Home Discharge Rate
In the present study, 41.1% of patients over 65 years with cervical spinal cord injury were discharged home. Damadi et al. reported that 40% of cervical spine fracture patients living at home returned home after discharge [11]. However, since their study only included cases with bone injuries and some cases without neurological deficits, it cannot be directly compared with ours. We believe the medical profession should understand that more than half the older patients with cervical cord injuries cannot be discharged home and should be treated accordingly.
Mortality Rate
In our study, only one patient with total cervical cord injury was excluded due to death in the hospital. This mortality rate was much lower than in previous reports [1,8,9,11,12]. Even if we assume that all 17 patients who were transferred to other hospitals due to medical complications subsequently faced death, this is still a low rate. We believe that this is because our hospital specializes in spinal cord diseases and has many medical and nursing professionals with specialized skills in spinal cord injury care.
Cause of Injury and the Presence or Absence of Bone Injury and Surgery
Most patients (71.7%) in our study had cervical spinal cord injuries without bone injuries, of which 47.5% of the injuries were caused by falls from a height of less than 1 m. This is consistent with previous reports that state that most cases of cervical spinal cord injury in older adults are caused by minor trauma such as falling [8,9,13]. Preexisting cervical spinal canal stenosis and ossification of the posterior longitudinal ligament have also been reported as risk factors in such cases [18,19]. It is generally believed that incomplete injury is common in such minor injury cases. Interestingly, no significant difference was found between the two groups in this study regarding the mechanism of injury, the presence or absence of bone injury, or the presence or absence of surgery. We believe, therefore, that there is hope for positive outcomes in patients with cervical spinal cord injury and bone injuries requiring surgery.
Age
This study demonstrated that the higher the age at the time of injury, the lower the rate of their being discharged home. This identification of age as an independent factor in multiple logistic regression analysis was consistent with previous research [8, 9]. In general, older age is associated with poorer functional outcomes [20, 21] with an increased likelihood of comorbidities and secondary complications [2]. Although this study was limited to patients over 65 years, age was identified as an independent risk factor, indicating its strong influence on the ability to return home.
Length of Hospital Stay
The length of hospital stay was significantly longer in the home discharge group. This could be because a more advanced Actives of daily living (ADL) acquisition is required for being discharged home. Additionally, some patients in the out-of-home discharge group were transferred to other hospitals early due to medical complications, which may have contributed to the difference in the length of hospital stay.
Neurological Findings
AIS:A at the time of injury was identified as an independent factor for being discharged home. Gulati et al. [9] reported that all cases of complete injury in patients over 65 years with cervical cord injury were not discharged home. In our study, only 6 of the 57 (10.5%) patients with complete injury could be discharged home, suggesting that patients with a complete injury can be discharged home if appropriate rehabilitation and environmental conditions are provided at the time of discharge. Therefore, even if a patient had a complete injury at the initial consultation, they should not give up on the goal of being discharged home.
Regarding AMS, the higher the value at admission, the higher the likelihood of a home discharge. It is not difficult to imagine that a mild degree of paralysis at the initial visit determines the subsequent prognosis.
SCIM
The SCIM at admission and discharge was significantly different between the two groups in a univariate analysis. Previous reports indicate that improvement in ADL is important for being discharged home in patients with cervical cord injury using a Functional Independence Measure [2,9]. Our study suggests that SCIM may also be useful as a measure for home discharge. However, SCIM at the initial visit was not identified as an independent factor in multivariate analysis as it was uniformly low in patients with cervical spinal cord injury and is not likely to help estimate the prognosis. The aforementioned AIS and AMS are likely to be useful when considering the prognosis at the initial visit.