C2 Fractures in the Elderly: Single-Center Evaluation of Risk Factors for Mortality

STUDY DESIGN: Retrospective cohort study. PURPOSE: The aim of this study was to identify features associated with increased mortality risk in traumatic C2 fractures in the elderly, including measures of comorbidity and frailty. OVERVIEW OF LITERATURE: C2 fractures in the elderly are of increasing relevance in the setting of an aging global population and have a high mortality rate. Previous analyzes of risk factors for mortality have not included the measures of comorbidity and/or frailty, and no local data have been reported to date. METHODS: This study comprises a retrospective review of 70 patients of age >65 years at Waikato Hospital, New Zealand with traumatic C2 fractures identified on computed tomography between 2010 and 2016. Demographic details, medical history, laboratory results on admission, mechanism of injury, and neurological status on presentation were recorded. Medical comorbidities were also detailed allowing calculation of the Charlson Comorbidity Index (CCI) and the modified Frailty Index (mFI). RESULTS: The most common mechanism of injury was a fall from standing height (n=52, 74.3%). Mortality rates were 14.3% (n=10) at day 30, and 35.7% (n=25) at 1 year. Bivariate analysis showed that both CCI and mFI correlated with 1-year mortality rates. Reduced albumin and hemoglobin levels were also associated with 30-day and 1-year mortality rates. Forward stepwise logistic regression models determined CCI and low hemoglobin as predictors of mortality within 30 days, whereas CCI, low albumin, increased age, and female gender predicted mortality at 1 year. CONCLUSIONS: The CCI was a useful tool for predicting mortality at 1 year in the patient cohort. Other variables, including common laboratory markers, can also be used for risk stratification, to initiate timely multidisciplinary management, and prognostic counseling for patients and family members.

application of ultrasound B-flow imaging in detection of carotid atherosclerotic micro-vessel with ischemic cerebrovascular disease

To investigate the detection and characterization of micro-vessels within the carotid atherosclerotic plaque using B-flow imaging [BFI] ultrasound with contrast-enhanced ultrasound [CEU] as the reference standard. Between August 2008 and July 2011, 78 patients with carotid atherosclerosis that were admitted at the Department of Ultrasonography in ZhongNan Hospital of Wuhan University, Wuhan, China underwent standard and BFI examination. Fifty-one patients received both BFI and CEU. We evaluated the relationship between BFI findings, and clinical symptoms in ischemic stroke, or transient ischemic attack patients. The correlation of cerebrovascular symptoms, stenosis, and plaque type on the detection of neovessels by BFI were statistically evaluated using chi2 test [McNemar test]. The agreement of the 2 sonographic methods was assessed by kappa coefficient. The diagnostic efficacy of BFI for carotid atherosclerotic micro-vessel detection was also calculated. The BFI findings of micro-vessel were correlated to patient's symptom. The agreement between BFI and CEU for diagnosis of microvascularization was good [kappa=0.406]. The following was calculated: sensitivity [0.483]; specificity [0.955]; positive predictive value [0.933]; negative predictive value [0.583]; and accuracy of BFI [0.686]. Logistic regression demonstrated a significant association between cerebrovascular events and the presence of BFI signals within carotid plaques [B: 2.422; 95% confidence interval: 1.728-73.407]. Compared with CEU, the BFI is less sensitive, however, it is a valid and practical method for detection of carotid atherosclerotic micro-vessels

Prognostic factors of early sequelae and fatal outcome of Japanese encephalitis.

A clinical case control study to identify prognostic factors present at hospital admission associated with early sequelae and fatal outcome of acute Japanese encephalitis (JE) was carried out in Gusi county, Henan Province, central China from June to September 1991. A total of 70 patients with laboratory-confirmed acute JE were studied, of whom 3 cases died and 33 cases had neurological or psychiatric sequelae at the end of three months follow-up. The results showed that acute JE at younger age, with higher body temperature, high white cell count in CSF, and deep coma present at hospital admission were markers for unfavorable outcomes (sequelae or fatal). A history of the vaccination was not correlated with the early sequelae and fatal outcome of the disease. The paper suggests that early diagnosis and treatment and universal JE vaccination for all susceptible populations are keys for decreasing incidence of sequelae and fatal outcome of acute JE.

Socio-economic status and micro-environmental factors in relation to the risk of Japanese encephalitis: a case-control study.

In a population-based case-control study in Southern Henan Province, central China, children suffering from Japanese encephalitis (JE) were compared with neighborhood controls matched by age and sex in terms of several social and environmental variables. Factors found by crude analysis to be associated with an increased risk of JE included lower family income, lower parental education, living in houses near the periphery of villages and poor quality of houses. When adjustment was made for confounding variables, only the association of house location within village remained of borderline significance (OR = 0.51, 95% CI = 0.15 approximately 1.03). It is suggested that the beneficial effect of higher family income and parental education was partly due to the fact that those parents might be more conscious about having their children vaccinated in the situation where there was a shortage of JE vaccine in the study area.