{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T16:01:27Z","timestamp":1783094487061,"version":"3.54.6"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2020,11,26]],"date-time":"2020-11-26T00:00:00Z","timestamp":1606348800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,11,26]],"date-time":"2020-11-26T00:00:00Z","timestamp":1606348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012620","name":"Royal Holloway University of London","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012620","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Intern Emerg Med"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Patients admitted with a cervical fracture are twice as likely to die within 30\u00a0days of injury than those with a hip fracture. However, guidelines for the management of cervical fractures are less available than for hip fractures. We hypothesise that outcomes may differ between these types of fractures. We analysed 1359 patients (406 men, 953 women) with mean age of 83.8\u00a0years (standard deviation\u2009=\u20098.7) admitted to a National Health Service hospital in 2013\u20132019 with a cervical (7.5%) or hip fracture (92.5%) of similar age. The association of cervical fracture (hip fracture as reference), hospital length of stay (LOS), co-morbidities, age and sex with outcomes (acute delirium, new pressure ulcer, and discharge to residential\/nursing care) was assessed by stepwise multivariate logistic regression. <jats:italic>Acute delirium without history of dementia<\/jats:italic> was increased with cervical fractures: odds ratio (OR)\u2009=\u20092.4, 95% confidence interval (CI)\u2009=\u20091.3\u20134.7, age\u2009\u2265\u200980\u00a0years: OR\u2009=\u20093.5 (95% CI\u2009=\u20091.9\u20136.4), history of stroke: OR\u2009=\u20091.8 (95% CI\u2009=\u20091.0\u20133.1) and ischaemic heart disease: OR\u2009=\u20091.9 (95% CI\u2009=\u20091.1\u20133.6); <jats:italic>pressure ulcers<\/jats:italic> was increased with cervical fractures: OR\u2009=\u200910.9 (95% CI\u2009=\u20095.3\u201322.7), LOS of 2\u20133\u00a0weeks: OR\u2009=\u20093.0 (95% CI\u2009=\u20091.2\u20137.5) and LOS of\u2009\u2265\u20093\u00a0weeks: OR\u2009=\u20094.9, 95% CI\u2009=\u20092.2\u201311.0; and <jats:italic>discharge to residential\/nursing care<\/jats:italic> was increased with cervical fractures: OR\u2009=\u20093.2 (95% CI\u2009=\u20091.4\u20137.0), LOS of\u2009\u2265\u20093\u00a0weeks: OR\u2009=\u20094.4 (95% CI\u2009=\u20092.5\u20137.6), dementia: OR\u2009=\u20092.7 (95% CI\u2009=\u20091.6\u20134.7), Parkinson\u2019s disease: OR\u2009=\u20093.4 (95% CI\u2009=\u20091.3\u20138.8), and age\u2009\u2265\u200980\u00a0years: OR\u2009=\u20092.7 (95% CI\u2009=\u20091.3\u20135.6). In conclusion, compared with hip fracture, cervical fracture is more likely to associate with acute delirium and pressure ulcers, and for discharge to residency of high level of care, independent of established risk factors.<\/jats:p>","DOI":"10.1007\/s11739-020-02567-x","type":"journal-article","created":{"date-parts":[[2020,11,26]],"date-time":"2020-11-26T18:34:18Z","timestamp":1606415658000},"page":"1207-1213","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures"],"prefix":"10.1007","volume":"16","author":[{"given":"Joshua","family":"Baxter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radcliffe","family":"Lisk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Osmani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keefai","family":"Yeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Robin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Fluck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher Henry","family":"Fry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2570-0938","authenticated-orcid":false,"given":"Thang Sieu","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,11,26]]},"reference":[{"key":"2567_CR1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ijotn.2017.04.004","volume":"26","author":"EM Curtis","year":"2017","unstructured":"Curtis EM, Moon RJ, Harvey NC, Cooper C (2017) Reprint of: the impact of fragility fracture and approaches to osteoporosis risk assessment worldwide. Int J Orthop Trauma Nurs 26:7\u201317","journal-title":"Int J Orthop Trauma Nurs"},{"issue":"1\u20132","key":"2567_CR2","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1007\/s11657-013-0136-1","volume":"8","author":"E Hernlund","year":"2013","unstructured":"Hernlund E, Svedbom A, Iverg\u00e5rd M, Compston J, Cooper C, Stenmark J, McCloskey EV, J\u00f6nsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos 8(1\u20132):136","journal-title":"Arch Osteoporos"},{"key":"2567_CR3","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1016\/j.injury.2018.04.015","volume":"49","author":"N Veronese","year":"2018","unstructured":"Veronese N, Maggi S (2018) Epidemiology and social costs of hip fracture. Injury 49:1458\u20131460","journal-title":"Injury"},{"key":"2567_CR4","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1007\/s00198-004-1627-0","volume":"15","author":"O Johnell","year":"2004","unstructured":"Johnell O, Kanis JA (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15:897\u2013902","journal-title":"Osteoporos Int"},{"key":"2567_CR5","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1093\/gerona\/glt105","volume":"69","author":"GS Tajeu","year":"2014","unstructured":"Tajeu GS, Delzell E, Smith W, Arora T, Curtis JR, Saag KG, Morrisey MA, Yun H, Kilgore ML (2014) Death, debility, and destitution following hip fracture. J Gerontol A Biol Sci Med Sci 69:346\u2013353","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2567_CR6","doi-asserted-by":"publisher","first-page":"2791","DOI":"10.1007\/s00198-017-4153-6","volume":"28","author":"S Williamson","year":"2017","unstructured":"Williamson S, Landeiro F, McConnell T, Fulford-Smith L, Javaid MK, Judge A, Leal J (2017) Costs of fragility hip fractures globally: a systematic review and meta-regression analysis. Osteoporos Int 28:2791\u20132800","journal-title":"Osteoporos Int"},{"key":"2567_CR7","volume-title":"Guideline on the management of alert, adult patients with a potential cervical spine injury in the Emergency Department","author":"College of Emergency Medicine Clinical Effectiveness Committee","year":"2010","unstructured":"College of Emergency Medicine Clinical Effectiveness Committee (2010) Guideline on the management of alert, adult patients with a potential cervical spine injury in the Emergency Department. College of Emergency Medicine, London"},{"key":"2567_CR8","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1007\/s00776-010-1493-x","volume":"15","author":"M Watanabe","year":"2010","unstructured":"Watanabe M, Sakai D, Yamamoto Y, Sato M, Mochida J (2010) Upper cervical spine injuries: age-specific clinical features. J Orthop Sci 15:485\u2013492","journal-title":"J Orthop Sci"},{"key":"2567_CR9","doi-asserted-by":"publisher","first-page":"e114","DOI":"10.1016\/j.wneu.2018.07.228","volume":"120","author":"AO Asemota","year":"2018","unstructured":"Asemota AO, Ahmed AK, Purvis TE, Passias PG, Goodwin CR, Sciubba DM (2018) Analysis of cervical spine injuries in elderly patients from 2001 to 2010 using a nationwide database: increasing incidence, overall mortality, and inpatient hospital charges. World Neurosurg 120:e114\u2013e130","journal-title":"World Neurosurg"},{"key":"2567_CR10","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1097\/BRS.0000000000000892","volume":"40","author":"ME Menendez","year":"2015","unstructured":"Menendez ME, Ring D, Harris MB, Cha TD (2015) Predicting in-hospital mortality in elderly patients with cervical spine fractures: a comparison of the Charlson and Elixhauser comorbidity measures. Spine 40:809\u2013815","journal-title":"Spine"},{"key":"2567_CR11","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1080\/10790268.2007.11753931","volume":"30","author":"MJ Sokolowski","year":"2007","unstructured":"Sokolowski MJ, Jackson AP, Haak MH, Meyer MDPR Jr, Sokolowski MS (2007) Acute outcomes of cervical spine injuries in the elderly: atlantaxial vs subaxial injuries. J Spinal Cord Med 30:238\u2013242","journal-title":"J Spinal Cord Med"},{"key":"2567_CR12","doi-asserted-by":"publisher","first-page":"567","DOI":"10.2106\/JBJS.I.00003","volume":"92","author":"MB Harris","year":"2010","unstructured":"Harris MB, Reichmann WM, Bono CM, Bouchard K, Corbett KL, Warholic N, Simon JB, Schoenfeld AJ, Maciolek L, Corsello P, Losina E (2010) Mortality in elderly patients after cervical spine fractures. J Bone Joint Surg Am 92:567\u2013574","journal-title":"J Bone Joint Surg Am"},{"key":"2567_CR13","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1302\/0301-620X.96B1.32024","volume":"96-B","author":"M Venkatesan","year":"2014","unstructured":"Venkatesan M, Northover JR, Wild JB, Johnson N, Lee K, Uzoigwe CE, Braybrooke JR (2014) Survival analysis of elderly patients with a fracture of the odontoid peg. Bone Joint J 96-B:88\u201393","journal-title":"Bone Joint J"},{"key":"2567_CR14","doi-asserted-by":"publisher","first-page":"2036","DOI":"10.1111\/jgs.13670","volume":"63","author":"Z Cooper","year":"2015","unstructured":"Cooper Z, Mitchell SL, Lipsitz S, Harris MB, Ayanian JZ, Bernacki RE, Jha AK (2015) Mortality and readmission after cervical fracture from a fall in older adults: comparison with hip fracture using national Medicare data. J Am Geriatr Soc 63:2036\u20132042","journal-title":"J Am Geriatr Soc"},{"key":"2567_CR15","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1080\/02688697.2018.1445828","volume":"32","author":"GE Peck","year":"2018","unstructured":"Peck GE, Shipway DJ, Tsang K, Fertleman M (2018) Cervical spine immobilisation in the elderly: a literature review. Br J Neurosurg 32:286\u2013290","journal-title":"Br J Neurosurg"},{"key":"2567_CR16","volume-title":"National hip fracture database annual report 2019","author":"Royal College of Physicians","year":"2019","unstructured":"Royal College of Physicians (2019) National hip fracture database annual report 2019. Royal College of Physicians, London"},{"key":"2567_CR17","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1093\/ageing\/afz161","volume":"49","author":"R Lisk","year":"2020","unstructured":"Lisk R, Yeong K, Enwere P, Jenkinson J, Robin J, Irvin-Sellers M, Fluck D, Osmani A, Sharmin R, Sharma P, Fry CH, Han TS (2020) Associations of 4AT with mobility, length of stay and mortality in hospital and discharge destination among patients admitted with hip fractures. Age Ageing 49:411\u2013417","journal-title":"Age Ageing"},{"key":"2567_CR18","doi-asserted-by":"publisher","DOI":"10.1007\/s00223-020-00722-2","author":"R Lisk","year":"2020","unstructured":"Lisk R, Yeong K, Fluck D, Fry CH, Han TS (2020) The ability of the Nottingham hip fracture score to predict mobility, length of stay and mortality in hospital, and discharge destination in patients admitted with a hip fracture. Calcif Tissue Int. https:\/\/doi.org\/10.1007\/s00223-020-00722-2 (Online ahead of print)","journal-title":"Calcif Tissue Int"},{"key":"2567_CR19","doi-asserted-by":"publisher","DOI":"10.1038\/s41430-020-00774-5","author":"TS Han","year":"2020","unstructured":"Han TS, Yeong K, Lisk R, Fluck D, Fry CH (2020) Prevalence and consequences of malnutrition and malnourishment in older individuals admitted to hospital with a hip fracture. Eur J Clin Nutr. https:\/\/doi.org\/10.1038\/s41430-020-00774-5 (Online ahead of print)","journal-title":"Eur J Clin Nutr"},{"key":"2567_CR20","volume-title":"ICD-10: international statistical classification of diseases and related health problems: tenth revision","author":"World Health Organization","year":"2004","unstructured":"World Health Organization (2004) ICD-10: international statistical classification of diseases and related health problems: tenth revision. WHO, Geneva"},{"key":"2567_CR21","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1007\/s00586-008-0603-3","volume":"17","author":"SA Malik","year":"2008","unstructured":"Malik SA, Murphy M, Connolly P, O\u2019Byrne J (2008) Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients. Eur Spine J 17:585\u2013591","journal-title":"Eur Spine J"},{"key":"2567_CR22","doi-asserted-by":"publisher","first-page":"633","DOI":"10.2165\/00007256-200232100-00003","volume":"32","author":"KL Quarrie","year":"2002","unstructured":"Quarrie KL, Cantu RC, Chalmers DJ (2002) Rugby union injuries to the cervical spine and spinal cord. Sports Med 32:633\u2013653","journal-title":"Sports Med"},{"key":"2567_CR23","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1016\/S0278-5919(03)00003-6","volume":"22","author":"MG Zmurko","year":"2003","unstructured":"Zmurko MG, Tannoury TY, Tannouty CA, Anderson DG (2003) Cervical sprains, disc herniations, minor fractures, and other cervical injuries in the athlete. Clin Sports Med 22:513\u2013521","journal-title":"Clin Sports Med"},{"key":"2567_CR24","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.neucir.2017.01.005","volume":"28","author":"E B\u00e1rbara-Bataller","year":"2017","unstructured":"B\u00e1rbara-Bataller E, M\u00e9ndez-Su\u00e1rez JL, Alem\u00e1n-S\u00e1nchez C, S\u00e1nchez-Enr\u00edquez J, Sosa-Henr\u00edquez M (2017) Spinal cord injuries resulting from diving accidents in the Canary Islands. Neurocirug\u00eda 28:183\u2013189","journal-title":"Neurocirug\u00eda"},{"key":"2567_CR25","unstructured":"National Institute for Health and Clinical Excellence. Spinal injury: assessment and initial management. NICE guideline [NG41]. Published date: 17 Feb 2016"},{"key":"2567_CR26","unstructured":"McMordie JH, Viswanathan VK, Gillis CC (2020) Cervical Spine Fractures Overview. Treasure Island (FL): StatPearls Publishing. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK448129\/. Accessed 15 Jul 2020"},{"key":"2567_CR27","unstructured":"Torlincasi AM, Waseem M. Cervical Injury (2020) Treasure Island (FL): StatPearls Publishing. Jan- https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK448146\/. Accessed 15 Jul 2020"},{"key":"2567_CR28","first-page":"87","volume":"11","author":"PR Worsley","year":"2018","unstructured":"Worsley PR, Stanger ND, Horrell AK, Bader DL (2018) Investigating the effects of cervical collar design and fit on the biomechanical and biomarker reaction at the skin. Med Devices (Auckl) 11:87\u201394","journal-title":"Med Devices (Auckl)"},{"key":"2567_CR29","doi-asserted-by":"publisher","first-page":"2452","DOI":"10.11124\/JBISRIR-2017-003872","volume":"17","author":"L Lacey","year":"2019","unstructured":"Lacey L, Palokas M, Walker J (2019) Preventative interventions, protocols or guidelines for trauma patients at risk of cervical collar-related pressure ulcers: a scoping review. JBI Database System Rev Implement Rep 17:2452\u20132475","journal-title":"JBI Database System Rev Implement Rep"},{"key":"2567_CR30","doi-asserted-by":"publisher","first-page":"e021769","DOI":"10.1136\/bmjopen-2018-021769","volume":"8","author":"JF Guest","year":"2018","unstructured":"Guest JF, Fuller GW, Vowden P, Vowden KR (2018) Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes. BMJ Open 8:e021769","journal-title":"BMJ Open"}],"container-title":["Internal and Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-020-02567-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11739-020-02567-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-020-02567-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T19:43:45Z","timestamp":1627155825000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11739-020-02567-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,26]]},"references-count":30,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["2567"],"URL":"https:\/\/doi.org\/10.1007\/s11739-020-02567-x","relation":{},"ISSN":["1828-0447","1970-9366"],"issn-type":[{"value":"1828-0447","type":"print"},{"value":"1970-9366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,26]]},"assertion":[{"value":"28 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 November 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 November 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study does not require National Health Service Research Ethics Committee approval since it involves secondary analysis of anonymised data. This study was conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This article does not contain any studies with animals performed by any of the authors. Informed consent Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal rights"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}