Older patients with traumatic spinal cord injury less likely than younger patients to receive surgical treatment

Older patients with traumatic spinal cord injury are less likely than younger patients to receive surgical treatment and experience a significant lag between injury and surgery, according to new research in CMAJ (Canadian Medical Association Journal).

The number of people with traumatic spinal cord injury over age 70 is increasing, and it is projected that people in this age group will eventually make up the majority of those with new spinal cord injuries. Currently, most spinal cord injuries occur in people aged 16 to 30 years.

To determine whether patients over age 70 with spinal cord injury were managed differently and had different outcomes, Canadian researchers looked at data from the Rick Hansen Spinal Cord Injury Registry for 1440 people in Canada who had a traumatic spinal cord injury. Of the total, 167 (11.6 %) were aged 70 years or older. These patients were more likely than younger patients to have been injured from falling (83.1% v. 37.4%). Younger patients were more likely to present with severe injuries resulting in paralysis below the trauma site; older patients had less severe injuries.

There were significant delays in treating older patients who arrived at participating acute care centres.

"Older patients experienced a triage delay (time of injury to arrival at a participating acute care centre) that was twice that of younger patients," writes Dr. Henry Ahn, St. Michael's Hospital, Toronto, Ontario, with coauthors. "This may have been due to delays in recognizing their less severe injuries, or may reflect a potential age-related therapeutic bias."

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

"The significant differences in injury-related characteristics, timing of surgery and outcomes between older and younger patients necessitate rethinking the management of traumatic spinal cord injury among older patients," say the authors. Reducing surgical delays for traumatic spinal cord injury, regardless of patient age, may help maximize neurologic improvement and avoid adverse events associated with prolonged immobilization such as pneumonia.

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