Late mortality during the first year after acute traumatic spinal cord injury: a prospective, population-based study.
BACKGROUND
Little is known about the possible impact of the system of care on mortality during the first year after acute traumatic spinal cord injury (TSCI).


OBJECTIVE
To evaluate late mortality (i.e., >7 days after trauma) during the first year after acute TSCI in 2 European Union (EU) regions, Thessaloniki in Greece and Stockholm in Sweden.


METHODS
This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS), which is a prospective, population-based study. Incidence cohorts of TSCI cases were identified and followed up in both study regions through STATSCIS. Data from Thessaloniki region were collected through physical examination, medical records review, and interviews with TSCI individuals and the medical teams. Data from Stockholm were retrieved mainly from the Nordic Spinal Cord Injury Registry, as well as from direct contact with all intensive care facilities of the region.


RESULTS
The annual case mortality rate after acute TSCI was nearly 20% in Thessaloniki and 0% in Stockholm. The mean time of survival after trauma for the 12 mortality cases of Thessaloniki was 47 days (median = 24, SD +/- 67, range = 8-228). Factors associated with mortality were higher age and presence of comorbid spinal disorders but also the inefficient transfer logistics, initially missed spinal instability, and unsuccessfully treated complications.


CONCLUSIONS
The annual case mortality rate in Thessaloniki was dramatically higher than in Stockholm. The different approaches to care, one systematic and the other not, is postulated to be an important factor leading to such major discrepancies between the outcomes of these 2 EU regions.
Divanoglou
Anestis
A
Division of Neurorehabilitation, Karolinska Institutet, Stockholm, Sweden. anestis.divanoglou@ki.se
Westgren
Ninni
N
Seiger
Ake
A
Hulting
Claes
C
Levi
Richard
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000453:epidemiology* / Q000401:mortality*; D018672:Community Health Planning; D005260:Female; D015600:Glasgow Coma Scale; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult