we correlated the prevalence of advanced directives with length of stay.
  
  
  METHODS
  We queried the data collected prospectively at an American College of Surgeons verified Level I hospital (National TRACS, American College of Surgeons) regarding patients aged 65 years or older presenting with cervical spine fractures (International Classification of Diseases-9 code 805.X) in calendar years 2000 through 2003.
  
  
  RESULTS
  We identified 58 patients (ages 65-94). Mortality was 24%. Twelve patients had quadriplegia or paraplegia and seven of these patients died. Respiratory failure was the primary cause of death. Application of rigid collars and a halo brace were the most commonly employed therapies. Mortality rates for halo stabilization and rigid collar and halo stabilization were similar (23% vs. 29%). Despite having a higher mean Injury Severity Score, the 16 patients with advanced directives had an intensive care unit length of stay similar to that of patients without advanced directives but a statistically significant shorter overall length of stay (13 vs. 6.9 days). Eighteen of 45 patients living at home at the time of injury returned home.
  
  
  CONCLUSIONS
  Cervical spine injury in the elderly does not inevitably relegate patients to a setting of more acute nursing care. The health and social factors that allowed many to return to living at home warrant investigation, as support of these factors may assist others with this injury.
authors.affiliation: Department of Surgery, McLaren Regional Medical Center, Flint, Michigan, USA.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Damadi
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Saxe
authors.forename: John J
authors.initials: JJ
authors.lastname: Fath
authors.forename: Keith N
authors.initials: KN
authors.lastname: Apelgren
mesh_terms: D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008824:Michigan / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000453:epidemiology* / Q000628:therapy; D014193:Trauma Centers; D016896:Treatment Outcome