Survival in 222 Patients With Severe CSCI: An 8-Year Epidemiologic Survey in Western China |
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| Affiliation: | 1. School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand;2. School of Psychology, University of Waikato, Hamilton, New Zealand;1. Medical School of Shihezi University, Shihezi, Xinjiang, China;2. Department of Psychology Rehabilitation, the First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang, China;1. Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil;2. Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, Australia;1. Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Kafrelsheikh University, Kafrelsheikh, Egypt;2. Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt;1. Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA;2. Department of Occupational Therapy, College of Rehabilitation Science, Thomas Jefferson University, Philadelphia, PA;3. Shriners Hospitals for Children, Philadelphia, PA;4. Shriners Hospitals for Children, Chicago, IL;5. Rush Medical College, Chicago, IL;6. Kennedy Krieger Rehabilitation Institute, Baltimore, MD;7. Shriners Hospitals for Children, Sacramento, CA;8. MGH Institute of Health Professions, Boston, MA;1. TIRR Memorial Hermann, Brain Injury Research Center, Houston, TX;2. Baylor College of Medicine, Department of Physical Medicine and Rehabilitation, Houston, TX;3. Zabolocki VA Medical Center, Milwaukee, WI;4. Craig Hospital, Research Department, Englewood, CO;5. University of Texas Health Science Center at Houston, School of Public Health, Department of Biostatistics and Data Science, Houston, TX |
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| Abstract: | ObjectiveTo assess the survival and the predictors of mortality in patients with severe cervical spinal cord injuries (CSCI).DesignRetrospective study.ParticipantsFrom January 1, 2010, to May 31, 2018, patients who suffered from severe CSCIs in Western China were enrolled in this study (N=222).InterventionsNot applicable.Main Outcome MeasuresSurvival rates and mortality risk factors. Measures were calculated by the product-limit method (Kaplan-Meier) and the Cox model.ResultsThe overall 1-year, 3-year, 5-year, and 8-year postoperative mortalities were 24.4%, 30.6%, 33.3%, 36.2%, and 39.0%, respectively. Most deaths occurred within 36 months after the injury. According to the Cox proportional hazards model, the significant predictors of survival were as follows: (1) age; (2) neurologic level; (3) treatment options (surgical or conservative); (4) ventilator support (P<.05). The 8-year mortality for older patients (>50y) was 50.2%, which was significantly higher than that for younger patients (32.4%, <50y). The risk of death was 2.053 times higher in higher levels of injury (C1-C4) than in lower levels of injury (C5-C8) (P<.05). Compared with conservative treatment, patients who received surgical treatment (either anterior or posterior decompression) had a lower risk of death (P<.05). No significant difference was detected in the risk of death between early surgery (<3d) and mid-term surgery (3-7d) (P>.05). However, patients who received late-term surgery (>7d) had a higher mortality risk (P<.05). The overall 8-year mortality risk of patients who needed ventilator support was much higher than those who did not need ventilator support (P<.05).ConclusionsAge, neurologic level, ventilator dependence, treatment options, and timing to surgery were main risk factors for mortality in patients with severe CSCIs. Better understanding of the predictors for survival could possibly contribute to the improvement of survival rates. |
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