Mortality after traumatic spinal cord injury: 50 years of follow-up
- Stein Atle Lie ( )
- Tiina Rekand ( )
- Nils Erik Gilhus ( )
- Marit Gronning ( )
- Published Online First 2 September 2009
Objective: To study mortality and causes of death in an unselected, geographically defined cohort of patients with traumatic spinal cord injury (TSCI) 1952-2001.
Methods: The patients were identified from hospital records. The date of death was obtained from the National Population Register, and causes of death recorded by linkage to the Norwegian Cause of Death Registry. The patient mortality was compared with the mortality in the Norwegian population, using standardized mortality ratios (SMR) adjusted for age and gender.
Results: A total of 401 patients (70 women and 331 men) were identified. By 31 August 2008 173 were dead. The median survival time in deceased patients was 7.4 years; 6.9 years for patients with cervical injuries and 8.2 years for patients with thoracolumbosacral injuries (TLS). TSCI patients had an increased mortality (SMR=1.85) compared to the Norwegian population. SMR did not change during the observation period. SMR was significantly higher for women than for men (2.88 vs. 1.72), and higher in patients with complete TSCI compared to patients with incomplete TSCI (4.23 vs. 1.25). SMR was 6.70 for patients with complete cervical injuries and 3.07 for patients with complete TLS injuries. Cause-specific SMR were 1.96 for respiratory disease, and for suicide including accidental poisoning 3.70 for men and 37.59 for women.
Conclusions: Patients with a TSCI, and especially women, have an increased mortality despite modern treatment and care. Special attention should be paid to respiratory dysfunction and pulmonary infections, and to prevent suicide and accidental poisoning.