Spinal injuries in Australia 2020-21

Six measures that may indicate the seriousness or severity of a hospitalised injury are:

• ED triage category, waiting times and end status
• urgency of admission
• average length of stay
• proportion of cases with time in an intensive care unit (ICU)
• proportion of cases involving continuous ventilator support (CVS)
• proportion of in–hospital deaths.

Spinal injury hospitalisations were more severe compared to total injury hospitalisations across all measures (Table 6).

Source: AIHW National Hospital Morbidity Database.

ICU = intensive care unit

CVS = continuous ventilatory support

Triage and waiting time

Every presentation to an ED is assigned 1 of 5 triage categories based on the urgency with which the patient requires medical care. In 2020-21, almost a third (29%) of ED presentations for spinal injuries were triaged as Semi-urgent. 98% of ED presentations for spinal injuries had a waiting time of less than one hour.

Urgency of admission

In 2020-21, over 9 in 10 spinal injury hospitalisations were emergency admissions (94%, or 25,051 cases).

Of these admissions:

• 4 in 5 emergency admissions were for fractures (78% or 19,429 cases).
• Over half of all emergency admissions were for falls (56% or 13,999 cases).
• Males made up over half of emergency admissions (54% or 13,448 cases).
• Females contributed to more elective surgery admissions than males (54% or 614 cases).
• The proportion of emergency admissions decreased with age and was lowest in the 65+ age group (93% or 12,397 cases).

Average length of hospital stay

The average length of hospital stay for spinal injuries was approximately 3 times that of all injuries overall. The average length of stay for principal diagnosis spinal injury hospitalisations varied by sex, region of spine injured and increased with age.

In 2020–21, the most severe injuries in terms of average length of stay were for:

• males with injuries to the cervical spine (14 days) and females with injuries to the sacrum (14 days)
• nerve injuries (44 days).

Intensive care

In 2020-21, almost 1 in 10 spinal injury cases involved an intensive care unit (ICU) stay (8.2% or 2,174). By comparison, for all injury hospitalisations (including spinal injuries), only 2.2% of all cases involved a stay in an intensive care unit.

Of the spinal injury hospitalisations with time in intensive care:

• In over a third of ICU cases, the spinal injury was the principal diagnosis (35%).
• Almost 3 in 4 ICU hospitalisations were for males (71% or 1,540 cases).
• The number of ICU admissions increased with age and was highest in the 65+ age group (35% or 766 cases).
• Fracture of the sacrum was the most common spinal diagnosis (1,074 cases).
  • The leading causes of sacral region injuries were falls and transport injuries (64% or 2,218 cases and 30% or 1,038 cases, respectively).

Continuous ventilator support

There were 1,200 cases or 4.5% of spinal injury hospitalisations with time spent on continuous ventilatory support (CVS).

In 2020-21: 

• three quarters of spinal injury hospitalisations requiring CVS were for those where the spinal injury was an additional diagnosis (74%, or 883 cases).
• Males contributed to 3 in 4 spinal injury hospitalisations with time spent on CVS (74%, or 885 cases).
• Younger people (those aged 15-24 year olds were more likely to need CVS during their hospitalisation (8.8%), compared to 2.3% for those aged 65+.
• Fracture of sacrum was the most common spine diagnosis for spinal injury diagnosis with time spent on CVS (669 cases).

Proportion of people who died in hospital

In 2020-21 there were 452 spinal injury hospitalisations where the patient died in care (17 deaths per 100,000 cases). 

• Over half of spinal injury hospital deaths involved a fracture (51% or 231 cases).
• Additional diagnosis injuries had a higher rate of death than principal diagnosis injuries (33 and 11 deaths per 100,000 cases, respectively). This aligns with the principal diagnosis commonly being the most serious. 
• Three in 4 deaths in care were for patients in the 65+ age group.
• The cause group intentional self–harm had the highest rate of death in hospital, with a rate over 3 times higher than the next leading cause group, falls (72 and 20 deaths per 100,000 cases respectively).