Life expectancy of ventilator-dependent persons with spinal cord injuries.

Abstract

OBJECTIVE: The purpose of this study is to estimate age-specific life expectancies for ventilator-dependent persons with spinal cord injury (SCI). DESIGN: Nonconcurrent prospective study. SETTING: Federally designated model SCI care systems. PATIENTS: The study included all 435 persons admitted to a model SCI care system between 1973 and 1992 who survived at least 24 h postinjury and who were either ventilator dependent at rehabilitation discharge or who died prior to discharge while still ventilator dependent. INTERVENTION: None. OUTCOME MEASURES: Standardized mortality ratio (SMR), life expectancy, and causes of death. RESULTS: The overall 1-year survival rate was 25.4%, while the 15-year survival rate was 16.8%. Among those who survived the first year, cumulative survival over the next 14 years was 61.4%. The mortality rate for persons injured since 1980 was reduced by 60% compared with persons injured between 1973 and 1979. Among year 1 survivors, the subsequent mortality rate was reduced by 39% for persons injured between 1980 and 1985, and 91% for persons injured since 1986, relative to persons injured between 1973 and 1979. The leading cause of death was respiratory complications, particularly pneumonia. CONCLUSIONS: With the development of improved methods of prevention and management of respiratory complications in this population, life expectancies should continue to improve. As a result, additional attention should be focused on enhancing the quality of life for these individuals.