N. Joseph1, J. A. Vosswinkel1, J. E. McCormack1, E. C. Huang1, D. N. Rutigliano1, M. J. Shapiro1, R. S. Jawa1 1Stony Brook University Medical Center,Trauma,Stony Brook, NY, USA
Introduction: Low-level falls, under three feet, in geriatric patients account for a substantial proportion of admissions at trauma centers. In the absence of significant head injury, spinal evaluation in these patients is often limited. We hypothesized that low-level falls often result in cervical, thoracolumbar, or sacrococcygeal vertebral fractures, which contribute to significant morbidity.
Methods: A county-wide trauma registry for admitted adult trauma patients age ≥ 65 years sustaining a fall from less than 3 feet from 2004 to 2013 was reviewed. Deaths in the emergency department were excluded. Statistical analyses were performed using parametric and nonparametric tests, percentage or median values with interquartile range are presented; p≤ 0.05 was significant.
Results: After a low level fall, 17.8% of elderly patients sustained a vertebral fracture, in the following distribution: cervical spine 42.8%, thoracic spine 5.6%, lumbar spine 4.9%, sacrococcygeal 36.3%, and multiple vertebral levels 9%.
In comparing demographics between elderly patients with vertebral fractures (EW) and those without vertebral fractures (EWO), significant differences were found in patient age (84, 79-89 vs. 82, 76-88 years), gender (26.1% male vs. 36.4% male), injury severity score (5, 4-9 vs. 10, 9-16), and GCS (15, 15-15 vs. 15, 15-15). In evaluating comorbidities, the 2 groups had similar rates of HTN, DM, dementia, heart disease, or respiratory disease. However, the EW group was significantly less frequently on anticoagulant or antiplatelet agents (19.6% vs. 24.3%).
In comparing hospitalization characteristics, significantly less EW patients required ICU admission (20.5.1% vs. 34.9%) or mechanical ventilation (6.0% vs. 10.3%) than EWO patients. However, hospital length of stay (LOS) (7, 4-10 vs. 7, 4-10 days), ICU LOS (4, 3-8 vs. 4, 2-7 days) and duration of mechanical ventilation (3.5, 2-13 vs. 4, 2-10 days) were similar. In evaluating complications, EW patients had significantly different rates of deep venous thrombosis and pulmonary embolism (0.8% vs. 02.7%) and sepsis (3.7% vs. 2.4%) than EWO patients. However, the groups had similar rates of pneumonia, myocardial infarction, and decubitus ulcers.
In comparing discharge disposition, significantly more EW patients went to acute rehabilitation (46.8% vs. 34.0%) and less EW went home (21.0% vs. 34.4%). Rate of discharge to a SNF were similar (23.2% vs 21.5%), as was the in-hospital mortality rate (8.6% vs. 9.4%) between EW and EWO patients.
Conclusion: Low level falls resulted in vertebral fracture in 17.8% of elderly patients. While C-spine fractures were most common, 10.5% had thoracic or lumbar spine fractures. None of the above comorbidities were associated with spinal fracture. Surprisingly, vertebral fractures in the elderly are not morbid, as measured by LOS or most complication rates. The data suggest the need for greater vigilance in spinal evaluation in the geriatric patient following a low level fall.