Risk factors associated with mortality after traumatic cervical spinal cord injury.

Abstract

To investigate the mortality rate following cervical spinal cord injury (SCI) injury and analyze the associated risk factors. Retrospective cohort study. One Level 1 trauma center. A cohort of 76 patients with traumatic cervical SCI was reviewed between January 2010 and May 2015, of which 54 patients were selected for the present retrospective study. Operative or conservative treatment. The following patient parameters were analyzed; age, sex, American Spinal Injury Association (ASIA) impairment scale, neurological impairment level, injury mechanism, radiological findings, treatment, tracheostomy rate, and mortality. The mean age of the patient cohort was 65 ± 17 years, with 11 females (20%) and 43 males (80%). A total of 16 (30%), 4 (7%), 22 (41%), and 12 patients (22%) were scored A, B, C, and D, respectively, on the ASIA impairment scale. Most of the injuries were at the C4 (30%) and C5 (33%) levels. Falls from standing (35%) and heights (39%) were the most common injury mechanisms. SCI in 40 patients (74%) occurred without major fracture or dislocation. Surgery was performed on 26 patients. The overall mortality was 19%. Patients in the deceased group were significantly older at the time of injury, compared with those who survived. Paralysis had been more severe in the deceased group. A significantly high number of patients in the deceased group received a tracheostomy. When analyzed using a multivariate logistic regression model, an ASIA impairment scale of A was a significant risk factor for mortality. The risk factors associated with mortality were age, tracheostomy, and an ASIA impairment scale of A, the latter had the highest risk. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.