The Impact of Age on Mortality, Impairment, and Disability among Adults with Acute Traumatic Spinal Cord Injury

被引:2
作者
Furlan, Julio C. [1 ,2 ]
Fehlings, Michael G. [1 ,3 ,4 ,5 ]
机构
[1] Toronto Western Res Inst, Univ Hlth Network, Dept Genet & Dev, Toronto, ON M5T 2S8, Canada
[2] Univ Toronto, Toronto Rehabil Inst, Lyndhurst Ctr, Toronto, ON, Canada
[3] Toronto Western Res Inst, Univ Hlth Network, Spinal Program, Krembil Neurosci Ctr, Toronto, ON M5T 2S8, Canada
[4] Univ Toronto, Dept Surg, Div Neurosurg, Toronto, ON, Canada
[5] Univ Toronto, Spinal Program, Toronto, ON, Canada
关键词
aging; functional recovery; mortality; motor recovery; spinal cord injury; REHABILITATION COSTS; PAIN INTERFERENCE; METHYLPREDNISOLONE; OUTCOMES; RECOVERY; NALOXONE; TRENDS; MOTOR;
D O I
10.1089/neu.2009.0888
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Given the potential effects of age on mortality, impairment, and disability among individuals with traumatic spinal cord injury (SCI), we examined these issues using a large, prospectively accrued clinical database. This study includes all patients who were enrolled in the Third National Spinal Cord Injury Study (NASCIS 3). Motor, sensory, and pain outcomes were assessed using NASCIS scores. Functional outcome was evaluated using the Functional Independence Measure (FIM). Data analyses included regression models adjusted for major potential confounders (i.e., sex, ethnicity, Glasgow Coma Scale [GCS] score, blood alcohol concentration on admission, drug protocol, cause, and level and severity of SCI). Mortality rates among older people (>= 65 years) were significantly greater than those of younger individuals at 6 weeks, at 6 months, and at 1 year following SCI (38.6% versus 3.1%; p<0.0001). Among survivors, age was not significantly correlated with motor recovery or change in pain scores in the acute and chronic stages after SCI based on regression analyses adjusted for major confounders. However, older individuals experienced greater functional deficit (based on FIM scores) than younger individuals, despite experiencing similar rates of sensorimotor recovery (based on NASCIS scores). Our results suggest that older individuals have a substantially increased mortality rate during the first year following traumatic SCI in comparison with younger patients. Among survivors, the potential of older patients with SCI to neurologically improve within the first year post-injury does not appear to translate into similar functional recovery compared to that seen in younger individuals. Given this fact, rehabilitation protocols that are more focused on functional recovery may reduce disability among older people with acute traumatic SCI.
引用
收藏
页码:1707 / 1717
页数:11
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