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.
Keywords
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Article info
Publication history
Published online: December 30, 2015
Accepted:
December 22,
2015
Received in revised form:
November 23,
2015
Received:
May 9,
2015
Footnotes
The findings from this study were presented at the 2015 American Surgical Congress, Las Vegas, NV
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
