[Survival of tetraplegic spinal cord injured persons after the first admission of a rehabilitation center and prognosis factors: a multicenter study of 697 subjects in French centers]

Abstract

Background: We surveyed survival and prognosis factors in tetraplegic spinal cord injured persons (TSCI) after their admission to a physical medicine and rehabilitation center.

Methods: This multicenter study included 697 individuals, the entire cohort of patients admitted to three of the principal French centers caring for spinal cord injured persons from 1949 to 1997. The data set was drawn from the medical files and included data on the accident and its complications, social and demographic features, and the characteristics of the spinal injury. Survival data were obtained for all subjects from the official registries of their place of birth. Univariate (Kaplan-Meier) and multivariate (Cox regression) analysis was made to study links between these data and survival.

Results: Univariate analysis indicated that the principal variables significantly related to survival were: level of the lesion, age at the time of the accident, the cause of the accident, and the presence of a permanent tracheotomy or a depressive syndrome requiring medical care. Multivariate analysis showed that the risk of dying was 82% lower for persons who did not have a permanent tracheotomy. The risk declined by 92%, 89% and 69% for TSCI aged 20 years or less, 20-39 years and 40-59 years respectively at the time of the accident compared with those aged more than 60 years. This risk was 37% lower for TSCI without depressive syndrome and 52% lower for persons injured at levels C6, C7, C8 compared with those injured at levels C2, C3, C4.

Conclusion: Multivariate analysis showed that the principal prognosis factors for survival are the presence of a permanent tracheotomy, the age at the time of the accident, the presence of a depressive syndrome and the level of the lesion. No statistical improvement of survival was observed related with time (corresponding to the year of inclusion) but, over the study period, there was an increasing number of spinal cord injured person who survived with high lesions.