title: Patients with thoracic trauma and concomitant spinal cord injury have a markedly decreased mortality rate compared to patients without spinal cord injury.
abstract: BACKGROUND
  The present study was performed to compare the clinical outcome, with special focus on the mortality rate of thoracic injuries, in patients with and without spinal cord injury.
  
  
  METHODS
  Patients who were treated for thoracic trauma at our institution between January 1998 and December 2007 were included in this retrospective cohort study. Patients were divided into two groups according to whether they had suffered a concomitant spinal cord injury (SCI) (N = 54) or not (N = 61). Survival analysis was performed using the Kaplan-Meier function and the Cox proportional hazards model. Age, sex, injury severity score (ISS), Charlson comorbidity index (CCI), and infection with pneumonia were included as covariates in the final model.
  
  
  RESULTS
  Patients with SCI have a 65 % reduction in the chance of dying compared to patients without SCI following thoracic trauma (HR = 0.35; 95%CI = 0.13-0.96; p = 0.041). Sex (HR = 0.67; 95 % CI: 0.26-1.71, P = 0.141), ISS > =25 (HR = 2.08 95 % CI: 0.58-7.49, P = 2.63) and a Charlson Comorbidity Index of 2 (HR = 1.82; 95 % CI: 0.58-7.22, P = 0.393) had no effect in the risk of dying. However, patients older than 60 years had four times the chance of dying than patients younger than 30 years (HR = 4.39; 95 % CI: 1.02-19, P = 0.048). Patients with pneumonia had a nonsignificant twofold increase in the risk of dying (HR = 2.28; 95 % CI: 0.97-5.34, P = 0.059).
  
  
  CONCLUSIONS
  Our results demonstrate that patients with thoracic trauma and concomitant SCI had markedly decreased mortality compared to patients without SCI, even after adjusting for age, sex, injury severity, comorbidities and pneumonia infection.
authors.affiliation: Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Maren
authors.initials: M
authors.lastname: Bertling
authors.affiliation: Department of General and Trauma Surgery, Medical School Hannover, Hannover, Germany.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Suero
authors.affiliation: Division of Spinal Cord Injury, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Mirko
authors.initials: M
authors.lastname: Aach
authors.affiliation: Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schildhauer
authors.affiliation: Division of Spinal Cord Injury, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Meindl
authors.affiliation: Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany. mcitak@gmx.de.|Division of Spinal Cord Injury, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany. mcitak@gmx.de.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Citak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000401:mortality*; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000401:mortality*; D055815:Young Adult
keywords: Death; Inflammation; Mortality; Spinal cord injury; Thoracic trauma