title: Mortality and Readmission After Cervical Fracture from a Fall in Older Adults: Comparison with Hip Fracture Using National Medicare Data.
abstract: OBJECTIVE
  To examine the prevalence of cervical spine fractures after falls in older Americans, to show changes in recent years, and to compare 12-month outcomes between individuals with cervical and hip fracture after falls.
  
  
  METHODS
  Retrospective study of Medicare data from 2007 to 2011.
  
  
  METHODS
  Acute care hospitals.
  
  
  METHODS
  Individuals aged 65 and older with cervical or hip fracture after a fall.
  
  
  METHODS
  Cervical fracture rate, 12-month mortality, and readmission rate after injury.
  
  
  RESULTS
  Rates of cervical fracture increased from 4.6 per 10,000 in 2007 to 5.3 per 10,000 in 2011; rates of hip fracture decreased from 77.3 per 10,000 in 2007 to 63.5 per 10,000 in 2011. Participants with cervical fracture with and without spinal cord injury (SCI) were more likely than those with hip fracture to receive treatment at large hospitals (59.4% and 54.1% vs 28.1%, P < .001), teaching hospitals (49.3% and 40.0% vs 13.4%, P < .001), and regional trauma centers (46.3% and 38.5% vs 13.0%, P < .001). Participants with cervical fracture without (24.7%) and with SCI (41.7%) had greater risk-adjusted mortality at 1 year than those with hip fracture (22.7%) (P < .001). By 1 year, 73.4% of participants with cervical fracture with and 59.5% without SCI and 59.3% of those with hip fracture had died or were readmitted to the hospital (P < .001).
  
  
  CONCLUSIONS
  Cervical spinal fractures occur in one of every 2,000 Medicare beneficiaries annually and appear to be increasing over time. Participants with cervical fracture had greater mortality than those with hip fracture. Given the increasing prevalence and the poor outcomes in this population, hospitals need to develop processes to improve care for these vulnerable individuals.
authors.affiliation: Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts.|Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.|Medical School of Medicine, Harvard University, Boston, Massachusetts.
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
authors.affiliation: Medical School of Medicine, Harvard University, Boston, Massachusetts.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.|Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Stuart
authors.initials: S
authors.lastname: Lipsitz
authors.affiliation: Medical School of Medicine, Harvard University, Boston, Massachusetts.|Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
authors.affiliation: Division of General Medicine, University of Michigan, Ann Arbor, Michigan.|Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.|Ariadne Labs, Boston, Massachusetts.
authors.forename: Rachelle E
authors.initials: RE
authors.lastname: Bernacki
authors.affiliation: T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Jha
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000453:epidemiology; D016103:Spinal Fractures / Q000453:epidemiology*; D014193:Trauma Centers / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: cervical fracture; mortality; readmission