Survival Analysis in Patients with Chronic Traumatic Spinal Cord Injury
-
Mahsa GHAJARZADEH
,
Abbas RAHIMI FOROUSHANI
,
Saharnaz NEDJAT
,
Abdolreza SHEIKHREZAEI
,
Hooshang SABERI
Abstract
Background: The goal of this study was to determine hazard rate of death rate and the causes of death in Iranian patients with Traumatic spinal cord injury (TSCI).
Methods: Overall, 1024 patients with chronic traumatic spinal cord injury referred to Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran from Jan 2013-2017 were enrolled. Epidemiological and neurological data, along with secondary complications were recorded for all participants. In the case of death, the cause, and the date of death were recorded. The Kaplan–Meier method was used for survival analysis. A log-rank test was carried out to compare survival due to different risk factors. Risk factors and relative risk estimates associated with death were assessed by means of a Cox regression model.
Results: Nineteen percent were lost to follow up. During the follow-up period, 22 out of 830 remaining cases (2.6%) died. Deaths were only observed in patients with cervical injuries (59% in C1-C4 level and 41% in C5-C7 level). Kaplan–Meier Log-rank test showed that probability of survival was significantly less in females, complete injury cases, patients with cervical spine injury, depression, and ADR (Autonomic dysreflexia). Controlling for age, sex and education level, Cox regression model showed that hazard rate of death was significantly affected by the categorical variables such as level of injury (HR=0.2, 95% CI=0.12-0.39), severe ADR.
Conclusion: Probability of survival is lower in female individuals, cases with complete injuries, patients with cervical spine injury, individuals wi-th depression (BDI>10), and clients who experience ADR.
1. Selassie A, Cao Y, Saunders LL (2015). Epidemiology of traumatic spinal cord injury among persons older than 21 years: A population-based study in South Carolina, 1998–2012. Top Spinal Cord Inj Rehabil,21(4):333-44.
2. Sabre L, Rekand T, Asser T, Kõrv J (2013). Mortality and causes of death after traumatic spinal cord injury in Estonia. J Spinal Cord Med,36(6):687-94.
3. O’Connor PJ (2005). Survival after spinal cord injury in Australia. Arch Phys Med Rehabil, 86(1):37-47.
4. Frankel H, Coll J, Charlifue S et al (1998). Long-term survival in spinal cord injury: a fifty year investigation. Spinal Cord,36(4):266-74.
5. Noe B, Stapelfeldt C, Parner E et al (2017). Survival after traumatic spinal cord injury in Denmark: a hospital-based study among patients injured in 1990–2012. Spinal Cord, 55(4):373-377
6. Krause JS, Carter RE, Pickelsimer EE et al (2008). A prospective study of health and risk of mortality after spinal cord injury. Arch Phys Med Rehabil,89(8):1482-91.
7. Michael J, Krause JS, Lammertse DP (1999). Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil, 80(11):1411-9.
8. Strauss D, DeVivo MJ, Shavelle R (2000). Long-term mortality risk after spinal cord injury. J Insur Med,32(1):11-6.
9. Van Den Berg ME, Castellote JM et al (2010). Survival after spinal cord injury: a systematic review. J Neurotrauma,27(8):1517-28.
10. Hatch BB, Wood-Wentz C, Therneau T et al (2017). Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury. Spinal Cord,55(6):540-544
11. Varma A, Hill EG, Nicholas J et al (2010). Predictors of early mortality after traumatic spinal cord injury: a population-based study. Spine (Phila Pa 1976),35(7):778-83.
12. Hagen EM, Lie SA, Rekand T et al (2010). Mortality after traumatic spinal cord injury: 50 years of follow-up. J Neurol Neurosurg Psychiatry,81(4):368-73.
13. Whiteneck GG, Charlifue S, Frankel H et al (1992). Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia,30(9):617-30.
14. Hartkopp A, Brønnum-Hansen H, Seidenschnur AM et al (1997). Survival and cause of death after traumatic spinal cord injury. A long-term epidemiological survey from Denmark. Spinal cord,35(2):76-85.
15. Samsa GP, Patrick CH, Feussner JR (1993). Long-term survival of veterans with traumatic spinal cord injury. Arch Neurol,50(9):909-14.
16. Krause JS, Cao Y, DeVivo MJ et al (2016). Risk and Protective Factors for Cause-Specific Mortality After Spinal Cord Injury. Arch Phys Med Rehabil,97(10):1669-78.
17. Barman A, Shanmugasundaram D, Bhide R et al (2014). Survival in persons with traumatic spinal cord injury receiving structured follow-up in South India. Arch Phys Med Rehabil,95(4):642-8.
18. Savic G, DeVivo MJ, Frankel HL et al (2017). Causes of death after traumatic spinal cord injury-a 70-year British study. Spinal Cord, 55(10):891-897.
19. Thietje R, Pouw MH, Schulz AP et al (2011). Mortality in patients with traumatic spinal cord injury: descriptive analysis of 62 deceased subjects. J Spinal Cord Med,34(5):482-7.
20. Hackler RH (1977). A 25-year prospective mortality study in the spinal cord injured patient: comparison with the long-term living paraplegic. J Urol,117(4):486-8.
21. Zeilig G, Dolev M, Weingarden H et al (2000). Long-term morbidity and mortality after spinal cord injury: 50 years of follow-up. Spinal Cord,38(9):563-6.
22. Soden R, Walsh J, Middleton J et al (2000). Causes of death after spinal cord injury. Spinal Cord,38(10):604.
23. Baron J, Swaine J, Presseau J et al (2016). Self-management interventions to improve skin care for pressure ulcer prevention in people with spinal cord injuries: a systematic review protocol. Syst Rev,5(1):150.
24. Regan MA, Teasell RW, Wolfe DL et al (2009). A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury. Arch Phys Med Rehabil,90(2):213-31.
25. Klotz R, Joseph P, Ravaud J et al (2002). The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured persons: Part III. Medical complications and associated factors. Spinal Cord,40(9):457-67.
26. Anson C, Shepherd C (1996). Incidence of secondary complications in spinal cord injury. Int J Rehabil Res,19(1):55-66.
27. Cuddigan J, Frantz RA (1998). Pressure ulcer research: pressure ulcer treatment: a monograph from the National Pressure Ulcer Advisory Panel. Adv Wound Care,11(6):294-300.
28. Rish BL, Dilustro JF, Salazar AM et al (1997). Spinal cord injury: a 25-year morbidity and mortality study. Mil Med,162(2):141-8.
29. Rabadi MH, Aston C (2016). Evaluate the impact of neurogenic bladder in veterans with traumatic spinal cord injury. J Spinal Cord Med,39(2):175-9.
30. Noreau L, Noonan V, Cobb J et al (2014). Spinal cord injury community survey: a national, comprehensive study to portray the lives of Canadians with spinal cord injury. Top Spinal Cord Inj Rehabil,20(4):249-64.
31. DeVivo MJ, Black K, Richards JS et al (1991). Suicide following spinal cord injury. Paraplegia,29(9):620-7.
32. Frisbie JH, Kache A (1983). Increasing survival and changing causes of death in myelopathy patients. J Am Paraplegia Soc,6(3):51-6.
33. Mohammadi MR, Ghanizadeh A, Rahgozart M et al (2005). Suicidal attempt and psychiatric disorders in Iran. Suicide Life Threat Behav,35(3):309-16.
34. Anderson CJ, Vogel LC, Chlan KM et al (2007). Depression in adults who sustained spinal cord injuries as children or adolescents. J Spinal Cord Med,30:S76-82.
35. Bombardier CH, Richards JS, Krause JS et al (2004). Symptoms of major depression in people with spinal cord injury: implications for screening. Arch Phys Med Rehabil,85(11):1749-56.
36. Hassanpour K, Hotz-Boendermaker S, Dokladal P et al (2012). Low depressive symptoms in acute spinal cord injury compared to other neurological disorders. J Neurol,259(6):1142-50.
37. Krause JS, Kemp B, Coker J (2000). Depression after spinal cord injury: relation to gender, ethnicity, aging, and socioeconomic indicators. Arch Phys Med Rehabil, 81(8):1099-109.
38. Fann JR, Bombardier CH, Richards JS et al (2011). Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment. Arch Phys Med Rehabil, 92(3):352-60.
39. Lidal IB, Snekkevik H, Aamodt G et al (2007). Mortality after spinal cord injury in Norway. J Rehabil Med,39(2):145-51.
40. Savic G, DeVivo MJ, Frankel HL et al (2018). Suicide and traumatic spinal cord injury-a cohort study. Spinal cord, 56(1):2-6.
41. Williams R, Murray A (2015). Prevalence of depression after spinal cord injury: a meta-analysis. Arch Phys Med Rehabil,96(1):133-40.
42. Tulsky DS, Kisala PA, Kalpakjian CZ et al (2015). Measuring depression after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Depression item bank and linkage with PHQ-9. J Spinal Cord Med,38(3):335-46.
43. Munce S, Straus S, Fehlings MG et al (2016). Impact of psychological characteristics in self-management in individuals with traumatic spinal cord injury. Spinal cord,54(1):29-33.
44. Elliott TR, Kennedy P (2004). Treatment of depression following spinal cord injury: an evidence-based review. Rehabil Psychol ,49(2):134.
45. Dryden DM, Saunders LD et al (2005). Depression following traumatic spinal cord injury. Neuroepidemiology,25(2):55-61.
46. Khazaeipour Z, Taheri-Otaghsara S-M, Naghdi M (2015). Depression following spinal cord injury: its relationship to demographic and socioeconomic indicators. Top Spinal Cord Inj Rehabil,21(2):149-55.
47. Sezer N, Akkuş S, Uğurlu FG (2015). Chronic complications of spinal cord injury. World J Orthop, 6(1):24-33.
48. Cragg J, Krassioukov A (2012). Autonomic dysreflexia. CMAJ,184(1):66-.
49. Middleton J, Dayton A, Walsh J et al (2012). Life expectancy after spinal cord injury: a 50-year study. Spinal Cord,50(11):803-11.
2. Sabre L, Rekand T, Asser T, Kõrv J (2013). Mortality and causes of death after traumatic spinal cord injury in Estonia. J Spinal Cord Med,36(6):687-94.
3. O’Connor PJ (2005). Survival after spinal cord injury in Australia. Arch Phys Med Rehabil, 86(1):37-47.
4. Frankel H, Coll J, Charlifue S et al (1998). Long-term survival in spinal cord injury: a fifty year investigation. Spinal Cord,36(4):266-74.
5. Noe B, Stapelfeldt C, Parner E et al (2017). Survival after traumatic spinal cord injury in Denmark: a hospital-based study among patients injured in 1990–2012. Spinal Cord, 55(4):373-377
6. Krause JS, Carter RE, Pickelsimer EE et al (2008). A prospective study of health and risk of mortality after spinal cord injury. Arch Phys Med Rehabil,89(8):1482-91.
7. Michael J, Krause JS, Lammertse DP (1999). Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil, 80(11):1411-9.
8. Strauss D, DeVivo MJ, Shavelle R (2000). Long-term mortality risk after spinal cord injury. J Insur Med,32(1):11-6.
9. Van Den Berg ME, Castellote JM et al (2010). Survival after spinal cord injury: a systematic review. J Neurotrauma,27(8):1517-28.
10. Hatch BB, Wood-Wentz C, Therneau T et al (2017). Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury. Spinal Cord,55(6):540-544
11. Varma A, Hill EG, Nicholas J et al (2010). Predictors of early mortality after traumatic spinal cord injury: a population-based study. Spine (Phila Pa 1976),35(7):778-83.
12. Hagen EM, Lie SA, Rekand T et al (2010). Mortality after traumatic spinal cord injury: 50 years of follow-up. J Neurol Neurosurg Psychiatry,81(4):368-73.
13. Whiteneck GG, Charlifue S, Frankel H et al (1992). Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia,30(9):617-30.
14. Hartkopp A, Brønnum-Hansen H, Seidenschnur AM et al (1997). Survival and cause of death after traumatic spinal cord injury. A long-term epidemiological survey from Denmark. Spinal cord,35(2):76-85.
15. Samsa GP, Patrick CH, Feussner JR (1993). Long-term survival of veterans with traumatic spinal cord injury. Arch Neurol,50(9):909-14.
16. Krause JS, Cao Y, DeVivo MJ et al (2016). Risk and Protective Factors for Cause-Specific Mortality After Spinal Cord Injury. Arch Phys Med Rehabil,97(10):1669-78.
17. Barman A, Shanmugasundaram D, Bhide R et al (2014). Survival in persons with traumatic spinal cord injury receiving structured follow-up in South India. Arch Phys Med Rehabil,95(4):642-8.
18. Savic G, DeVivo MJ, Frankel HL et al (2017). Causes of death after traumatic spinal cord injury-a 70-year British study. Spinal Cord, 55(10):891-897.
19. Thietje R, Pouw MH, Schulz AP et al (2011). Mortality in patients with traumatic spinal cord injury: descriptive analysis of 62 deceased subjects. J Spinal Cord Med,34(5):482-7.
20. Hackler RH (1977). A 25-year prospective mortality study in the spinal cord injured patient: comparison with the long-term living paraplegic. J Urol,117(4):486-8.
21. Zeilig G, Dolev M, Weingarden H et al (2000). Long-term morbidity and mortality after spinal cord injury: 50 years of follow-up. Spinal Cord,38(9):563-6.
22. Soden R, Walsh J, Middleton J et al (2000). Causes of death after spinal cord injury. Spinal Cord,38(10):604.
23. Baron J, Swaine J, Presseau J et al (2016). Self-management interventions to improve skin care for pressure ulcer prevention in people with spinal cord injuries: a systematic review protocol. Syst Rev,5(1):150.
24. Regan MA, Teasell RW, Wolfe DL et al (2009). A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury. Arch Phys Med Rehabil,90(2):213-31.
25. Klotz R, Joseph P, Ravaud J et al (2002). The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured persons: Part III. Medical complications and associated factors. Spinal Cord,40(9):457-67.
26. Anson C, Shepherd C (1996). Incidence of secondary complications in spinal cord injury. Int J Rehabil Res,19(1):55-66.
27. Cuddigan J, Frantz RA (1998). Pressure ulcer research: pressure ulcer treatment: a monograph from the National Pressure Ulcer Advisory Panel. Adv Wound Care,11(6):294-300.
28. Rish BL, Dilustro JF, Salazar AM et al (1997). Spinal cord injury: a 25-year morbidity and mortality study. Mil Med,162(2):141-8.
29. Rabadi MH, Aston C (2016). Evaluate the impact of neurogenic bladder in veterans with traumatic spinal cord injury. J Spinal Cord Med,39(2):175-9.
30. Noreau L, Noonan V, Cobb J et al (2014). Spinal cord injury community survey: a national, comprehensive study to portray the lives of Canadians with spinal cord injury. Top Spinal Cord Inj Rehabil,20(4):249-64.
31. DeVivo MJ, Black K, Richards JS et al (1991). Suicide following spinal cord injury. Paraplegia,29(9):620-7.
32. Frisbie JH, Kache A (1983). Increasing survival and changing causes of death in myelopathy patients. J Am Paraplegia Soc,6(3):51-6.
33. Mohammadi MR, Ghanizadeh A, Rahgozart M et al (2005). Suicidal attempt and psychiatric disorders in Iran. Suicide Life Threat Behav,35(3):309-16.
34. Anderson CJ, Vogel LC, Chlan KM et al (2007). Depression in adults who sustained spinal cord injuries as children or adolescents. J Spinal Cord Med,30:S76-82.
35. Bombardier CH, Richards JS, Krause JS et al (2004). Symptoms of major depression in people with spinal cord injury: implications for screening. Arch Phys Med Rehabil,85(11):1749-56.
36. Hassanpour K, Hotz-Boendermaker S, Dokladal P et al (2012). Low depressive symptoms in acute spinal cord injury compared to other neurological disorders. J Neurol,259(6):1142-50.
37. Krause JS, Kemp B, Coker J (2000). Depression after spinal cord injury: relation to gender, ethnicity, aging, and socioeconomic indicators. Arch Phys Med Rehabil, 81(8):1099-109.
38. Fann JR, Bombardier CH, Richards JS et al (2011). Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment. Arch Phys Med Rehabil, 92(3):352-60.
39. Lidal IB, Snekkevik H, Aamodt G et al (2007). Mortality after spinal cord injury in Norway. J Rehabil Med,39(2):145-51.
40. Savic G, DeVivo MJ, Frankel HL et al (2018). Suicide and traumatic spinal cord injury-a cohort study. Spinal cord, 56(1):2-6.
41. Williams R, Murray A (2015). Prevalence of depression after spinal cord injury: a meta-analysis. Arch Phys Med Rehabil,96(1):133-40.
42. Tulsky DS, Kisala PA, Kalpakjian CZ et al (2015). Measuring depression after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Depression item bank and linkage with PHQ-9. J Spinal Cord Med,38(3):335-46.
43. Munce S, Straus S, Fehlings MG et al (2016). Impact of psychological characteristics in self-management in individuals with traumatic spinal cord injury. Spinal cord,54(1):29-33.
44. Elliott TR, Kennedy P (2004). Treatment of depression following spinal cord injury: an evidence-based review. Rehabil Psychol ,49(2):134.
45. Dryden DM, Saunders LD et al (2005). Depression following traumatic spinal cord injury. Neuroepidemiology,25(2):55-61.
46. Khazaeipour Z, Taheri-Otaghsara S-M, Naghdi M (2015). Depression following spinal cord injury: its relationship to demographic and socioeconomic indicators. Top Spinal Cord Inj Rehabil,21(2):149-55.
47. Sezer N, Akkuş S, Uğurlu FG (2015). Chronic complications of spinal cord injury. World J Orthop, 6(1):24-33.
48. Cragg J, Krassioukov A (2012). Autonomic dysreflexia. CMAJ,184(1):66-.
49. Middleton J, Dayton A, Walsh J et al (2012). Life expectancy after spinal cord injury: a 50-year study. Spinal Cord,50(11):803-11.
| Files | ||
| Issue | Vol 48 No 12 (2019) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v48i12.3559 | |
| Keywords | ||
| Survival Traumatic spinal cord injury Mortality Iran | ||
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How to Cite
1.
GHAJARZADEH M, RAHIMI FOROUSHANI A, NEDJAT S, SHEIKHREZAEI A, SABERI H. Survival Analysis in Patients with Chronic Traumatic Spinal Cord Injury. Iran J Public Health. 2019;48(12):2260-2269.
