Journal:AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION
Year, Volume, Issue, Page(s):14, 1, 94, 180
Study examined how survival in incomplete spinal cord injury (SCI) depends on ambulatory function and the extent of bowel or bladder dysfunction, computed the life expectancies for various subgroups, and determined whether survival has improved over time. Data were obtained from the SCI Model Systems database for 8,206 adults with American Spinal Injury Association (ASIA) Impairment Scale (AIS) Grade D SCI who were not ventilator dependent and who survived more than 1 year after injury. The database included a total of 114,739 person-years of follow-up and 1,730 deaths during the 1970 - 2011 study period. Empirical age- and sex-specific mortality rates were computed. Regression analysis of survival data with time-dependent covariates was used to determine the effect of risk factors, to test for a time trend, and to estimate mortality rates for subgroups. Life expectancies were obtained from life tables constructed for each subgroup. Results indicated that the ability to walk, whether independently or with an assistive device, was associated with longer survival than wheelchair dependence. The need for an indwelling catheter, and to a lesser extent intermittent catheterization, was associated with increased mortality risk. Patients who walked unaided and who did not require catheterization had life expectancies roughly 90 percent of normal. Those who required a wheelchair for locomotion had life expectancies comparable with that in paraplegia, less than 75 percent of normal. No time trend in survival was found. Findings suggest that the life expectancy of people with AIS D SCI depends strongly on the ability to walk and the need for catheterization.