title: Effect of older age on treatment decisions and outcomes among patients with traumatic spinal cord injury.
abstract: BACKGROUND
  Older people are at increased risk of traumatic spinal cord injury from falls. We evaluated the impact of older age (≥ 70 yr) on treatment decisions and outcomes.
  
  
  METHODS
  We identified patients with traumatic spinal cord injury for whom consent and detailed data were available from among patients recruited (2004-2013) at any of the 31 acute care and rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry. Patients were assessed by age group (< 70 v. ≥ 70 yr). The primary outcome was the rate of acute surgical treatment. We used bivariate and multivariate regression models to assess patient and injury-related factors associated with receiving surgical treatment and with the timing of surgery after arrival to a participating centre.
  
  
  RESULTS
  Of the 1440 patients included in our study cohort, 167 (11.6%) were 70 years or older at the time of injury. Older patients were more likely than younger patients to be injured by falling (83.1% v. 37.4%; p < 0.001), to have a cervical injury (78.0% v. 61.6%; p = 0.001), to have less severe injuries on admission (American Spinal Injury Association Impairment Scale grade C or D: 70.5% v. 46.9%; p < 0.001), to have a longer stay in an acute care hospital (median 35 v. 28 d; p < 0.005) and to have a higher in-hospital mortality (4.2% v. 0.6%; p < 0.001). Multivariate analysis did not show that age of 70 years or more at injury was associated with a decreased likelihood of surgical treatment (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI] 0.22-1.07). An unplanned sensitivity analysis with different age thresholds showed that a threshold of 65 years was associated with a decreased chance of surgical treatment (OR 0.39, 95% CI 0.19-0.80). Older patients who underwent surgical treatment had a significantly longer wait time from admission to surgery than younger patients (37 v. 19 h; p < 0.001).
  
  
  CONCLUSIONS
  We found chronological age to be a factor influencing treatment decisions but not at the 70-year age threshold that we had hypothesized. Older patients waited longer for surgery and had a substantially higher in-hospital mortality despite having less severe injuries than younger patients. Further research into the link between treatment delays and outcomes among older patients could inform surgical guideline development.
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont. ahnh@smh.ca.
authors.forename: Henry
authors.initials: H
authors.lastname: Ahn
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Bailey
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Carly S
authors.initials: CS
authors.lastname: Rivers
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Noonan
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Eve C
authors.initials: EC
authors.lastname: Tsai
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Daryl R
authors.initials: DR
authors.lastname: Fourney
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Najmedden
authors.initials: N
authors.lastname: Attabib
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Kwon
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Christie
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Joel
authors.initials: J
authors.lastname: Finkelstein
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: R John
authors.initials: RJ
authors.lastname: Hurlbert
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Andrea
authors.initials: A
authors.lastname: Townson
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Brian
authors.initials: B
authors.lastname: Drew
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Jason
authors.initials: J
authors.lastname: Chen
authors.affiliation: St. Michael's Hospital, University of Toronto Spine Program (Ahn), Toronto, Ont.; Western University (Bailey), London, Ont.; Rick Hansen Institute (Rivers, Noonan, Chen), Vancouver, BC; University of British Columbia (Noonan, Kwon, Townson, Dvorak), Vancouver, BC; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa (Tsai), Ottawa, Ont.; University of Saskatchewan (Fourney), Saskatoon, Sask.; Horizon Health Network/Dalhousie University (Attabib), St. John, NB; Dalhousie University (Christie), Halifax, NS; Division of Neurosurgery and Spinal Program, University of Toronto (Fehlings), Toronto, Ont.; Sunnybrook Health Sciences Centre, University of Toronto (Finkelstein), Toronto, Ont.; University of Calgary Spine Program (Hurlbert), Calgary, Alta.; Hôpital du Sacré-Coeur de Montréal, Hôpital Ste-Justine, Université de Montréal (Parent), Montréal, Que.; Hamilton General Hospital, McMaster University (Drew), Hamilton, Ont.
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D018579:Patient Selection; D012042:Registries; D013119:Spinal Cord Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D061665:Time-to-Treatment; D016896:Treatment Outcome