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Abstract
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BACKGROUND: Despite improvements in rescue, medical care and rehabilitation, the life expectancy of patients suffering from traumatic spinal cord injury (TSCI) remains limited. The causes are for this are manifold.
OBJECTIVE: Analysis of the etiology, life expectancy and the causes of death in patients with TSCI.
METHODS: A total of 190 patients with TSCI were evaluated. Inclusion criteria were an age at the time of injury of 16-60 years old. Further criteria to be met were the absence of life-limiting comorbid conditions and a minimum survival time of 1 year after the occurrence of injury. Data collection was made during inpatient and outpatient treatment and stored in a database. Every death notice induced extensive investigation into the circumstances of death.
RESULTS: Spinal cord injury occurred at an average age of 33.8 years. The most common causes were falls (48.4%), followed by road traffic accidents (35.8%). Swimming accidents, most notably diving into shallow water, made up 4.2% of the causes. The average life expectancy of paraplegic patients was 30.8 years and tetraplegic patients only reached an average survival time of 19.6 years. The leading cause of death in tetraplegic patients was pneumonia (33.0%), followed by cardiovascular disease (18.0%), suicide and malignant tumors (11.0% each). Paraplegic patients died primarily due to cardiovascular disease (35.6%), followed by malignant tumors (20.0%) and pneumonia (16.7%). In both tetraplegic and paraplegic groups, no significant differences between complete and incomplete spinal cord injury (SCI) regarding the life expectancy was observed (tetraplegic patients 19.3/20.2 years, paraplegic patients 30.6/32.9 years, respectively). The life expectancy of tetraplegic individuals in Germany varies depending on their relevant health insurance cover between 16.4 and 23.8 years.
CONCLUSION: In spite of considerable improvements in rescue and emergency services as well as treatment modalities, the life expectancy of patients suffering from TSCI remains limited. Especially patients with high level lesions resulting in tetraplegia, die prematurely due to pneumonia. The longer a patient survives SCI and the lower the level of lesion, the more likely a cause of death related to age-associated diseases becomes. Suicide is very common in tetraplegic patients with incomplete SCI. The extent of health insurance coverage has a considerable influence regarding life expectancy of tetraplegic patients in Germany. © 2018, Springer Verlag. All rights reserved.
Language: de |