Preinjury Patient Characteristics and Postinjury Neurological Status Are Associated With Mortality Following Spinal Cord Injury
Preinjury Patient Characteristics and Postinjury Neurological Status Are Associated With Mortality Following Spinal Cord Injury
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DOI：
10.1097/brs.0000000000002533
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发表时间：
2018-07-01
期刊：
影响因子：
3
通讯作者：
Kepler, Christopher K.
中科院分区：
文献类型：
--
作者：
Casper, David S.;Zmistowski, Benjamin;Kepler, Christopher K.
研究设计.回顾性队列研究。本研究调查了脊髓损伤（SCI）和损伤后死亡率之间的关系。SCI）是在急性创伤环境中治疗的严重疾病。由于神经功能缺损、脊柱不稳定和相关损伤，这些患者通常需要复杂的住院治疗，发病率和死亡率很高。据推测，这种严重的损伤会导致很高的损伤后死亡率;然而，SCI及其治疗对长寿预测因素的影响在很大程度上仍不清楚。从前瞻性维护的数据库中回顾了在地区SCI转诊中心就诊的患者。收集了2004年至2009年间426例不同程度损伤的SCI患者。检索损伤特征，包括损伤严重程度评分、SCI水平和SCI类型。为了确定5年死亡率的独立预测因素，使用患者和损伤特征进行logistic回归分析。平均年龄为47.4岁（范围：14-95岁），74.5%（318/426）为男性。一半的队列持续低能量损伤机制（220/426; 52.4%）。SCI队列的30天、90天、1年、2年和5年死亡率分别为6.6%（28/426）、9.2%（39/426）、12.0%（51/426）、15.0%（64/426）和17.8%（76/426）。Logistic回归分析显示，随着年龄的增长，（B = 1.06，P < 0.001），增加ICU住院时间（B = 1.06; P = 0.002），就诊时运动评分降低（B = 0.98; P = 0.004）和缺乏手术干预（B = 0.38; P < 0.001）是5年死亡率的独立预测因素。有大量的死亡率与SCI有关。很大比例的死亡发生在受伤后不久。死亡率与神经功能缺损和损伤严重程度以及损伤前患者特征相关。为了应对这种高死亡率，需要努力解决与神经功能缺损相关的伴随疾病过程。
Study Design. Retrospective cohort study.Objectives. This study investigates the association between spinal cord injuries (SCI) and post-injury mortality.Summary of Background Data. SCIs) are severe conditions treated in the acute trauma setting. Owing to neurological deficits, unstable spinal columns, and associated injuries, these patients often have complex inpatient hospitalizations with significant morbidity and mortality. It is assumed that a high rate of postinjury mortality would follow such severe injuries; however, the effect of SCI and its treatment on predictors of longevity remain largely unknown.Methods. Patients seen at a regional referral center for SCI were reviewed from a prospectively maintained database. Four hundred and twenty-six patients with SCI and varying degrees of injury between 2004 and 2009 were collected. Injury characteristics, including injury severity score, level of SCI, and type of SCI were retrieved. To determine independent predictors of 5-year mortality, a logistic regression using patient and injury characteristics at the time of presentation was performed.Results. Average age was 47.4 years (range: 14-95), and 74.5% (318/426) were male. Half of the cohort sustained low-energy mechanisms of injury (220/426; 52.4%). The 30-day, 90-day, 1-year, 2-year, and 5-year mortality rates in the SCI cohort were 6.6% (28/426), 9.2% (39/426), 12.0% (51/426), 15.0% (64/426), and 17.8%, respectively (76/426). Logistic regression demonstrated that increasing age (B = 1.06, P < 0.001), increasing ICU length-of-stay (B = 1.06; P = 0.002), decreased motor score at presentation (B = 0.98; P = 0.004), and lack of surgical intervention (B = 0.38; P < 0.001) were independent predictors of mortality at 5 years.Conclusion. There is substantial mortality associated with SCI. A significant proportion of the mortalities occurred acutely after injury. Mortality was associated with neurological deficit and severity of injury, as well as with preinjury patient characteristics. To combat this high rate of death, efforts are needed to address the concomitant disease processes associated with neurological deficits.