Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures

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.