title: The elderly patient with spinal injury: treat or transfer?
abstract: BACKGROUND
  The purpose of this investigation was to delineate whether elderly patients with spinal injuries benefit from transfers to higher level trauma centers.
  
  
  METHODS
  Retrospective review of the National Trauma Data Bank 2007 to 2011, including patients > 65 (y) with any spinal fracture and/or spinal cord injury from a blunt mechanism. Patients who were transferred to level I and II centers from other facilities were compared to those admitted and received their definitive treatment at level III or other centers.
  
  
  RESULTS
  Of 3,313,117 eligible patients, 43,637 (1.3%) met inclusion criteria: 19,588 (44.9%) were transferred to level I-II centers, and 24,049 (55.1%) received definitive treatment at level III or other centers. Most of the patients (95.8%) had a spinal fracture without a spinal cord injury. Transferred patients were more likely to require an intensive care unit admission (48.5% versus 36.0%, P < 0.001) and ventilatory support (16.1% versus 13.3%, P < 0.001). Mortality for the entire cohort was 7.7% (8.6% versus 7.1%, P < 0.001) and significantly higher, at 21.7% for patients with a spinal cord injury (22.3% versus 21.0%, P < 0.001). After adjusting for all available covariates, there was no difference in the adjusted mortality between patients transferred to higher level centers and those treated at lower level centers (adjusted odds ratio [95% confidence interval]: 1.05 [0.95-1.17], P = 0.325).
  
  
  CONCLUSIONS
  Transfer of elderly patients with spinal injuries to higher level trauma centers is not associated with improved survival. Future studies should explore the justifications used for these transfers and focus on other outcome measures such as functional status to determine the potential benefit from such practices.
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.affiliation: Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: zcooper@partners.org.
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
authors.affiliation: Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Joaquim M
authors.initials: JM
authors.lastname: Havens
authors.affiliation: Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Reza
authors.initials: R
authors.lastname: Askari
authors.affiliation: Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000401:mortality / Q000628:therapy*; D016103:Spinal Fractures / Q000401:mortality / Q000628:therapy*; D014193:Trauma Centers; D014481:United States; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy*
keywords: Elderly; Mortality; Outcomes; Spine injuries; Transfers; Trauma centers