Older patients with traumatic spinal cord injuries less likely to get surgery

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Older patients with traumatic spinal cord injuries are less likely to receive surgery compared with younger patients and they experience a significant lag between injury and surgery, according to new research from St Michael’s Hospital, Toronto, Canada.

The number of people with traumatic spinal cord injuries over age 70 is increasing, and it is projected that people in this age group will account for the majority of new spinal cord injuries, mostly from falls. Most spinal cord injuries now occur in people between the ages of 16 and 30.

To determine whether patients over age 70 with spinal cord injuries were managed differently and had different outcomes, researchers looked at data from the Rick Hansen Spinal Cord Injury Registry of 1,440 people in Canada suffering from traumatic spinal cord injury. Of the total, 167 (11.7%) were aged 70 years or older.

These patients were more likely to have fallen compared with younger patients (83.1% vs 37.4%) and to have had a longer stay in an acute care hospital, according to the paper published in the Canadian Medical Association Journal. Younger patients were more likely to have severe injuries resulting in paralysis below the trauma site whereas older patients had less severe injuries.

The time between injury to arrival at an acute care centre was about twice as long for older patients than younger patients. Once admitted, older patients also waited about twice as long for surgery as younger patients.

“These delays may be due to delays in recognising the less severe injuries in seniors or they may reflect a potential age related therapeutic bias,” said study author Henry Ahn.

Older patients were also significantly more likely to die from a traumatic spinal cord injury than younger people.

“These significant differences in injury demographics, timing of surgery and outcomes in older compared with younger patients necessitates rethinking the management of traumatic spinal cord injury in those in the oldest age group,” Ahn said.

The researchers suggested that developing policies with mandated time frames for treatment and management of spinal cord injuries, similar to hip fractures, could improve care and outcomes for these older patients.