Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Org1

119 views

Published on

East zone medico legal services pvt

Published in: Business
  • Be the first to comment

  • Be the first to like this

Org1

  1. 1. Objective. To identify predictors of early mortality following traumatic spinal cord injury (TSCI). Summary of Background Data. Limited information is available on factors associated with early mortality following TSCI. Ability to identify high risk individuals can help to appropriately treat them, and reduce mortality. Methods. Early mortality was defined as death occurring during the initial hospital admission. Retrospective analysis of 1995 patients with TSCI, admitted to various hospitals of South Carolina from 1993 to 2003, was performed. There were 251 patients with early mortality. Multivariable logistic regression was used in modeling of early death following TSCI with gender, race, age, Frankel grade, trauma center, level of injury, injury severity score (ISS), traumatic brain injury (TBI), and medical comorbidities as covariates. Results. Increasing age after 20 years (OR: 1.2, P = <0.0001), male gender (OR: 1.6, P = 0.016), severe (ISS ≥15) systemic injuries (OR: 1.9, P = 0.012), TBI (OR: 3.7, P < 0.0001), 1 or more comorbidities (P < 0.0001), poor neurologic status (P = 0.015), and level 1 trauma center (OR: 1.4, P = 0.026) were significantly associated with early mortality, after adjusting for other covariates. Conclusion. Early mortality following TSCI is influenced by multiple factors. Timely recognition of these factors is crucial for improving survival in the acute care setting. Severe systemic injuries, medical comorbidities, and TBI continue to be the main limiting factors affecting the outcome. These findings also suggest the need to allocate resources for trauma prevention, and promote research towards improving the care of acutely injured patients. Introduction Traumatic spinal cord injury (TSCI) is a serious medical disorder in terms of both mortality and morbidity. The annual incidence of TSCI in the United States, excluding those that die at the scene of accident, is approximately 11,000 and the prevalence is 253,000.[1] Though TSCI primarily affects young adults, the average age of TSCI has increased steadily from 28.7 years in 1979 to 37.6 years in 2000, a reflection of rise in the median age of the general population. The proportion of persons older than 60 years at injury has also increased from 4.7% before 1980 to 10.9% after 2000. Since 2000, 79.6% of injuries have occurred among males, with a slight trend towards decreasing male percentage, compared to 1980 and earlier.[1] Frequently TSCI is associated with other injuries. Due to the complexity and multitude of clinical problems associated with TSCI, early and long-term outcomes are influenced by a host of factors. There have been numerous studies on long-term morbidity following TSCI.[2–8] Causes of death or factors predisposing to mortality following TSCI reported in long-term prospective and retrospective studies, have included advanced age; cord injury at a higher spinal level; infections (septicemia from infected decubiti, urinary tract infection, and pneumonitis); pulmonary thromboembolism; medical comorbidities (cardiovascular disease, diabetes, and pulmonary disease); and suicide. However, there is a paucity of
  2. 2. information on early mortality following TSCI. In a review of English language medical literature published from 1960 to 1978, Krause[9] reported a mortality rate ranging from 4.4% to 16.7% following admission for acute TSCI. Current data on early mortality, after TSCI, and an understanding of factors contributing to the same are lacking. Further, few studies have used statewide population based dataset. This retrospective study was performed to identify predictors of early mortality following TSCI. In this study, the term "early mortality" is defined as death occurring within the acute care facility, before discharge or transfer to an extended care facility. To our knowledge, this is among the very few studies that address the influence of demographic, clinical, and provider characteristics on early mortality among acutely injured spinal cord patients. Recognition of factors associated with early mortality can help streamline the trauma care system, identify high-risk patients and potentially reduce deaths in this patient population. Variable Definitions The primary outcome variable for all analyses was early mortality status (yes or no), defined as death in the acute care setting before discharge or transfer to an extended care facility. Covariates were selected based on clinical relevance. Race was dichotomized as white and nonwhite, with the nonwhite category including African Americans as well as those identified as other than white or black (64 subjects or 3% overall). Age (years) was treated as a continuous variable in all analyses. Functional state was defined according to Frankel grading system.[12] The database included a comorbidity scale developed for use with administrative data.[13] This method identifies 30 conditions known to be significant predictors of in- hospital mortality and resource use. All 10 ICD-9-CM diagnosis fields were searched for any of these 30 conditions. For the purposes of our analysis, subjects were categorized as having 0, 1, 2, or 3 or more comorbid conditions. Level of injury was categorized into cervical, dorsal, and lumbosacral. For the purposes of analysis, injury level was coded as missing for nonspecific injuries (n = 151). Overall injury severity was graded using the Injury Severity Score (ISS).[14] The ISS is an anatomically-based measure ranging from 1 to 75. Briefly, the injury scoring system divides the body into 6 regions: head or neck, face, chest, abdominal or pelvic contents, pelvic girdle or extremities, and external. The Injury Severity Score is then calculated using the 3 most severely injured body regions. ICDMAP-90 software was used to translate the ICD-9-CM diagnosis codes into an equivalent ISS. Subjects were then categorized as mildly, moderately or severely injured based on the following ISS values: mild = ISS from 1 to 8; moderate = ISS from 9 to 14; and severe = ISS ≥15. Because of sparse numbers for the mild ISS class (only 2 early mortality subjects were classified with a mild injury), we combined the mild and
  3. 3. moderate injury severity categories to facilitate subsequent data analyses. Subjects were classified as experiencing traumatic brain injury (TBI), based on case definition for TBI provided by CDC.[11] Hospitals were classified as either level 1 or level 2 trauma centers based on the SC Department of Health and Environmental Control Health Regulation Office that evaluates trauma level status of hospitals. For analysis purposes, trauma facilities designated as 3 and 4 were grouped with level 2.

×