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

Abstract

Study design: Retrospective population-based study with mortality follow-up. Objective: To study mortality, causes and risk factors for death in Estonian patients with traumatic spinal cord injury (TSCI). Setting: All Estonian hospitals. Methods: Medical records of patients with TSCI from all regional, central, general, and rehabilitation hospitals in Estonia from 1997 to 2007, were retrospectively reviewed. Mortality status was ascertained as of 31 December 2011. Causes of death were collected from the Estonian Causes of Death Registry. Standardized mortality ratios (SMRs) were calculated for the entire sample and for causes of death. A Cox proportional hazards modeling was used to identify the risk indicators for death. Results: During the observation period (1997-2011) 162 patients of 595 died. Nearly half of the patients (n = 76) died during the first year after TSCI. The main causes of death were external causes (30%), cardiovascular disease (29%). and suicide (8%). The overall SMR was 2.81 (95% confidence interval 2.40-3.28) and SMR was higher for women than for men (3.80 vs. 2.70). Cause-specific SMRs were markedly elevated for sepsis and suicide. Mortality was significantly affected by the age at the time of injury, neurological level, and extent of the injury as well as the year of TSCI and complications. Conclusion: Life expectancy is significantly decreased in patients with TSCI in Estonia compared with the general population. Deaths during the first year after the injury have an important impact on statistics. Treatment of cardiovascular diseases, infections, and prevention of suicide are useful for reducing mortality in patients with TSCI.

Self-harm and suicide before and after spinal cord injury: a systematic review

“…However, interestingly, in one study, all those who committed suicide were male. 23 Nevertheless, owing to the small sample size, it is not possible to suggest this as a significant risk.…”

Impact of fatal cases on the epidemiology of traumatic spinal cord injury in Estonia

“…The TSCI incidence rate in Estonia based on hospital‐registered data is one of the highest in Europe (39.7 per million population) , and mortality is high amongst TSCI patients . The aim of the current study was to include pre‐hospital deaths with the hospital data for calculation of the total incidence of TSCI.…”

A New Risk Factor for Traumatic Spinal Cord Injury

“…[27][28][29] More comprehensive assessment, including that of suicide risk, is required at outpatient clinics in patients with TSCI. In our study, the questionnaire was self-administered, and this should be considered a limitation because behavioral measures and clinical interview can be more reliable.…”