A prospective study of health and risk of mortality after spinal cord injury

Arch Phys Med Rehabil, 2008 · DOI: 10.1016/j.apmr.2007.11.062 · Published: August 1, 2008

Spinal Cord Injury Rehabilitation Public Health

Simple Explanation

This study investigated the factors that contribute to mortality in individuals with spinal cord injuries (SCI). It looked at various health conditions and how they relate to the risk of death. The research followed a group of adults with SCI over several years, collecting data on their health and tracking mortality rates. The findings highlight that certain health issues, like pressure ulcers, infections, depression, and the need for surgeries, significantly increase the risk of mortality in people with SCI.

Study Duration

8 years

Participants

1389 adults with traumatic SCI, at least 1 year postinjury

Evidence Level

Prospective cohort study

Key Findings

1
Multiple types of health conditions were associated with mortality, including probable major depression, surgeries to repair pressure ulcers, fractures and/or amputations, symptoms of infections, and days hospitalized.
2
The best set of health predictors included probable major depression, surgeries to repair pressure ulcers, fractures and/or amputations, symptoms of infections, and days hospitalized.
3
Inclusion of health variables improved prediction of survival compared with biographic and injury variables alone.

Research Summary

This study aimed to identify health outcomes associated with elevated mortality risk after SCI, evaluating the association of health outcomes with hazard of mortality after SCI. Cox proportional hazards modeling identified significant health predictors of mortality status, controlling for biographic and injury factors. Multiple health conditions were associated with mortality. The findings suggest the need for prevention strategies targeting individuals with multiple secondary conditions, including providing information on the association of health with the likelihood of early mortality.

Practical Implications

Early Identification of Risk

Regular outpatient assessments should include increased risk of mortality based on the presence of multiple health indicators.

Targeted Interventions

Interventions should target secondary conditions with the strongest associations with early mortality, such as pressure ulcers, UTIs, amputations or fractures, and the development of a depressive disorder.

Holistic Health Promotion

A 'holistic' approach to promote better health may be needed to reduce mortality, given that a broad constellation of risk factors are predictive of mortality.

Study Limitations

1
The study only established an association of health outcomes with mortality, not causality.
2
The data were heavily left censored, with participants entering the analysis an average of just under 10 years after SCI onset.
3
Risk and protective factors were only collected once with as much as an 8-year lag between collection and determination to mortality status.

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