Functional outcome and discharge destination in elderly patients with spinal cord injuries.
METHODS
Retrospective cohort study.


OBJECTIVE
To describe functional outcome and discharge destination of elderly patients with traumatic spinal cord injuries.


METHODS
National Spinal Injuries Unit, Glasgow, UK.


METHODS
We collected data for 5 years on all patients >65 years old with a traumatic spinal cord injury treated at the National Spinal Injuries Unit.


RESULTS
We identified 39 patients. Of these, nine patients died during admission; all had cervical spine injuries. The mean age of the 30 survivors was 73 years (range 65-88). The most common cause of injury was a fall: 26 patients (87%). In addition, 21 (70%) sustained injury to cervical cord, 3 (10%) had thoracic and 6 (20%) had lumbar spine fractures. In all, 23 patients (77%) were treated by orthosis and 7 (23%) underwent surgical intervention. Twelve (40%) patients showed an improvement in American Spinal Injury Association impairment scale. The median hospital stay was 136 days. Thus, 11 patients (37%), all with incomplete injuries, were discharged home, 10 (33%) were transferred to nursing homes/community hospitals and 9 patients (30%) were discharged back to the referring hospital, while they were awaiting adjustments at home. Patients who were discharged home had significantly higher Functional Independence Measure scores, both at the onset of rehabilitation and at discharge, than those who were discharged to a nursing home or other hospitals (P<0.01 and <0.001, respectively).


CONCLUSIONS
Although the elderly patients may benefit from the services of a dedicated spinal injuries centre, they should be carefully selected. The patient, relatives as well as the referring doctors should be alerted to the likely long-term outcomes early in the course of the injury. Elderly patients with complete lesions of the spinal cord will almost certainly remain institutionalized. Early endeavour should be made to find alternate rehabilitation settings with a lower-intensity treatment.
Gulati
A
A
Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK. gulatiaashish@doctors.org.uk
Yeo
C J
CJ
Cooney
A D
AD
McLean
A N
AN
Fraser
M H
MH
Allan
D B
DB
D000058:Accidental Falls / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries; D015331:Cohort Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000401:mortality / Q000534:rehabilitation* / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000293:injuries; D006113:United Kingdom / Q000453:epidemiology