Abstract
Study design
Retrospective cohort.
Objective
To evaluate the survival outcomes in patients with traumatic spinal cord injury (TSCI).
Setting
A teaching hospital in Brazil.
Methods
A total of 434 patients diagnosed with TSCI (2004–2014) were included. Overall survival, standardized mortality ratios (SMR), and causes of death were assessed by Student’s t-test, χ2 test, Kaplan–Meier analysis, and Cox proportional-hazards regression.
Results
The mean follow-up was 4.8 years (±3.3 years). Individuals with tetraplegia had a median survival of 11 years, with participants in the paraplegia group not reaching median survival. The overall mortality rate was 37 per 1000 person-years. Age-adjusted SMR was 28.8 (95% CI: 22.8–36). There were 77 deaths with 56 defined causes, of which pneumonia was the most frequent (35.7%). Combined infectious etiologies caused 55.3% of deaths. Multivariate analysis revealed higher mortality among individuals with tetraplegia vs. paraplegia in the first 2 years post injury (HR = 8.28, 95% CI: 2.76–24.80), after 2 years post injury (HR = 2.35, 95% CI: 1.31–4.24), and in all years combined (HR = 3.36, 95% CI: 2.04–5.52).
Conclusion
Mortality among patients with TSCI was 28.8 times higher than in the reference population. In more than half of the cases, the cause of death was linked to infectious diseases. Pneumonia caused two times more deaths in individuals with tetraplegia than in individuals with paraplegia, with a higher impact in the first 2 years post injury. Reported findings indicate the need for a surveillance and prevention program with emphasis on vaccination and respiratory rehabilitation.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
World Health Organization. WHO: International Perspectives on Spinal Cord Injury. Geneva: WHO; 2013.
Rahimi-Movaghar V, Sayyah MK, Akbari H, Khorramirouz R, Rasouli MR, Moradi-Lakeh M, et al. Epidemiology of traumatic spinal cord injury in developing countries: a systematic review. Neuroepidemiology. 2013;41:65–85.
Lofvenmark I, Wikmar LN, Hasselberg M, Norrbrink C, Hultling C. Outcomes 2 years after traumatic spinal cord injury in Botswana: a follow-up study. Spinal Cord. 2017;55:285–9.
Munakomi S, Bhattarai B, Cherian I. Prospective observational research on the clinical profile and outcome analysis among a cohort of patients sustaining traumatic cervical spine and cord injury in a peripheral tertiary spine care centre in Nepal. F1000Res. 2017;6:1957.
Hagen EM. Still a need for data from developing countries on traumatic spinal cord injury. Neuroepidemiology. 2013;41:86–7.
Burns AS, O’Connell C. The challenge of spinal cord injury care in the developing world. J Spinal Cord Med. 2012;35:3–8.
Chamberlain JD, Meier S, Mader L, von Groote PM, Brinkhof MWG. Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology. 2015;44:182–98.
Scovil CY, Ranabhat MK, Craighead IB, Wee J. Follow-up study of spinal cord injured patients after discharge from inpatient rehabilitation in Nepal in 2007. Spinal Cord. 2012;50:232–7.
Barman A, Shanmugasundaram D, Bhide R, Viswanathan A, Magimairaj HP, Nagarajan G, et al. Survival in persons with traumatic spinal cord injury receiving structured follow-up in South India. Arch Phys Med Rehabil. 2014;95:642–8.
Hossain MS, Rahman MA, Herbert RD, Quadir MM, Bowden JL, Harvey LA. Two-year survival following discharge from hospital after spinal cord injury in Bangladesh. Spinal Cord. 2016;54:132–6.
Gosselin RA, Coppotelli C. A follow-up study of patients with spinal cord injury in Sierra Leone. Int Orthop. 2005;29:330–2.
Rashid SM, Jusabani MA, Mandari FN, Dekker MCJ. The characteristics of traumatic spinal cord injuries at a referral hospital in Northern Tanzania. Spinal Cord Ser Cases. 2017;3:17021.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–7.
Prefeitura de São Paulo. Programa de Aprimoramento das Informações de Mortalidade no Município de São Paulo (PRO-AIM). Sistema de Informações sobre Mortalidade (SIM).
Yeo JD, Walsh J, Rutkowski S, Soden R, Craven M, Middleton J. Mortality following spinal cord injury. Spinal Cord. 1998;36:329–36.
Strauss DJ, Devivo MJ, Paculdo DR, Shavelle RM. Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil. 2006;87:1079–85.
Savic G, DeVivo MJ, Frankel HL, Jamous MA, Soni BM, Charlifue S. Causes of death after traumatic spinal cord injury-a 70-year British study. Spinal Cord. 2017;55:891–7.
Sabre L, Rekand T, Asser T, Korv J. Mortality and causes of death after traumatic spinal cord injury in Estonia. J Spinal Cord Med. 2013;36:687–94.
Cao Y, Selassie AW, Krause JS. Risk of death after hospital discharge with traumatic spinal cord injury: a population-based analysis, 1998-2009. Arch Phys Med Rehabil. 2013;94:1054–61.
Lidal IB, Snekkevik H, Aamodt G, Hjeltnes N, Biering-Sorensen F, Stanghelle JK. Mortality after spinal cord injury in Norway. J Rehabil Med. 2007;39:145–51.
Brommer B,Engel O,Kopp MA,Watzlawick R,Muller S,Pruss H, et al. Spinal cord injury-induced immune deficiency syndrome enhances infection susceptibility dependent on lesion level. Brain. 2016;139(Pt 1):692–707.
Kanyilmaz S, Hepguler S, Atamaz FC, Gokmen NM, Ardeniz O, Sin A. Phagocytic and oxidative burst activity of neutrophils in patients with spinal cord injury. Arch Phys Med Rehabil. 2013;94:369–74.
Raab AM, Krebs J, Perret C, Michel F, Hopman MT, Mueller G. Maximum inspiratory pressure is a discriminator of pneumonia in individuals with spinal-cord injury. Respir Care. 2016;61:1636–43.
Brown R, DiMarco AF, Hoit JD, Garshick E. Respiratory dysfunction and management in spinal cord injury. Respir Care. 2006;51:853–68.
Berlowitz DJ, Wadsworth B, Ross J. Respiratory problems and management in people with spinal cord injury. Breathe. 2016;12:328–40.
Middleton JW, Dayton A, Walsh J, Rutkowski SB, Leong G, Duong S. Life expectancy after spinal cord injury: a 50-year study. Spinal Cord. 2012;50:803–11.
Ahoniemi E, Pohjolainen T, Kautiainen H. Survival after spinal cord injury in Finland. J Rehabil Med. 2011;43:481–5.
Franca E, Teixeira R, Ishitani L, Duncan BB, Cortez-Escalante JJ, Morais Neto OL, et al. Ill-defined causes of death in Brazil: a redistribution method based on the investigation of such causes. Rev Saude Publica. 2014;48:671–81.
Cardoso BB, Kale PL. Coding pulmonary sepsis and mortality statistics in Rio de Janeiro, RJ. Rev Bras Epidemiol. 2016;19:609–20.
Tamplin J, Berlowitz DJ. A systematic review and meta-analysis of the effects of respiratory muscle training on pulmonary function in tetraplegia. Spinal Cord. 2014;52:175–80.
Postma K, Bussmann JB, Haisma JA, van der Woude LH, Bergen MP, Stam HJ. Predicting respiratory infection one year after inpatient rehabilitation with pulmonary function measured at discharge in persons with spinal cord injury. J Rehabil Med. 2009;41:729–33.
Lopes MA, Lima ED. Continuous use of intermittent bladder catheterization-can social support contribute? Rev Lat Am Enferm. 2014;22:461–6.
Raboni SM, Moura FEA, Caetano BC, Avanzi VM, Pereira LA, Nogueira MB, et al. Global Influenza Hospital-based Surveillance Network (GIHSN): results of surveillance of influenza and other respiratory viruses in hospitalised patients in Brazil, 2015. BMJ Open. 2018;8:e017603.
Correa AR, Lundgren FL, Pereira-Silva JL, Frare e Silva RL, Cardoso AP, Lemos AC, et al. Brazilian guidelines for community-acquired pneumonia in immunocompetent adults—2009. J Bras Pneumol. 2009;35:574–601.
Donalisio MR, Arca CHM, Madureira PRd. Perfil clínico, epidemiológico e etiológico de pacientes com pneumonia adquirida na comunidade internados em um hospital geral da microrregião de Sumaré, SP. J Bras Pneumol. 2011;37:200–8.
Teeter L, Gassaway J, Taylor S, LaBarbera J, McDowell S, Backus D, et al. Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project. J Spinal Cord Med. 2012;35:503–26.
Hossain MS, Harvey LA, Rahman MA, Bowden JL, Islam MS, Taylor V, et al. A pilot randomised trial of community-based care following discharge from hospital with a recent spinal cord injury in Bangladesh. Clin Rehab. 2017;31:781–9.
Chishtie J, Chishtie F, Yoshida K, Balogh R. Spinal cord injury rehabilitation and pressure ulcer prevention after the 2005 South Asian Earthquake: a CBR case study from Pakistan. Disabil Rehabil. 2018;1–9.
Mendonça FM, Drumond E, Cardoso AMP. Problemas no preenchimento da Declaração de Óbito: estudo exploratório. Rev Bras Estud Popul. 2010;27:285–95.
Messias KLM, Bispo Júnior JP, Pegado MFdQ, Oliveira LC, Peixoto TG, Sales MAC, et al. Qualidade da informação dos óbitos por causas externas em Fortaleza, Ceará, Brasil. Cien Saude Colet. 2016;21:1255–67.
Silva JACd, Yamaki VN, Oliveira JPSd, Teixeira RKC, Santos FAF, Hosoume VSN. Declaração de óbito, compromisso no preenchimento. Avaliação em Belém–Pará, em 2010. Rev Assoc Med Bras. 2013;59:335–40.
Author information
Authors and Affiliations
Contributions
VFL was responsible for the study design, data collection, data interpretation, manuscript writing, and manuscript editing. DRS was responsible for data collection, data interpretation, and manuscript editing. MI was responsible for study design and manuscript editing. LRB was responsible for the study design, data interpretation, and manuscript editing.
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Leite, V.F., Souza, D.R.d., Imamura, M. et al. Post-discharge mortality in patients with traumatic spinal cord injury in a Brazilian hospital: a retrospective cohort. Spinal Cord 57, 134–140 (2019). https://doi.org/10.1038/s41393-018-0183-y
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41393-018-0183-y
This article is cited by
-
Videofluoroscopic Profiles of Swallowing and Airway Protection Post-traumatic Cervical Spinal Cord Injury
Dysphagia (2022)
-
Transcranial direct current stimulation combined with robotic training in incomplete spinal cord injury: a randomized, sham-controlled clinical trial
Spinal Cord Series and Cases (2021)
-
Poor adherence to influenza vaccination guidelines in spinal cord injury: results from a community-based survey in Switzerland
Spinal Cord (2020)
-
A case for inspiratory muscle training in SCI: potential role as a preventative tool in infectious respiratory diseases like COVID-19
Spinal Cord Series and Cases (2020)
-
Factors affecting long-term mortality rate after diagnosis of syringomyelia in disabled spinal cord injury patients: a population-based study
Spinal Cord (2020)
