Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury

B. B. Hatch, C. M. Wood-Wentz, Terry M Therneau, M. G. Walker, J. M. Payne, R. K. Reeves

Research output: Contribution to journalArticle

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Abstract

Study Design:Retrospective chart review.Objectives:To identify factors predictive of survival after spinal cord injury (SCI).Setting: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.Spinal Cord advance online publication, 7 February 2017; doi:10.1038/sc.2016.182.

Original languageEnglish (US)
JournalSpinal Cord
DOIs
StateAccepted/In press - Feb 7 2017

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Spinal Cord Injuries
Survival
Wounds and Injuries
Blood Vessels
Length of Stay
Neoplasms
Rehabilitation
Spinal Cord Ischemia
Paraplegia
Population Characteristics
Tertiary Healthcare
Publications
Spinal Cord
Pathologic Constriction
Ischemia
Retrospective Studies
Regression Analysis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury. / Hatch, B. B.; Wood-Wentz, C. M.; Therneau, Terry M; Walker, M. G.; Payne, J. M.; Reeves, R. K.

In: Spinal Cord, 07.02.2017.

Research output: Contribution to journalArticle

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title = "Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury",
abstract = "Study Design:Retrospective chart review.Objectives:To identify factors predictive of survival after spinal cord injury (SCI).Setting: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.Spinal Cord advance online publication, 7 February 2017; doi:10.1038/sc.2016.182.",
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T1 - Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury

AU - Hatch, B. B.

AU - Wood-Wentz, C. M.

AU - Therneau, Terry M

AU - Walker, M. G.

AU - Payne, J. M.

AU - Reeves, R. K.

PY - 2017/2/7

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N2 - Study Design:Retrospective chart review.Objectives:To identify factors predictive of survival after spinal cord injury (SCI).Setting: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.Spinal Cord advance online publication, 7 February 2017; doi:10.1038/sc.2016.182.

AB - Study Design:Retrospective chart review.Objectives:To identify factors predictive of survival after spinal cord injury (SCI).Setting: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.Spinal Cord advance online publication, 7 February 2017; doi:10.1038/sc.2016.182.

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