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.
Subject(s)
Spinal Cord Injuries/mortality , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Length of Stay , Male , Middle Aged , Neoplasms/complications , Neoplasms/mortality , Neoplasms/rehabilitation , Proportional Hazards Models , Retrospective Studies , Severity of Illness Index , Sex Factors , Spinal Cord Injuries/etiology , Spinal Cord Injuries/rehabilitation , Spinal Cord Ischemia/complications , Spinal Cord Ischemia/mortality , Spinal Cord Ischemia/rehabilitation , Survival Analysis , Young AdultABSTRACT
OBJECTIVE: History and laboratory evaluations are common for patients entering substance abuse detoxification programs. We sought to identify if patient history and laboratory characteristics entering a detoxification program were associated with unsuccessful detoxification. DESIGN: Retrospective cohort study of 186 patients of a residential-inpatient short-term medical detoxification facility. Unsuccessful detoxification was defined as leaving for urgent medical referral or against program advice. RESULTS: Patients were predominantly male, middle-aged, minority, unemployed, and poly-substance users. Twenty-four patients (13%) did not complete the detoxification program (4 left for urgent medical referral, 20 left against program advice). Unsuccessful detoxification was associated with nausea and/or vomiting (p = 0.032), Caucasian race (p = 0.002), and opiates as a drug of choice (p = 0.018). Laboratory abnormalities were common but none were associated with unsuccessful detoxification. CONCLUSIONS: For patients admitted to a medically monitored detoxification facility, few patient characteristics were associated with detoxification outcome. Routine admission laboratories without clinical correlation may be unwarranted.