The Impact of Co-Morbidities on Age-Related Differences in Mortality after Acute Traumatic Spinal Cord Injury

Furlan, Julio C.; Kattail, Deepa; Fehlings, Michael G.

doi:10.1089/neu.2008.0764

Cited by 59 publications

(29 citation statements)

References 28 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Chamberlain

Meier²,

Mader³

et al. 2015

Neuroepidemiology

130

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Background/Aims: Mortality and longevity studies of spinal cord injury (SCI) are essential for informing healthcare systems and policies. This review evaluates the current evidence among people with SCIs worldwide in relation to the WHO region and country income level; demographic and lesion characteristics; and in comparison with the general population. Methods: A systematic review of relevant databases for original studies. Pooled estimates were derived using random effects meta-analysis, restricted to traumatic SCI. Results: Seventy-four studies were included. In-hospital mortality varied, with pooled estimates of 24.1% (95% confidence interval (CI) 14.1-38.0), 7.6% (95% CI 6.3-9.0), 7.0% (95% CI 1.5-27.4), and 2.1% (95% CI 0.9-5.0) in the WHO regions of Africa, the Americas, Europe and Western Pacific. The combined estimate for low- and middle-income countries was nearly three times higher than for high-income countries. Pooled estimates of first-year survival were 86.5% (95% CI 75.3-93.1), 95.6% (95% CI 81.0-99.1), and 94.0% (95% CI 93.3-94.6) in the Americas, Europe and Western Pacific. Pooled estimates of standardized mortality ratios in tetraplegics were 2.53 (2.00-3.21) and 2.07 (1.47-2.92) in paraplegics. Conclusion: This study found substantial variation in mortality and longevity within the SCI population, compared to the general population, and between WHO regions and country income level. Improved standardization and quality of reporting is needed to improve inferences regarding the extent to which mortality outcomes following an SCI are related to healthcare systems, services and policies.

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Section: Resultsmentioning

confidence: 99%

“…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].…”

Section: Resultsmentioning

confidence: 99%

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

Chamberlain

Meier²,

Mader³

et al. 2015

Neuroepidemiology

130

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“…1,2 In the past several years there has been a surge of interest in medical treatment standards to prevent secondary injury and optimize the cord for potential recovery. [3][4][5][6] The optimization of spinal cord perfusion is thought to play a critical role in the prevention of secondary injury.…”

Section: Introductionmentioning

confidence: 99%

Medical and Surgical Management after Spinal Cord Injury: Vasopressor Usage, Early Surgerys, and Complications

Inoue

Manley

Patel

et al. 2014

Journal of Neurotrauma

102

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The optimal mean arterial blood pressure for maintenance of spinal cord perfusion is not known. Our aim was to describe vasopressor usage and examine their effects in patients with spinal cord injury (SCI). We undertook a retrospective cohort study of 131 patients with SCI who received any kind of vasopressors to maintain blood pressure in the neurocritical care unit of a Level 1 trauma center (2005-2011). Vasopressor usage and complications were obtained from the medical record. Neurological outcomes were evaluated by the American Spinal Injury Association score. Dopamine was the most commonly used vasopressor (48.0%), followed by phenylephrine (45.0%), norepinephrine (5.0%), epinephrine (1.5%), and vasopressin (0.5%). Logistic regression analysis demonstrated that complications (e.g., ventricular tachycardia, troponin elevation, atrial fibrillation, heart rate >130 or <50, etc.) due to vasopressors were independently associated with the overall usages of dopamine (odds ratio [OR] 8.97; p<0.001) and phenylephrine (OR, 5.92; p=0.004), age ≥60 years old (OR, 5.16; p=0.013), and complete SCI (OR, 3.23; p=0.028). There was no difference in neurological improvement with either dopamine (OR, 1.16; p=0.788) or phenylephrine (OR 0.96; p=0.940). Incomplete SCI (OR, 2.64; p=0.019) and surgery <24 h after SCI (OR, 4.25; p=0.025) were independently associated with improved outcome. In summary, vasopressors are associated with increased complications in SCI patients. Further prospective studies are required in order to determine the potential benefits and risks of blood pressure management in patients with SCI.

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“…For example, there are a number of studies showing that persons who incur a SCI at later ages have poorer functional outcomes than those injured at younger ages. [9][10][11] Within a theoretical reserve capacity model of aging that is disrupted by SCI, Adkins 7 posits that the impact of injury 'decreases the further out on the age continuum the injury occurs' (p. 5). However, if the injury occurs far enough along the continuum, then even a minimal change in rate will lower reserve capacity below 40% because capacity is already low.…”

Section: Introductionmentioning

confidence: 99%

“…Further, adults with older ages of SCI-onset may have other pre-existing comorbidities that affect outcomes compared with younger adults. 9 Fortunately, increases in life expectancy are providing opportunities to clarify the changes to body systems resulting from SCI, aging or both. What is clear is that physiologic systems do deteriorate with age, and this has been well documented in person with SCI.…”

Section: Introductionmentioning

confidence: 99%

An evidence-based review of aging of the body systems following spinal cord injury

et al. 2010

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Study design: Systematic review. Objective: To systematically review evidence on aging of the body systems after spinal cord injury (SCI). Setting: Toronto, Ontario and Vancouver, British Columbia, Canada. Methods: Electronic databases (MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO), were searched for studies published between 1980 and 2009. The search was augmented by reviewing the reference lists of relevant papers. Non-intervention studies that were longitudinal or cross-sectional with ablebodied controls that were at minimum matched on chronological age were included for review. Levels of evidence were assigned to the study design using a modified Sackett scale. Results: Of the 74 studies selected for inclusion, 16 were longitudinal in design. The hypothesis that SCI represents a model for premature aging is supported by a large proportion of level 5 evidence for the cardiovascular and endocrine systems, level 2, 4 and 5 evidence for the musculoskeletal system, and limited level 5 evidence for the immune system. Only a few level 4 and 5 studies for the respiratory system were found. The evidence on the genitourinary system, gastrointestinal system, and for skin and subcutaneous tissues provide level 4 and 5 evidence that premature aging may not be occurring. The evidence on the nervous system does not provide evidence of premature aging as a result of SCI. Conclusions: Premature aging appears to occur in some systems after SCI. Additional longitudinal studies are required to confirm these findings. Sponsorship: Rick Hansen Institute; Ontario Neurotrauma Foundation.

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The Impact of Co-Morbidities on Age-Related Differences in Mortality after Acute Traumatic Spinal Cord Injury

Cited by 59 publications

References 28 publications

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

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

Medical and Surgical Management after Spinal Cord Injury: Vasopressor Usage, Early Surgerys, and Complications

An evidence-based review of aging of the body systems following spinal cord injury

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