In-hospital mortality in people with complete acute traumatic spinal cord injury at a tertiary care center in India—a retrospective analysis

Chhabra, Harvinder Singh; Sharawat, Rajesh; Vishwakarma, Gayatri

STUDY DESIGN: This is a retrospective study. OBJECTIVES: To analyze the causes and risk factors of mortality in people admitted with complete acute traumatic spinal cord injury (ATSCI). SETTING: The study was performed at the Indian Spinal Injuries Centre, New Delhi. METHODS: Data between 2000 and 2016 were retrospectively collected from case records of people with ATSCI. Risk factors for mortality were examined using multivariable logistic regression. RESULTS: Mortality rate in ATSCI admissions (n = 758) during the study period was 10%. Median (IQR) age of study participants was 34 (21) years with a range of 14–85 years. Respiratory complications, septicemia, and cardiovascular causes were responsible for 42%, 28, and 18% of deaths. Mortality rate in people with paraplegia and tetraplegia was 3% and 22%, respectively. The proportion surviving at 6 weeks was significantly different across people with paraplegia and people with high and low tetraplegia (p < 0.001). Greater age (OR (multivariable models) = 1.03, 95% CI = 1.01–1.06), associated injuries (OR = 2.42, 95% CI = 1.11–5.27), high tetraplegia (OR = 5.09, 95% CI = 2.21–11.72), low tetraplegia (OR = 4.84, 95% CI = 1.29–18.09), need for ventilator support (OR = 31.32, 95% CI = 14.92–65.35), septicemia (OR = 4.60, 95% CI = 1.05–20.07), respiratory complications (OR = 3.46, 95% CI = 1.63–7.33), and cardiovascular causes (OR = 39.03, 95% CI = 8.29–183.89) were significant risk factors associated with mortality. CONCLUSION: Respiratory complications, septicemia, and cardiovascular causes were the commonest causes of in-hospital mortality in people with complete ATSCI. Greater age, presence of associated injuries, tetraplegia, and ventilator support were risk factors significantly associated with mortality. To reduce morbidity and mortality in the acute phase, there is a need to focus on respiratory management and prevention of infections, especially in tetraplegics.