Document Detail


Halo vest immobilization in the elderly: a death sentence?
MedLine Citation:
PMID:  16294074     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cervical spine fractures (CSFs) in elderly patients are increasingly common as the population ages. In many centers, halo vest immobilization (HVI) is the treatment of choice. Our anecdotal experience suggested that elderly patients treated with HVI have frequent bad outcomes. The purpose of this study was to compare the outcomes of elderly and younger CSF patients as related to treatment (HVI, surgery, or hard collar). METHODS: Registry data from our Level I trauma center were reviewed to identify patients admitted with CSFs during an 80-month period. We excluded those with Glasgow Coma Scale (GCS) score of 3 at admission or death within 24 hours of admission. Patients were grouped as OLD (aged > or = 66 years) or YNG (aged 18-65 years). Data were compared using chi and Student's t test, with p < 0.05 considered statistically significant. RESULTS: One hundred twenty-nine OLD (aged 79.7 +/- 0.7 years) and 289 YNG (aged 38.3 +/- 0.8 years) patients met study criteria. Injury Severity Score was higher in YNG (18.9 +/- 0.8 vs. 14.8 +/- 1.0, p < 0.05), and GCS score was the same (OLD, 13.7 +/- 0.2; YNG, 13.0 +/- 0.2; p = 0.06) in both, but mortality was higher in OLD patients (21% vs. 5%, p < 0.05). OLD HVI patients had higher mortality than YNG HVI (40% vs. 2%). Among OLD patients, age, Injury Severity Score, GCS, and number of comorbidities were the same for each treatment subgroup. Despite this, mortality for the HVI subgroup was higher than either the surgery or collar subgroup. Of the OLD HVI patients that died, 14 died with pneumonia and 10 had a cardiac or respiratory arrest that preceded death. CONCLUSION: OLD patients with CSFs have higher mortality than YNG. HVI in OLD patients is associated with the worst outcomes, irrespective of injury severity, and should be considered a last resort. Further study is warranted to determine the optimal treatment for CSF in OLD patients.
Authors:
Sarah Majercik; Robert Z Tashjian; Walter L Biffl; David T Harrington; William G Cioffi
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  59     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-11-18     Completed Date:  2005-12-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  350-6; discussion 356-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Trauma and Surgical Critical Care, Rhode Island Hospital/Brown Medical School, Providence, Rhode Island, USA. sarahmaj@aol.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Cervical Vertebrae / injuries*
Female
Glasgow Coma Scale
Humans
Immobilization / adverse effects*,  instrumentation
Injury Severity Score
Male
Odontoid Process / injuries
Retrospective Studies
Spinal Fractures / mortality*,  surgery,  therapy*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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