Frailty & Outcomes in Cervical Spine Injury

Introduction

Cervical spine injury (CSI) can cause significant morbidity and mortality in frail older adults. Comprehensive Geriatric Assessment has been shown to improve outcomes and reduce length of stay (Scottish Trauma Audit Group; British Geriatric Society). This retrospective observational study analysed outcomes in 53 CSI patients admitted to the Royal Alexandra Hospital (RAH) between January and August 2025.

Methods

Variables including age, sex, clinical frailty score (CFS), length of stay (LOS), mortality, physiotherapy input, and geriatrician review were analysed. Patients were stratified into three age groups: under 65, 65–74, and over 75 years. Non-parametric statistical methods were used due to the small sample size and non-normal data distributions, with statistical significance defined as p<0.05.

Results

The mean age of the cohort was 74.1 years, with a mean CFS of 4.5 and a mean LOS of 16.0 days. Clinical frailty differed significantly by age group, with mean CFS values of 2.58 (under 65), 3.12 (65–74), and 5.55 (over 75). Patients who died had a higher median CFS (6.5 vs 4.0, p=0.028). Mean LOS increased from 5.7 days in patients with CFS 1 to 19.3 days in those with CFS 7. CFS demonstrated a significant positive association with LOS when analysed as a continuous variable (p=0.008). Age also showed a weaker association with LOS (p=0.021).

Physiotherapy input differed significantly by age group (p=0.002), with higher utilisation in older patients. A DME (orthopaedic geriatrician) review was conducted in 48.4% of geriatric patients. New RAH criteria will mandate DME review for geriatric CSI patients, and outcomes will be re-audited.

Conclusions

Higher clinical frailty was significantly associated with longer hospital stay and increased mortality following CSI. Frailty appears to be a stronger predictor of outcome than age alone, supporting consideration of frailty-informed pathways to improve care for older CSI patients.