Improving Management of Spinal Fractures in Older Adults at a Trauma Unit

Introduction

In our hospital, management of spinal fractures in older adults are led by external neurosurgical services. Decisions often prioritise imaging characteristics over patient characteristics. Challenges include conducting low-yield imaging such as MRIs, prolonged immobilisation, delayed decision-making reliant on digital communication and bracing complications. This audit evaluated whether collaborative, patient-centred decision-making between geriatricians, orthopaedics and therapists who are familiar with the spinal pathway improved length of stay and resource utilisation.

Methods

We conducted two audit cycles for adults aged above 60 years with acute spinal fractures, excluding sacral fractures or transfers to neurosurgical centre.  Cycle 1 included admissions from January to October 2022 (n=97, mean age 79 years). Cycle 2 focussed on orthopaedic admissions between January and October 2024 (n=54, mean age 81). Interventions included routine ortho-geriatrician input within 72 hours, avoidance of unnecessary bed rest, education, early effective analgesia and multi-disciplinary decision-making regarding investigations and bracing. Outcomes measured were length of stay (LOS) and frequency of weight-bearing X-rays, MRIs and spinal orthoses.

Results

Weight-bearing X-rays increased (34% vs 54%), with median time halved from 4.5 days to 2.1 days. Although protocol-driven MRI advice increased (32% vs 85%), clinical multidisciplinary review led to more MRIs being appropriately declined (2% vs 24%), reducing non-indicated scans from 39% to 18%. Orthosis use dropped from 40% to 16%, and median LOS decreased from 10.4 to 7 days. Upon review of records at any future encounters up to 1 year, reducing imaging or bracing interventions caused no evident harm.

Conclusion

The audit demonstrates that collaboration amongst professionals familiar with spinal fractures within a trauma unit significantly reduces LOS, unnecessary imaging and improper bracing. It is important for trauma networks to improve collaboration between tertiary services and trauma units to empower parent teams in delivering individualised, cost-effective care.