Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures
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Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures Joshua Baxter1 · Radcliffe Lisk2 · Ahmad Osmani2 · Keefai Yeong2 · Jonathan Robin3 · David Fluck4 · Christopher Henry Fry5 · Thang Sieu Han6 Received: 28 August 2020 / Accepted: 9 November 2020 © The Author(s) 2020
Abstract Patients admitted with a cervical fracture are twice as likely to die within 30 days of injury than those with a hip fracture. However, guidelines for the management of cervical fractures are less available than for hip fractures. We hypothesise that outcomes may differ between these types of fractures. We analysed 1359 patients (406 men, 953 women) with mean age of 83.8 years (standard deviation = 8.7) admitted to a National Health Service hospital in 2013–2019 with a cervical (7.5%) or hip fracture (92.5%) of similar age. The association of cervical fracture (hip fracture as reference), hospital length of stay (LOS), co-morbidities, age and sex with outcomes (acute delirium, new pressure ulcer, and discharge to residential/ nursing care) was assessed by stepwise multivariate logistic regression. Acute delirium without history of dementia was increased with cervical fractures: odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.3–4.7, age ≥ 80 years: OR = 3.5 (95% CI = 1.9–6.4), history of stroke: OR = 1.8 (95% CI = 1.0–3.1) and ischaemic heart disease: OR = 1.9 (95% CI = 1.1–3.6); pressure ulcers was increased with cervical fractures: OR = 10.9 (95% CI = 5.3–22.7), LOS of 2–3 weeks: OR = 3.0 (95% CI = 1.2–7.5) and LOS of ≥ 3 weeks: OR = 4.9, 95% CI = 2.2–11.0; and discharge to residential/nursing care was increased with cervical fractures: OR = 3.2 (95% CI = 1.4–7.0), LOS of ≥ 3 weeks: OR = 4.4 (95% CI = 2.5–7.6), dementia: OR = 2.7 (95% CI = 1.6–4.7), Parkinson’s disease: OR = 3.4 (95% CI = 1.3–8.8), and age ≥ 80 years: OR = 2.7 (95% CI = 1.3–5.6). In conclusion, compared with hip fracture, cervical fracture is more likely to associate with acute delirium and pressure ulcers, and for discharge to residency of high level of care, independent of established risk factors. Keywords Geriatrics · Pressure ulcers · Length of stay · Mortality · Discharge destination
* Thang Sieu Han [email protected] 1
Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
2
Department of Orthogeriatrics, Ashford and St Peter’s NHS Foundation Trust, Guildford Road, Chertsey KT16 0PZ, Surrey, UK
3
Department of Medicine, Ashford and St Peter’s NHS Foundation Trust, Guildford Road, Chertsey KT16 0PZ, Surrey, UK
4
Department of Cardiology, Ashford and St Peter’s NHS Foundation Trust, Guildford Road, Chertsey KT16 0PZ, Surrey, UK
5
School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol BS8 1TD, UK
6
Institute of Cardiovascular Research, Royal Holloway, University of London, Egham TW20 0EX, Surrey, UK
Abbreviations CI Confidence interval LOS Length of stay OR Odds ratio SD Sta
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