Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury.
METHODS
Retrospective chart review.


OBJECTIVE
To identify factors predictive of survival after spinal cord injury (SCI).


METHODS
Tertiary care institution.


METHODS
Multiple-variable Cox proportional hazards regression analysis for 759 patients with SCI (535 nontraumatic and 221 traumatic) included age, sex, completeness of injury, level of injury, functional independence measure (FIM) scores, rehabilitation length of stay and SCI cause. Estimated years of life lost in the decade after injury was calculated for patients vs uninjured controls.


RESULTS
Median follow-up was 11.4 years. Population characteristics included paraplegia, 58%; complete injury, 11%; male sex, 64%; and median rehabilitation length of stay, 16 days. Factors independently predictive of decreased survival were increased age (+10 years; hazard ratio (HR (95% CI)), 1.6 (1.4-1.7)), male sex (1.3 (1.0-1.6)), lower dismissal FIM score (-10 points; 1.3 (1.2-1.3)) and all nontraumatic causes. Metastatic cancer had the largest decrease in survival (HR (95% CI), 13.3 (8.7-20.2)). Primary tumors (HR (95% CI), 2.5 (1.7-3.8)), vascular (2.5 (1.6-3.8)), musculoskeletal/stenosis (1.7 (1.2-2.5)) and other nontraumatic SCI (2.3 (1.5-3.6)) were associated with decreased survival. Ten-year survival was decreased in nontraumatic SCI (mean (s.d.), 1.8 (0.3) years lost), with largest decreases in survival for metastatic cancer and spinal cord ischemia.


CONCLUSIONS
Age, male sex and lower dismissal FIM score were associated with decreased survival, but neither injury severity nor level was associated with it. Survival after SCI varies depending on SCI cause, with survival better after traumatic SCI than after nontraumatic SCI. Metastatic cancer and vascular ischemia were associated with the greatest survival reduction.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
B B
BB
Hatch
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
C M
CM
Wood-Wentz
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
T M
TM
Therneau
Rockford Spine Center, Rockford, Illinois, USA.
M G
MG
Walker
Physical Medicine and Rehabilitation, Mayo Clinic Health System, Faribault, MN, USA.
J M
JM
Payne
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
R K
RK
Reeves
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality / Q000534:rehabilitation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013119:Spinal Cord Injuries / Q000209:etiology / Q000401:mortality* / Q000534:rehabilitation; D020760:Spinal Cord Ischemia / Q000150:complications / Q000401:mortality / Q000534:rehabilitation; D016019:Survival Analysis; D055815:Young Adult