title: Understanding post-hospital morbidity associated with immobilisation of cervical spine fractures in older people using geriatric medicine assessment techniques: A pilot study.
abstract: BACKGROUND
  There is a paucity of research into the outcomes and complications of cervical spine immobilisation (hard collar or halothoracic brace) in older people.
  
  
  OBJECTIVE
  To identify morbidity and mortality outcomes using geriatric medicine assessment techniques following cervical immobilisation in older people with isolated cervical spine fractures.
  
  
  METHODS
  We identified participants using an injury database. We completed a questionnaire measuring pre-admission medical co-morbidities and functional independence. We recorded the surgical plan and all complications. A further questionnaire was completed three months later recording complications and functional independence.
  
  
  RESULTS
  Sixteen patients were recruited over a three month period. Eight were immobilised with halothoracic brace, 8 with external hard collar. Three deaths occurred during the study. Lower respiratory tract infection was the most common complication (7/16) followed by delirium (6/16). Most patients were unable to return home following the acute admission, requiring sub-acute care on discharge. The majority of patients were from home prior to a fall, 6/16 were residing there at 3 months. Most participants had an increase in their care needs at 3 months. There was no difference in the type or incidence of complications between the different modes of immobilisation.
  
  
  CONCLUSIONS
  Geriatric medicine assessment techniques identified the morbidity and functional impairment associated with cervical spine immobilisation. This often results in a prolonged length of stay in supported care. This small pilot study recommends a larger study over a longer period using geriatric medicine assessment techniques to better define the issues.
authors.affiliation: Caulfield Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Australia. Electronic address: chris.moran@monash.edu.
authors.forename: Chris
authors.initials: C
authors.lastname: Moran
authors.forename: Eva
authors.initials: E
authors.lastname: Kipen
authors.forename: Patrick
authors.initials: P
authors.lastname: Chan
authors.forename: Louise
authors.initials: L
authors.lastname: Niggemeyer
authors.forename: Simon
authors.initials: S
authors.lastname: Scharf
authors.forename: Peter
authors.initials: P
authors.lastname: Hunter
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: Russell
authors.initials: R
authors.lastname: Gruen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002574:Cervical Vertebrae / Q000293:injuries*; D015897:Comorbidity; D003693:Delirium / Q000453:epidemiology*; D016267:External Fixators; D005260:Female; D015577:Geriatric Assessment; D005853:Geriatrics; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009989:Orthotic Devices; D010351:Patient Discharge; D010865:Pilot Projects; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology*; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D016103:Spinal Fractures / Q000453:epidemiology / Q000534:rehabilitation* / Q000601:surgery; D016896:Treatment Outcome
keywords: Cervical spine fracture; Older adults