Factors associated with early mortality after cervical spinal cord injury

Abstract

Background: A relatively high early mortality rate (<30 days post-injury) for cervical spinal cord injury (SCI) has been observed. Objective: To investigate this early mortality rate observed after cervical SCI and analyze the associated influential factors. Methods: Medical records for 1163 patients with cervical SCI were reviewed, and the number of patients with early mortality was documented. Through logistic regression analysis, the effects of age, gender, occupation, cause of injury, severity of injury, highest involved spinal cord segment, nutritional condition during hospitalization, surgical treatment, tracheotomy, etc., on early mortality were assessed. Implementation of early treatment (i.e. surgery, tracheotomy, and nutritional support) and its effect on patient prognosis were also analyzed. Results: Early mortality occurred in 109 of 1163 patients (9.4%). Four factors affected the early mortality rate, including level and severity of SCI, whether or not surgery was performed, the time interval between SCI and surgery, malnutrition, and tracheotomy. Patients with an American Spinal Injury Association grade of A, a high cervical SCI (C1-C3), and/or no surgical intervention were statistically more likely to have early mortality (P < 0.001). Conclusion: Severe cervical SCI, upper-level cervical cord injury, malnutrition, and inappropriate tracheotomy are risk factors for early mortality in patients with cervical SCI. Surgery can reduce early mortality. Early tracheotomy should be performed in patients with complete upper-level cervical SCI, but patients with incomplete cervical SCI or complete low-level cervical SCI should initially be treated surgically to maintain smooth airway flow.

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

“…table; for all online suppl. material, see www.karger.com/doi/10.1159/000382079) [7,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107]. The study duration ranged from less than one year to more than 50 years, and included data beginning in 1935 until 2009.…”

“…Among studies that reported risk of mortality with age at injury, HRs ranged between 1.03 and 3.44 [7,81], and ORs ranged between 1.02 and 1.31 [60,97]. Comparing males to females across studies, HRs ranged between 0.94 and 1.40 [7,77], and ORs ranged between 1.15 and 1.60 [44,58].…”

“…Among those studies that investigated the causes of death, the reported leading causes of death were diverse (n = 22) [9,10,19,37,40,42,51,65,74,78,84,86,87,88,89,90,92,94,97,106,107,108,109]. The most commonly reported leading cause of death was pneumonia (n = 5) [19,51,78,94,109], followed by heart disease (n = 3) [10,74,84].…”

Outcome Analysis of Upper versus Lower Cervical Spine Injuries

“…[1][2][3][4] Injury to the cervical spinal cord accounts for 2 to 3% of trauma patients and 8.2% of all trauma-related deaths. 5 It includes 50 to 75% of all spine injuries. [1][2][3][4][5][6] Suspicion, early diagnosis of injury, preservation of spinal cord function, maintenance or restoration of spinal alignment, and stability are keys to successful management.…”

“…5 It includes 50 to 75% of all spine injuries. [1][2][3][4][5][6] Suspicion, early diagnosis of injury, preservation of spinal cord function, maintenance or restoration of spinal alignment, and stability are keys to successful management. Approximately 12,000 new cases (40 cases/million) are added every year to the existing 0.3 to 0.5 million victims in the United States.…”