Old people suffering from spinal cord injury less likely to receive surgery

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The gap between spinal cord injury, diagnosis and surgery in older patients has increased substantially, a new research published in CMAJ (Canadian Medical Association Journal) has claimed. The study has also suggested that older patients with traumatic spinal cord injury are less likely than younger patients to receive surgical treatment.

Researchers note that the number of older people who are suffering from traumatic spinal cord injury is increasing and according to projection, if the current rate goes on, 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.

For the study, researchers analysed data from he Rick Hansen Spinal Cord Injury Registry for 1440 people in Canada who had a traumatic spinal cord injury. They found that 167 patients (11.6 per cent) were either aged 70 or older. These patients were more likely than younger patients to have been injured from falling (83.1 per cent v. 37.4 per cent). Younger patients were more likely to present with severe injuries resulting in paralysis below the trauma site; older patients had less severe injuries.

Researchers found that there were significant delays in treating older patients who arrived at participating acute care centres.

Dr. Henry Ahn, St. Michael’s Hospital, Toronto, Ontario, and co-authors noted in the study that older patients experienced a triage delay (time of injury to arrival at a participating acute care centre) that was twice that of younger patients.

The authors acknowledge that this delay may be because of delays in recognizing their less severe injuries, but do raise a point that raises a question on potential age-related therapeutic bias.

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

Researchers say that there are significant differences in injury-related characteristics, timing of surgery and outcomes between older and younger patients and this calls for rethinking the management of traumatic spinal cord injury among older patients.

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.