| Abstract No.: | A-C1077 |
| Country: | Canada |
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| Title: | The Influence of Age on Functional Recovery after Traumatic Spinal Cord Injury: Analysis of the Third National Acute Spinal Cord Injury Study (NASCIS-3) Database |
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| Authors/Affiliations: | 2 Julio Furlan; 1 Michael Bracken; 3 Michael Fehlings;
1 Center for Perinatal, Pediatric and Environmental Epidemiology, Yale University, Hew Haven, CT, USA; 2 Department of Gentics and Development, Toronto Western Research Institute, University Health Network, Toronto, ON,Canada; 3 Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network; and University of Toronto, ON, Canada
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| Content: | Objectives: Given the increasing incidence of spinal cord injury (SCI) in the geriatric population (65 years of age or older), we sought to examine whether age is a key determinant of functional recovery after acute traumatic SCI.
Materials and Methods: All patients who were enrolled in the NASCIS-3 trial were included (Bracken et al., JAMA 1997; 277:1597-604). Functional Independence Measure (FIM) scores were obtained at 6 weeks, at 6 months and at 1 year following traumatic SCI. Data analysis was carried out using Fisher’s exact test, Mann Whitney U test and multiple linear regression. In addition to unadjusted regression analysis, the correlation between age and FIM score was also examined using multivariate regression analyses controlled for potential major confounders. These included gender, ethnic group, Glasgow Coma Score, serum alcohol concentration, NASCIS-3 drug protocol, cause of injury, level and severity of SCI.
Results: There were 499 patients (423 males and 76 females; ages from 14 to 92 years with a mean age of 35.7 years) who were received methypredinosolone for 24 hours, methypredinosolone for 48 hours or tirilazad mesylate for 48 hours. Younger (n=455) and elderly patients (n=44) were comparable with regard to ethnic group, weight, Glasgow Coma Score and NASCIS-3 drug protocol. However, elderly patients with SCI had significantly greater proportion of females (p=0.01), higher frequency of falls as the cause of SCI (p<0.001), lesser severe SCI (p=0.014), greater proportion of cervical SCI (p=0.0018) and lower serum alcohol concentrations on admission (p=0.048) in comparison with younger patients with SCI. While increase in age was significantly correlated with lower FIM scores at 6 weeks post-SCI (p=0.025), there were no significant correlations between age and FIM scores at 6 months (p=0.289) and at 1 year (p=0.61) in the unadjusted models and after controlling for major potential confounders.
Conclusion: Age at time of injury was not significantly correlated with functional recovery in the chronic stage after SCI. Those results are consistent with our previous data that indicate elderly individuals have similar motor and sensory recovery as well as similar extent of degeneration and axonal preservation in comparison with younger individuals following acute traumatic SCI. Those findings, therefore, reinforce the need for individualizing treatment protocols for elderly patients with SCI who have the potential to neurologically and functionally recovery.
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