Chest
Volume 108, Issue 1, July 1995, Pages 226-232
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Clinical Investigations in Critical Care
Life Expectancy of Ventilator-Dependent Persons With Spinal Cord Injuries

https://doi.org/10.1378/chest.108.1.226Get rights and content

Objective: The purpose of this study is to estimate age-specific life expectancies for ventilator-dependent persons with spinal cord injury (SCI).

Design: Nonconcurrent prospective study.

Setting: Federally designated model SCI care systems.

Patients: The study included all 435 persons admitted to a model SCI care system between 1973 and 1992 who survived at least 24 h postinjury and who were either ventilator dependent at rehabilitation discharge or who died prior to discharge while still ventilator dependent.

Intervention: None.

Outcome measures: Standardized mortality ratio (SMR), life expectancy, and causes of death.

Results: The overall 1-year survival rate was 25.4%, while the 15-year survival rate was 16.8%. Among those who survived the first year, cumulative survival over the next 14 years was 61.4%. The mortality rate for persons injured since 1980 was reduced by 60% compared with persons injured between 1973 and 1979. Among year 1 survivors, the subsequent mortality rate was reduced by 39% for persons injured between 1980 and 1985, and 91% for persons injured since 1986, relative to persons injured between 1973 and 1979. The leading cause of death was respiratory complications, particularly pneumonia.

Conclusions: With the development of improved methods of prevention and management of respiratory complications in this population, life expectancies should continue to improve. As a result, additional attention should be focused on enhancing the quality of life for these individuals.

Section snippets

Study Population

This study was conducted on 435 persons who sustained a traumatic SCI between 1973 and 1992 that resulted in ventilator dependency, who survived at least 24 h after injury, and who were admitted within 1 year of injury to a federally designated model regional SCI care system located throughout the United States (the identity of each facility appears in the acknowledgment). All persons either remained ventilator dependent at the time of discharge from rehabilitation or died prior to discharge

Results

The mean and SD age at injury of the entire study population was 39.6 ± 22.6 years. Median age at injury was 33 years. The comparable mean and median ages at injury for the overall spinal cord injury population are 30.5 ± 14.9 years and 26 years, respectively.35 Therefore, persons who sustain SCI resulting in ventilator dependency are on average, slightly older than those who do not require ventilators. Typical of SCI in general, 81.4% of the study population were men, 75.4% were white, 18.2%

Discussion

This study provides the most up-to-date, complete, and accurate information currently available about long-term survival and causes of death for a relatively large sample of ventilator-dependent persons followed up prospectively for several years by the model SCI care systems. Perhaps the most striking and by far the most encouraging finding is the substantial improvement in survival rates that has occurred since the inception of the model SCI care system program, particularly among persons who

Acknowledgment

The authors express their sincere appreciation to project directors and data coordinators at the following institutions that submitted data to this collaborative study: The University of Alabama at Birmingham; Rancho Los Amigos Medical Center, Downey, Calif; Craig Hospital, Englewood, Colo; Shepherd Center for Treatment of Spinal Injuries, Inc, Atlanta; Northwestern University Medical Center and Rehabilitation Institute of Chicago; Boston University Medical Center; Rehabilitation Institute of

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