A prospective study of health and risk of mortality after spinal cord injury.
A prospective study of health and risk of mortality after spinal cord injury.
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DOI：
10.1016/j.apmr.2007.11.062
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发表时间：
2008-08
影响因子：
4.3
通讯作者：
Wilson, Dulaney
中科院分区：
文献类型：
--
作者：
Krause, James S.;Carter, Rickey E.;Pickelsimer, Elisabeth;Wilson, Dulaney
测试多种健康参数与脊髓损伤(SCI)患者死亡率之间的假设关系，同时控制生物和损伤特征的差异。前瞻性队列研究，包括1997年底和1998年初收集的健康数据和2005年12月确定的死亡状况。美国东南部的一家大型康复医院。共1389例成人创伤性脊髓损伤，伤后至少1年。不适用。主要结果是从调查到死亡的时间(或审查时间)。死亡率状况是使用国家死亡指数和社会保障死亡指数确定的。截至2005年12月31日，共有225人死亡(16.2%)。COX比例风险模型确定了几个重要的死亡状况的健康预测因素，同时控制了传记和伤害因素。进行了两组分析--第一组确定感兴趣的单一变量的重要性，第二组分析根据一组最佳变量建立综合模型。多种类型的健康状况与死亡率有关。最好的健康预测指标包括可能的重度抑郁症、修复压疮、骨折和/或截肢的手术、感染症状和住院天数。包括这些变量以及一般健康评级，与仅有生物和伤害变量相比，随着伪R2从0.12增加到0.18，一致性从0.730增加到0.776，生存预测得到了改善。除了继发性疾病一直是预防工作的传统重点(如压疮、尿路感染)外，截肢、骨折和抑郁症状还与较高的死亡风险相关；然而，需要进一步研究确定特定条件与死亡原因的关联，并确定干预措施是否可以改变这些条件并最终提高存活率。
To test hypothesized relationships between multiple health parameters and mortality among persons with spinal cord injury (SCI) while controlling for variations in biographical and injury characteristics. Prospective cohort study with health data collected in late 1997 and early 1998 and mortality status ascertained in December 2005. A large rehabilitation hospital in the Southeastern United States. A total of 1389 adults with traumatic SCI, at least 1 year postinjury. Not applicable. The primary outcome was time from survey to mortality (or time of censoring). Mortality status was determined using the National Death Index and the Social Security Death Index. There were 225 deaths (16.2%) by December 31, 2005. Cox proportional hazards modeling identified several significant health predictors of mortality status, while controlling for biographic and injury factors. Two sets of analyses were conducted—the first identifying the significance of a single variable of interest and the second analysis building a comprehensive model based on an optimal group of variables. Multiple types of health conditions were associated with mortality. The best set of health predictors included probable major depression, surgeries to repair pressure ulcers, fractures and/or amputations, symptoms of infections, and days hospitalized. Inclusion of these variables, along with a general health rating, improved prediction of survival compared with biographic and injury variables alone, as the pseudo R2 increased from .12 to .18 and the concordance from .730 to .776. In addition to secondary conditions that have been the traditional focus of prevention efforts (eg, pressure ulcers, urinary tract infections), amputations, fractures, and depressive symptoms were associated with higher risk for mortality; however, further research is needed to identify the association of specific conditions with causes of death and to determine if interventions can modify these conditions and ultimately improve survival.
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影响因子：
9.6
作者：
DEVIVO, MJ;IVIE, CS
通讯作者：
IVIE, CS
影响因子：
3
作者：
Alander, DH;Parker, J;Stauffer, ES
通讯作者：
Stauffer, ES
影响因子：
1.9
作者：
DeVivo, MJ;Underhill, AT;Fine, PR
通讯作者：
Fine, PR
影响因子：
2.6
作者：
KEMP, BJ;ADAMS, BM
通讯作者：
ADAMS, BM
DOI：
10.1016/j.apmr.2004.06.062
发表时间：
2004-11-01
影响因子：
4.3
作者：
Krause, JS;DeVivo, MJ;Jackson, AB
通讯作者：
Jackson, AB