title: Determinants of in-hospital death after acute spinal cord injury: a population-based study.
abstract: OBJECTIVE
  First, to evaluate the influence of comorbid diseases and concomitant injuries on the risk of in-hospital death after traumatic spinal cord injury (TSCI). Second, to identify the risk characteristics of TSCI patients with likelihood of death.
  
  
  METHODS
  Population-based retrospective cohort study.
  
  
  METHODS
  Sixty-two acute care hospitals in South Carolina, USA.
  
  
  METHODS
  Records of 3389 TSCI patients hospitalized with acute TSCI were evaluated. Days elapsing from the date of injury to date of death established the survival time (T). Cox regression examined risk of in-hospital death as a function of counts of comorbid conditions and injuries along with their joint effects controlling for other covariates.
  
  
  RESULTS
  Counts of comorbid conditions and injuries showed dose-dependent risk of death while in-hospital independent of demographical and clinical covariates. Hazard ratios (HR) for counts 3+, 2 and 1 comorbid conditions were 2.19 (P<0.001), 1.73 (P=0.005) and 1.20 (P=0.322), respectively. For counts of 4+, 3 and 2 other injuries were 1.85 (P<0.001), 1.81 (P<0.001) and 1.46 (P=0.022), respectively. The joint effect of the two was transadditive with statistically significant HR ranging from 1.72-3.14.
  
  
  CONCLUSIONS
  Counts of comorbid conditions and injured body regions strongly indicate risk of in-hospital death after TSCI and their joint effects elicited dose-dependent gradient independent of demographical and clinical covariates. Assessing risk of in-hospital death based on joint use of counts of comorbid diseases and injuries is highly informative to target TSCI patients at high risk of dying.
authors: Department of Medicine, Division of Epidemiology and Biostatistics, Medical University of South Carolina, Charleston, SC 29425, USA. selassie@musc.edu
authors: A W
authors: AW
authors: Selassie
authors: A
authors: A
authors: Varma
authors: L L
authors: LL
authors: Saunders
authors: W
authors: W
authors: Welldaregay
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005006:Ethnicity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007348:Insurance, Health; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality; D011153:Population; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013022:South Carolina / Q000453:epidemiology; D013119:Spinal Cord Injuries / Q000150:complications / Q000401:mortality*; D013923:Thromboembolism / Q000150:complications / Q000401:mortality; D014193:Trauma Centers / Q000145:classification / Q000706:statistics & numerical data; D055815:Young Adult