PMID- 34224881
OWN - NLM
STAT- MEDLINE
DCOM- 20211104
LR  - 20211104
IS  - 1878-8769 (Electronic)
IS  - 1878-8750 (Linking)
VI  - 153
DP  - 2021 Sep
TI  - Impact of Frailty on Morbidity and Mortality in Adult Patients Presenting with an 
      Acute Traumatic Cervical Spinal Cord Injury.
PG  - e408-e418
LID - S1878-8750(21)00971-2 [pii]
LID - 10.1016/j.wneu.2021.06.130 [doi]
AB  - OBJECTIVE: The aim of this study was to determine if baseline frailty was an 
      independent predictor of adverse events (AEs) and in-hospital mortality in 
      patients being treated for acute cervical spinal cord injury (SCI). METHODS: A 
      retrospective cohort study was performed using the National Trauma Database 
      (NTDB) from 2017. Adult patients (>18 years old) with acute cervical SCI were 
      identified using the International Classification of Diseases, Tenth Revision, 
      Clinical Modification diagnostic and procedural coding systems. Patients were 
      categorized into 3 cohorts based on the criteria of the 5-item modified frailty 
      index (mFI-5): mFI = 0, mFI = 1, or mFI>/=2. Patient demographics, comorbidities, 
      type of injury, diagnostic and treatment modality, AEs, and in-patient mortality 
      were assessed. A multivariate logistic regression analysis was used to identify 
      independent predictors of in-hospital AEs and mortality. RESULTS: Of 8986 
      patients identified, 4990 (55.5%) were classified as mFI = 0, 2328 (26%) as mFI = 
      1, and 1668 (18.5%) as mFI>/=2. On average, the mFI>/=2 cohort was 5 years older than 
      the mFI = 1 cohort and 22 years older than the mFI = 0 cohort (P < 0.001). Most 
      patients in each cohort sustained either complete SCI or central cord syndrome 
      after a fall or transport accident (mFI = 0, 77.31% vs. mFI = 1, 89.5% vs. mFI>/=2, 
      93.65%). With respect to in-hospital events, the proportion of patients who 
      experienced any AE increased significantly along with frailty score (mFI = 0, 
      30.42% vs. mFI = 1, 31.74% vs. mFI>/=2, 34.95%; P < 0.001). In-hospital mortality 
      followed a similar trend, increasing with frailty score (mFI = 0, 10.53% vs. 
      mFI = 1, 11.33% vs. mFI>/=2, 16.23%; P < 0.001). On multivariate regression 
      analysis, both mFI = 1 1.21 (odds ratio [OR], 1.21; 95% confidence interval [CI], 
      1.05-1.4; P = 0.008) and mFI>/=2 (OR, 1.23; 95% CI, 1.05-1.45; P = 0.012) predicted 
      AEs, whereas only mFI>/=2 was found to be a predictor for in-hospital mortality 
      (OR, 1.45; 95% CI, 1.14-1.83; P = 0.002). CONCLUSIONS: Increasing frailty is 
      associated with an increased risk of AEs and in-hospital mortality in patients 
      undergoing treatment for cervical SCI.
CI  - Published by Elsevier Inc.
FAU - Elsamadicy, Aladine A
AU  - Elsamadicy AA
AD  - Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA. 
      Electronic address: aladine.elsamadicy@yale.edu.
FAU - Sandhu, Mani Ratnesh S
AU  - Sandhu MRS
AD  - Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
FAU - Freedman, Isaac G
AU  - Freedman IG
AD  - Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
FAU - Reeves, Benjamin C
AU  - Reeves BC
AD  - Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
FAU - Koo, Andrew B
AU  - Koo AB
AD  - Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
FAU - Hengartner, Astrid
AU  - Hengartner A
AD  - Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
FAU - Havlik, John
AU  - Havlik J
AD  - Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
FAU - Sherman, Josiah
AU  - Sherman J
AD  - Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
FAU - Maduka, Richard
AU  - Maduka R
AD  - Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
FAU - Agboola, Isaac K
AU  - Agboola IK
AD  - Department of Emergency Medicine, Yale School of Medicine, New Haven, 
      Connecticut, USA.
FAU - Johnson, Dirk C
AU  - Johnson DC
AD  - Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
FAU - Kolb, Luis
AU  - Kolb L
AD  - Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
FAU - Laurans, Maxwell
AU  - Laurans M
AD  - Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
LA  - eng
PT  - Journal Article
DEP - 20210702
PL  - United States
TA  - World Neurosurg
JT  - World neurosurgery
JID - 101528275
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cervical Cord/injuries
MH  - Cohort Studies
MH  - Comorbidity
MH  - Female
MH  - Frailty/*complications
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Spinal Cord Injuries/*complications
OTO - NOTNLM
OT  - Cervical spine injury
OT  - Frailty
OT  - Spinal cord injury
OT  - Spine trauma
EDAT- 2021/07/06 06:00
MHDA- 2021/11/05 06:00
CRDT- 2021/07/05 20:15
PHST- 2021/05/18 00:00 [received]
PHST- 2021/06/25 00:00 [revised]
PHST- 2021/06/26 00:00 [accepted]
PHST- 2021/07/06 06:00 [pubmed]
PHST- 2021/11/05 06:00 [medline]
PHST- 2021/07/05 20:15 [entrez]
AID - S1878-8750(21)00971-2 [pii]
AID - 10.1016/j.wneu.2021.06.130 [doi]
PST - ppublish
SO  - World Neurosurg. 2021 Sep;153:e408-e418. doi: 10.1016/j.wneu.2021.06.130. Epub 
      2021 Jul 2.