79.09 Elderly Patients With Cervical Spine Fractures Following Ground Level Falls are at Risk for BCVI

Posted on January 31, 2019

E. Warnack1, C. DiMaggio1, S. Frangos1, M. Klein1, C. Berry1, M. Bukur1  1New York University School Of Medicine,New York, NY, USA

Introduction:
Osteopenia is common in the elderly, increasing their risk of sustaining cervical fractures after ground level falls (GLF). Neck CTA is used to screen for Blunt Cerebrovascular Injuries (BCVI) after high cervical (C) spine fractures. We sought to examine the incidence of BCVI and subsequent stroke in elderly GLF patients as compared to other higher injury mechanisms.

Methods:

The Trauma Quality Improvement Program database (2011-2016) was used to identify blunt trauma patients with isolated (other body region AIS <3) high C spine (C1- C4) fractures. Patients were stratified into three groups: non-elderly patients (<65) with all mechanisms of injury, elderly patients (≥ 65) with GLF, and elderly patients with all other mechanisms of injury. Demographics and outcomes were compared. Multivariable logistic regression was used to determine predictors for BCVI, stroke, and mortality. Secondary outcomes included rates of spinal cord injury (SCI) and acute kidney injury (AKI), given risk for contrast exposure.

Results:

17,558 patients with high C spine injuries were identified. 50.2% involved patients ≥ 65. BCVI was highest in the < 65 group (0.8%) and lowest in elderly patients with GLF (0.3%, p = .001). When controlling for other factors, elderly patients with GLF were less likely to sustain BCVI (AOR 0.46, p = .03) but had comparable rates of stroke attributable to BCVI (15.4% vs. 9.5%, p= .685), compared to elderly patients with other mechanisms of injury. There was no significant difference in mortality (AOR 1.08, p = .34). SCI was less common (AOR 0.78, p = .002) in elderly patients with GLF. AKI was more common in elderly patients (0.9% vs. 0.5%, p = .002).

Conclusion:
In elderly patients with isolated C spine fracture after GLF, BCVI occurs less frequently, but is associated with a comparable rate of stroke as compared to other mechanisms.  Low injury mechanism should not preclude BCVI screening in the presence of high C spine fractures.