The impact of co-morbidities on age-related differences in mortality after acute traumatic spinal cord injury

Abstract

Despite the shift in demographics of spinal cord injury (SCI) due to an aging population, relatively little has been reported regarding the effect of age on outcomes after SCI. This study examines the potential confounding effect of co-morbidities on the age-related differences in the hospital mortality following acute traumatic SCI. All consecutive patients with SCI who were admitted to our spine center from 1996 to 2007 were included. Co-morbidities were classified using the Charlson Co-morbidity Index (CCI), Cumulative Illness Rating Scale, and the number of ICD-9 codes. Major potential confounders included age, gender, co-morbidity, and level and severity of SCI. There were 217 males and 80 females with ages from 15 to 96 years. Most patients had an incomplete cervical SCI following falls or motor vehicle accidents. The mean in-hospital mortality rate was 5.7%. Using univariate analyses, older age, relevant pre-existing medical conditions, and motor complete SCI were major risk factors for in-hospital death after acute SCI. Among the three co-morbidity assessments, the CCI was the most reliable co-morbidity index for prediction of hospital mortality in SCI patients after controlling for age in the Cox proportional hazard modeling. In addition, the CCI appears to be a major confounder, which accounts for the majority of age-related differences in mortality following SCI. Our findings have implications for future clinical trials of therapies for adult patients with acute SCI and for management strategies of elderly individuals with SCI.

Type and Timing of Rehabilitation Following Acute and Subacute Spinal Cord Injury: A Systematic Review

“… 19 , 20 One study found that a higher blood alcohol concentration at acute care admission predicted worse performance in ADLs, but not other outcomes. 22 Four of the SCIRehab publications 19 , 20 , 23 , 24 analyzed the predictive value of body mass index (BMI) and reported a consistent association between a high BMI (≥30 kg/m 2 ) and better QoL outcomes. 19 , 20 A higher educational background was also related with a positive QoL outcome.…”

“… 19 , 20 , 25 Complete injuries were related to poorer neurologic and ambulation outcomes and higher rates of mortality. 22 , 26 Stronger somatosensory-evoked potential (SSEP) recordings (pudendal and tibial nerves) were predictive of better ambulation outcomes. 26 Increased time from injury to rehabilitation was associated with worse ADL and QoL outcomes, but not with increased risk of rehospitalization or pressure ulcers.…”

“…Not surprisingly, parameters that reflect injury severity have been associated with poorer outcomes following rehabilitation. These include lower FIM motor scores, 19 , 20 , 25 lesion completeness, 22 , 26 SSEP characteristics, 26 time from injury to rehabilitation, 19 , 20 , 25 and increased severity as measured by International Standards for the Neurological Classification of SCI. 6 , 19 , 20 , 26 …”

Spontaneous Recovery Patterns and Prognoses after Spinal Cord Injury

“…40 In a retrospective cohort study (N = 297) of patients with acute traumatic SCI, Furlan et al found that comorbidities confounded the age-related differences in mortality during initial hospitalization following an acute traumatic SCI. 36 In addition, this study demonstrated that the Charlson Comorbidity Index (CCI) is a reliable and valid way to measure comorbidities for the purpose of predicting in-hospital mortality for patients with acute traumatic SCI after controlling for age. Thus, a measure of comorbidities (using the CCI) appears to be an important fac-Pearls ■ Patients without initial motor or sensory function below the injury may still achieve excellent recovery.…”

“…Interestingly, in this study, except for an increased risk for men to develop pulmonary embolus, there were no other gender effects on the development of other medical complications. Similarly, Furlan et al found no gender differences in inpatient mortality associated with acute traumatic SCI 36. …”