Survival and cause of death after traumatic spinal cord injury. A long-term epidemiological survey from Denmark

Abstract

Life expectancy among individuals with spinal cord injuries (SCI) has remained lower than in the normal population, even with optimal medical management. But signi®cant improvement has been achieved, as will be illustrated in this retrospective study of an unselected group of traumatic survivors of SCI, dead or still living. There has been a complete follow-up over 4 decades, information being obtained from available medical records, death certi®cates, and post mortem records. The survey included a total of 888 individuals (713 men and 175 women) who had survived the injury and primary treatment and were rehabilitated at the centre for Spinal Cord Injured in Hornbñk, Denmark. At the end of the follow-up, 31st December 1992, 236 (197 men and 39 women) had died. The commonest causes of death were lung diseases, particularly pneumonia; suicide; and ischaemic heart disease. Among functionally complete tetraplegic individuals there was a recognizably high percentage of deaths from pneumonia, and among the least disabled individuals (Frankel class E) we found a high frequency of suicides. The Standardised Mortality Ratios (SMRs) were highest for septicaemia, followed by uraemia and pneumonia. A signi®cant decrease in the overall mortality was observed from the ®rst (1953 ± 1973) to the second half of the observation period (1972 ± 1992). Similarly the survival curves for both men and women demonstrate that the gap in survival probability between the normal population and the SCI has diminished considerably from the early to the later period. Likewise, except for suicide and ischaemic heart disease, a decrease in SMRs was seen for all causes of death. In particular there were large decreases related to lung embolus, septicaemia, pneumonia, and uraemia. The patterns of causes of death in the study group begin to approximate those of the general population, though many cause-speci®c deaths for SCI remain substantially above the normal population. Continuous improvement in preventive measures as well as treatment procedures is still necessary.

Altered left ventricular diastolic function in subjects with spinal cord injury

“…1,3 In this report, the analysis of cardiac structure and function in a sample of young, nonhypertensive, nondiabetic nonsmoker individuals revealed that (1) subjects with SCI exhibited an impaired LV diastolic function in comparison with the able-bodied ones; (2) diastolic dissimilarities between SCI and healthy subjects persisted after adjusting for hemodynamic and inflammatory parameters; (3) worse LV diastolic function was paralleled by a pattern of LV concentric remodeling among subjects with SCI. Overall, these data suggest that subjects with SCI exhibit alterations in LV diastolic function independently of traditional cardiovascular risk factors.…”

“…1,2 Previous studies demonstrated that subjects with SCI exhibit higher atherosclerotic burden in comparison with able-bodied individuals. 3 Interestingly, this process is not explained by traditional cardiovascular risk factors, indicating that alternative mechanisms might influence the development of early atherosclerosis in such individuals.…”

Prostate cancer: a hazard also to be considered in the ageing male patient with spinal cord injury

“…The value of such prompt therapeutical reaction has been illustrated clearly over the years by the marked decrease in renal deaths after spinal cord injury during the last half century. 11,12 Urodynamic investigation will objectivate the pathological parameters and will permit a guide to the choice of treatment. In the patient presented here anticholinergic drugs were prescribed and bladder emptying was changed from straining to selfcatheterization.…”

International lower urinary tract function basic spinal cord injury data set

“…Causes of death after spinal cord injury (SCI) have changed from being primarily due to urinary tract diseases increasingly to being caused by cardiovascular diseases and respiratory complications, [1][2][3][4] thus becoming more similar to the causes of death in the general population. This is at least true in centres providing centralized care for individuals with SCI.…”

“…6 The longevity in persons with SCI still remains below the life expectancies in the general population. [1][2][3]7,8 Because of the increasing prevalence of individuals living with SCI, both traumatic and nontraumatic lesions, there is an increasing need for data pertaining to SCI. To facilitate comparisons regarding injuries/lesions, treatments and outcomes between patients, centres and countries, such data should be in the form of common international data sets collected on individuals with SCI.…”