title: The mortality inflection point for age and acute cervical spinal cord injury.
abstract: BACKGROUND
  Acute cervical spinal cord injury (cSCI) is associated with significant morbidity and mortality. Vertebral level and American Spinal Injury Association (ASIA) score influence both hospital course and ultimate outcome. While controlling for these variables, we describe the effect of age on cSCI-related pneumonia and mortality.
  
  
  METHODS
  All patients treated at our regional spinal cord injury center with an acute cSCI during a 5-year period (2005-2009) were reviewed retrospectively. Patient demographics, injury level, ASIA score, length of stay (LOS), radiologic, laboratory, and microbiology data were reviewed. Pneumonia was defined as an infiltrate on chest X-ray along with two of the following: leukocytosis, fever greater than 101°F, or positive bronchial alveolar lavage cultures; all occurring within the same 24-hour period.
  
  
  RESULTS
  There were 244 cSCI during the study period. In-hospital mortality was significantly higher for those older than 75 years (40.5% vs. 4.0%, p < 0.0001). Pneumonia rates were not significantly different between age groups. In all age groups, high ASIA scores (A and B) were associated with increased pneumonia (61.9% vs. 17.4%, p < 0.0001) and mortality (16.7% vs. 3.5%, p = 0.002). Similarly, patients with higher cervical injury levels (C4 and above) had a higher incidence of pneumonia (39.5% vs. 25.9%, p < 0.05) and a trend toward higher mortality.
  
  
  CONCLUSIONS
  Age was associated with an increase in mortality among patients with an acute cSCI. Injury level and ASIA score contributed significantly to overall pneumonia rate and mortality at all ages; however, pneumonia did not correlate directly with mortality in this population. Other factors play a role in the mortality associated with geriatric spinal cord-injured patients, including end-of-life decision making; these need to be investigated further in future studies.
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. niels.martin@jefferson.edu
authors.forename: Niels D
authors.initials: ND
authors.lastname: Martin
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Marks
authors.forename: Joshua
authors.initials: J
authors.lastname: Donohue
authors.forename: Carolyn
authors.initials: C
authors.lastname: Giordano
authors.forename: Murray J
authors.initials: MJ
authors.lastname: Cohen
authors.forename: Michael S
authors.initials: MS
authors.lastname: Weinstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D055815:Young Adult