Life expectancy after spinal cord injury: a 50-year study

Middleton, James; Dayton, A; Walsh, John; Rutkowski, Sue; Leong, Grace; Duong, Son Q.

doi:10.1038/sc.2012.55

Cited by 197 publications

(143 citation statements)

References 25 publications

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“…2,10 An ageing background population and an independent increase in age at the time of injury account for a proportional increase in older patients with SCI. 1,10 An expected increase in the incidence of agerelated conditions requires a focus on chronic and preventative healthcare.…”

Section: Discussionmentioning

confidence: 99%

“…1 Despite improvements in acute mortality, there is still a decreased life expectancy now most frequently attributed to cancer. 2 Colorectal cancer (CRC) screening in this group has received little attention despite reports of an at least equivalent cancer risk 3-5 and presentation with more advanced disease. 6 Detection of occult neoplastic disease is difficult due to higher rates of gastrointestinal complaints 6,7 and the high frequency of PR bleeding should exclude SCI patients from faecal occult blood testing.…”

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confidence: 99%

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Colonoscopy after spinal cord injury: a case–control study

2014

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Design: An age-and gender-matched case-control study. Objective: To compare colonoscopy after spinal cord injury (SCI) with the general population in terms of indications, bowel preparation, technical success and disease detection. Setting: Victoria, Australia. Methods: Consecutive SCI colonoscopies between January 1998 and February 2013 were compared with a randomly selected ageand gender-matched control group. Injury level, indication for procedure and demographics were collected. Outcome measures included quality of bowel preparation, completion rates, procedural duration and benign and malignant disease detection. Results: A total of 440 colonoscopies were assessed, comprising 148 SCI patients and 292 age-and gender-matched controls. Both the groups were of similar age (54.7 years vs 54.5 years, P = 0.906) and comprised predominantly males (87.1% vs 86.3%, P = 0.919). SCI colonoscopies were more often performed to investigate abnormalities (85.1% vs 58.2%, Po0.001) than for screening or surveillance (18.2% vs 40.8%, Po0.001). Unsatisfactory bowel preparation was recorded more often in the SCI group (36.0% vs 13.0%, Po0.001) and completion rates were lower (75.7% vs 93.1%, Po0.001). Overall disease detection was lower in the SCI group (45.3% vs 59.6%, Po0.006). The polyp detection rate was lower for SCI (11.4% vs 25.3%, P = 0.001). The rate of diagnosis of malignancy was equivalent (2.7% vs 3.0%, P = 0.904). Conclusion: SCI patients have the same risk of malignancy as the general population and are less likely to undergo screening colonoscopy. Colonoscopy is then limited by poor bowel preparation and lower completion rates with a subsequent lower polyp detection rate. INTRODUCTIONThere is both an increasing prevalence and increasing average age of SCI patients. 1 Despite improvements in acute mortality, there is still a decreased life expectancy now most frequently attributed to cancer. 2 Colorectal cancer (CRC) screening in this group has received little attention despite reports of an at least equivalent cancer risk 3-5 and presentation with more advanced disease. 6 Detection of occult neoplastic disease is difficult due to higher rates of gastrointestinal complaints 6,7 and the high frequency of PR bleeding should exclude SCI patients from faecal occult blood testing. 3 Colonoscopy is challenging with difficulties in bowel preparation and low intubation rates despite multiday bowel preparation, 3,8,9 and studies assessing yield and safety of colonoscopy after SCI 3,8 have been limited by a small sample size or lack of a control group. We seek to highlight the difficulties with colonoscopy after SCI using a noninjured control group but to emphasise its importance by demonstrating the rates of benign and malignant diseases.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Colonoscopy after spinal cord injury: a case–control study

2014

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“…5 We have not performed a detailed literature review of life expectancy at this time. Newer data, confirming improved survival in developed countries, are available from Middleton et al 66 who projected from New South Wales (Australian) data that the estimated life expectancies (25-65 years; percentage of mean life expectancy) 'ranged between 64%-69%, 74%-65%, 88%-91% and 97%-96% for C1-4 ASIA A-C, C5-8A-C, T1-S5 A-C and ASIA D lesions, respectively' . 66 …”

Section: Survival Of Tsci Globally (Supplementarymentioning

confidence: 99%

The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate

Lee

Cripps

Fitzharris³

et al. 2013

Spinal Cord

720

458

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“…[1][2][3][4] However, little is known about survival after spinal cord injury in low-and middle-income countries (LMICs), especially after discharge from hospital. Most data on survival after spinal cord injury in LMICs are obtained retrospectively from hospital records and focus on acute survival during the period of hospitalisation immediately after spinal cord injury.…”

Section: Introductionmentioning

confidence: 99%

Two-year survival following discharge from hospital after spinal cord injury in Bangladesh

et al. 2015

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Study design: Mixed retrospective-prospective cohort study. Objectives: To determine 2-year survival following discharge from hospital after spinal cord injury in Bangladesh. Setting: Bangladesh. Methods: Medical records were used to identify all patients admitted in 2011 with a recent spinal cord injury to the Centre for Rehabilitation of the Paralysed, a large Bangladeshi hospital that specialises in care of people with spinal cord injury. Patients or their families were subsequently visited or contacted by telephone in 2014. Vital status and, where relevant, date and cause of death were determined by verbal autopsy. Results: 350 of 371 people admitted with a recent spinal cord injury in 2011 were discharged alive from hospital. All but eleven were accounted for two years after discharge (97% follow-up). Two-year survival was 87% (95% CI 83% to 90%). Two-year survival of those who were wheelchair-dependent was 81% (95% CI 76% to 86%). The most common cause of death was sepsis due to pressure ulcers. Conclusion: In Bangladesh, approximately one in five people with spinal cord injury who are wheelchair-dependent die within two years of discharge from hospital. Most deaths are due to sepsis from potentially preventable pressure ulcers.

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Life expectancy after spinal cord injury: a 50-year study

Abstract: Survival related strongly to extent of neurological impairment. Future research should focus on identifying contextual factors, personal or environmental, that may contribute to the reduced life expectancy after SCI.

Cited by 197 publications

References 25 publications

Colonoscopy after spinal cord injury: a case–control study

Colonoscopy after spinal cord injury: a case–control study

The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate

Two-year survival following discharge from hospital after spinal cord injury in Bangladesh

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