Risk factors for mortality after spinal cord injury in the USA

Abstract

Study design: Cohort study. Objectives: First, to examine three sets of risk and protective factors for mortality after spinal cord injury (SCI), with an emphasis on health and secondary conditions. Second, to extend earlier work with several methodologic enhancements and addition of new predictors. Setting: Twenty hospitals designated as SCI Model Systems (SCIMSs) of care in the United States. Methods: Altogether, 8183 adults with traumatic SCI who received at least one follow-up evaluation between November 1995 and October 2006 from one of the SCIMSs were included in the study. There were 76 262 person-years and 1381 deaths at the end of June 2011. Mortality status determined by National Death Index and Social Security Death Index searches. Three successive sets of risk factors were evaluated with a logistic regression model on person-year observations to estimate the chance of dying in any given year. Results: Several biographic and injury, socio-environmental and health factors were significantly related to the odds of mortality. A history of pneumonia or kidney calculus was associated with greater odds of mortality, whereas deep vein thrombosis was not. Poor general health, decline in health over the past year, hospitalization and a grade 3 or 4 pressure ulcer were also related to mortality. Consistent with a mediating effect, odds ratios declined with the addition of each successive set of factors. Conclusion: The relationship of biographic and injury characteristics with mortality after SCI is mediated by socio-environmental and health factors. Assessment of these variables enhances our ability to identify individuals at risk for excess mortality.

Traumatic spinal cord injury in the north-east Tanzania – describing incidence, etiology and clinical outcomes retrospectively

“…Pressure ulcers are also a common cause of death to persons with spinal cord injury in many lower income countries [4,14,31]. The magnitude of pressure ulcers, respiratory complications and urinary tract infections partly explain the high in-hospital mortality of 24.4% of all TSCI admissions [32]. Mortality could also have been instigated by associated injuries as LOS was found to be significantly shorter for persons who had associated injuries involving mostly head and chest.…”

“…There was a significantly longer mean LOS for the wheelchair-dependent group (p ≤ 0.001) when compared to those who did not need one. Increased hospital stay and bed rest consequently adds to the risk of complications such as pressure ulcers, urinary tract infections and hypostatic pneumonia especially in the older patients and eventually death [14,32,33]. Appropriate wheelchair obtained earlier will enable the individual to be mobile, functional, productive and to interact with the social and physical environment from earlier stage.…”

Impact of Marital Status on 20-Year Subjective Well-being Trajectories

“…This is consistent with studies that indicate that those who have the greatest number of problems are at the greatest risk for mortality and those who survive are the ones who show higher levels of adaptation. 28,29 Third, all data are selfreport measures. Therefore, the variables are, by definition, subjective and represent perceptions of life satisfaction and life problems.…”

Survival of patients with spinal cord injury after cardiac arrest in Department of Veterans Affairs hospital: Pilot study

“…Interestingly, one of the two survivors was classified as having cervical 5 motor and sensory complete tetraplegia. Finally, although not unique to the SCI population, grade III and grade IV pressure ulcers are associated with increased mortality and pressure ulcer management was the most common reason for admission in this study [15]. End-of-life discussions are crucial in any patient population.…”