Determinants of in-hospital death after acute spinal cord injury: a population-based study

Abstract

Objectives: First, to evaluate the influence of comorbid diseases and concomitant injuries on the risk of in-hospital death after traumatic spinal cord injury (TSCI). Second, to identify the risk characteristics of TSCI patients with likelihood of death. Study design: Population-based retrospective cohort study. Setting: Sixty-two acute care hospitals in South Carolina, USA. Methods: Records of 3389 TSCI patients hospitalized with acute TSCI were evaluated. Days elapsing from the date of injury to date of death established the survival time (T). Cox regression examined risk of in-hospital death as a function of counts of comorbid conditions and injuries along with their joint effects controlling for other covariates. Results: Counts of comorbid conditions and injuries showed dose-dependent risk of death while in-hospital independent of demographical and clinical covariates. Hazard ratios (HR) for counts 3 þ , 2 and 1 comorbid conditions were 2.19 (Po0.001), 1.73 (P ¼ 0.005) and 1.20 (P ¼ 0.322), respectively. For counts of 4 þ , 3 and 2 other injuries were 1.85 (Po0.001), 1.81 (Po0.001) and 1.46 (P ¼ 0.022), respectively. The joint effect of the two was transadditive with statistically significant HR ranging from 1.72-3.14. Conclusion: Counts of comorbid conditions and injured body regions strongly indicate risk of in-hospital death after TSCI and their joint effects elicited dose-dependent gradient independent of demographical and clinical covariates. Assessing risk of in-hospital death based on joint use of counts of comorbid diseases and injuries is highly informative to target TSCI patients at high risk of dying.

In-hospital end-of-life decisions after new traumatic spinal cord injury in the Netherlands

“…Furthermore, methodological differences between studies may determine mortality figures, as well as information on the application of ELDs. As this is the first study that has focussed primarily on this subject, and studies on in-hospital mortality after TSCI did not report on ELDs, [12][13][14][15][16][17][18][19] it is not possible to compare our results with those of other studies in this diagnostic group. We found slightly more nontreatment decisions compared with studies on trauma patients (42-61%).…”

“…11 Several studies have been performed on in-hospital death after new TSCI. [12][13][14][15][16][17][18][19] However, the only studies on ELDs after new TSCI we could find were studies on ethical considerations, including case reports, [20][21][22] and the aforementioned study on clinicians' viewpoints towards non-treatment decisions. 11 Information on the occurrence of ELDs and characteristics of the patients involved is thus lacking.…”

Mortality and Longevity after a Spinal Cord Injury: Systematic Review and Meta-Analysis

“…More than one third of all included studies were from the United States (n = 28) [18,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]; roughly 13% of studies were conducted in Canada (n = 10) [17,63,64,65,66,67,68,69,70,71], 5% in Israel (n = 4) [72,73,74,75], 5% in Australia (n = 4) [9,76,77,78]; 4% in France (n = 3) [79,80,81]; 4% from Norway (n = 3) [7,10,19]; while the remaining were from countries including Brazil, China, Estonia, Finland, Greece, Germany, Iceland, Italy, Japan, the Netherlands, Nigeria, Poland, Scotland, Sierra Leone, South Africa, Sweden, Taiwan, and the United Kingdom (see online suppl. table; for all online suppl.…”

Mortality and causes of death after traumatic spinal cord injury in Estonia

“…2 The death rate has been found to be higher among the elderly, with more counts of comorbidities. 8 Also, the predictors of survival are the neurological level and extent of injury. Country-specific, as well as cross-country studies are desirable to inform relevant health policy for improved primary and secondary prevention and care.…”