Survival after spinal cord injury in Australia*1

Abstract

O’Connor PJ. Survival after spinal cord injury in Australia. Objective To assess survival after spinal cord injury (SCI) in Australia. Design Cohort study of incident cases from 1986 to 1997, with follow-up to the end of 1998. Setting Cases registered by 6 Australian treatment centers for the acute care and rehabilitation of SCI patients. Participants Subjects (N=2892), age 15 years and older, from a national population-based SCI register. Interventions Not applicable. Main outcome measures Cumulative and relative survival proportions and hazard ratios. Results The all-cases cumulative survival proportion was 94% at 1 year and 86% at 10 years; the relative survival proportions were 95% and 92%, respectively. Significant predictors of survival were: age at injury, sex, neurologic level, and extent of lesion. Cox regression modeling revealed a statistically significant reduction in the 2-month (36% reduction, P=.01) and 1-year (27% reduction, P=.04) hazard ratio from 1986 to 1991 to 1992 to 1997. Benchmarking analysis revealed no statistically significant difference in survival experience between the 6 spinal treatment units. Conclusions Further improvement in survival rates can be achieved through better understanding of the predictors, temporal patterns, and causes of death, and by benchmarking. Early deaths have an important impact on overall survival rates, and warrant further study. International standardization of methods is strongly recommended.