Causes of death following spinal cord injury during inpatient rehabilitation and the first five years after discharge. A Dutch cohort study

Study design:Prospective multicentre cohort study.Objectives:To determine mortality, causes and determinants of death of individuals with spinal cord injury ( SCI) within five years after first inpatient rehabilitation.Setting: NLD.Methods:Patients were included on admission to first clinical rehabilitation after traumatic or nontraumatic SCI. Inclusion criteria: age between 18 and 65, American Spinal Injury Association impairment scale A-D and expected long-term wheelchair dependency. Information about survival, cause of death, relevant comorbidity and psychosocial circumstances was obtained from the rehabilitation physician or general practitioner. Determinants of death were retrieved from a prospectively collected database. Deceased persons and survivors were compared using χ 2-test and t-test. Cox regression analysis was performed to describe independent predictors of death. The Kaplan-Meier method was used to calculate survival curves for independent predictors. Excess mortality was described by a standardized mortality ratio ( SMR).Results:Mean duration of follow up was 6.2 years. A total of 27 persons ( 12.2%) died during this period ( SMR 5.3). Main causes of death were cardiovascular disease ( 37.0%), pulmonary disease ( 29.6%) and neoplasm ( 14.8%). Older age at injury, nontraumatic SCI, family history of cardiovascular disease, less social support and a history of other medical conditions on admission were related to death. Older age at injury, nontraumatic SCI and a history of other medical conditions were independent predictors of death.Conclusion:Twelve per cent of persons with SCI who had survived the acute hospital phase died during follow up ( SMR 5.3). The main causes of death were cardiovascular and pulmonary disease.