Predictors of Early Mortality After Traumatic Spinal Cord Injury

Abstract

STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To identify predictors of early mortality following traumatic spinal cord injury (TSCI). SUMMARY OF BACKGROUND DATA.: Limited information is available on factors associated with early mortality following TSCI. Ability to identify high risk individuals can help to appropriately treat them, and reduce mortality. METHODS.: Early mortality was defined as death occurring during the initial hospital admission. Retrospective analysis of 1995 patients with TSCI, admitted to various hospitals of South Carolina from 1993 to 2003, was performed. There were 251 patients with early mortality. Multivariable logistic regression was used in modeling of early death following TSCI with gender, race, age, Frankel grade, trauma center, level of injury, injury severity score (ISS), traumatic brain injury (TBI), and medical comorbidities as covariates. RESULTS.: Increasing age after 20 years (OR: 1.2, P = <0.0001), male gender (OR: 1.6, P = 0.016), severe (ISS > or =15) systemic injuries (OR: 1.9, P = 0.012), TBI (OR: 3.7, P < 0.0001), 1 or more comorbidities (P < 0.0001), poor neurologic status (P = 0.015), and level 1 trauma center (OR: 1.4, P = 0.026) were significantly associated with early mortality, after adjusting for other covariates. CONCLUSION.: Early mortality following TSCI is influenced by multiple factors. Timely recognition of these factors is crucial for improving survival in the acute care setting. Severe systemic injuries, medical comorbidities, and TBI continue to be the main limiting factors affecting the outcome. These findings also suggest the need to allocate resources for trauma prevention, and promote research towards improving the care of acutely injured patients.

Determinants of in-hospital death after acute spinal cord injury: a population-based study

“…11 Studies also accounted for polytrauma using the count of injuries in various body regions. 3, 6 We did not find any published study that evaluated TSCI mortality in large population with counts of comorbid conditions, injuries and their joint effects. The purpose of this study was to identify mutable risk factors of in-hospital death among TSCI patients accounted by the counts of comorbidities, injuries and their joint effects using timeto-event analyses.…”

“…As noted in other studies, 4 having a single comorbidity did not show a significant effect on mortality. Overall, studies that used counts showed better risk estimates of mortality 3,6 than studies that assigned weights to selected diseases. 10 Despite prolific use, the Charleson Comorbidity Index showed little or limited predictive power on trauma mortality.…”

“…The contents of the data file are reported elsewhere. 6 The Central Nervous System injuries (CNS) Registry System augments and validates the data through medical chart review and interviewing a representative sample of patients. Data are reliable and valid.…”

“…Epidemiological studies of in-hospital mortality after TSCI have identified important risk factors that include advancing age, 6 lesion type and level of injury, 6 comorbidities 4, 6 and complications such as venous thromboembolism, 7,8 traumatic brain injury 6 and polytrauma 3 with varying strength of association. While there is uniformity in most of the studies regarding the risk of death with advancing age and medical complications, there is discordant association on the effect of comorbid conditions due to different classification schemes.…”

Baseline Prevalence of Heart Diseases, Hypertension, Diabetes, and Obesity in Persons with Acute Traumatic Spinal Cord Injury: Potential Threats in the Recovery Trajectory

“…The contents of the data file are reported elsewhere. 17 The CNS Registry System augments and validates the data through medical chart review and through interviewing a representative sample of patients. The Institutional Review Board of the Medical University of South Carolina approved this study.…”