Risk factors associated with mortality after traumatic cervical spinal cord injury

OBJECTIVES: To investigate the mortality rate following cervical spinal cord injury (SCI) injury and analyze the associated risk factors. DESIGN: Retrospective cohort study. SETTING: One Level 1 trauma center. PATIENTS/PARTICIPANTS: 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. INTERVENTION: Operative or conservative treatment. MAIN OUTCOME MEASUREMENTS: 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. RESULTS: 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. CONCLUSIONS: The risk factors associated with mortality were age, tracheostomy, and an ASIA impairment scale of A, the latter had the highest risk. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.