創傷性脊髓損傷者一年內存活及影響因素

Objective: To examine one-year mortality and its determinants among persons with traumatic spinal cord injury (SCI) in Taiwan. Method: To recruit patients of SCI occurring during a 5-year period of from July 1, 1999 to June 30, 2004 by reviewing hospital records of 5 medical centers, including the Mackay Memorial Hospital at Taipei City and at Tamshui Town, Taipei County, the Chang-Gung Memorial Hospital at Linkou, Taipei County, the Tri-Service General Hospital, the Tzu Chi General Hospital at Hualien County, with codes of International Classification of Diseases. In addition to using the death registration of the Department of Health in Taiwan, follow-up telephone calls were also conducted to crosscheck the survival and causes of death among study subjects. The proportional hazards model was used to identify factors associated with the one-year survival. Results: A total of 713 subjects were recruited. The mortality rate of the first year after injury was 11.7% and three leading causes of death during the first year period were unintentional injuries (59.5%), diseases of the digestive system (6.8%), and cancers (6.8%). In the result of proportional hazards model analysis, the adjusted hazard ratio (HR) of death was associated with age at injury (HR=1.02, 95% confidence interval (CI)=1.01 to 1.04) and scores of the Injury Severity Scale (HR=1.07, 95% CI=1.06 to 1.08). Furthermore, the HR of the pedestrians to persons with motor vehicle injury was 3.52 (95% CI=1.28 to 9.71). Compared to persons with the level of motor function and key muscles grade of 3 or more, evaluated by American Spinal Injury Association Impairment Scale, those with no motor and sensory function, those with only sensory function, and those with motor function but key muscles grade less than 3, respectively, were 17.7 times (95% CI=9.04 to 34.7), 8.68 times (95% CI=3.82 to 19.8), and 3.09 times (95% CI=1.35 to 7.09) were more likely to die. Conclusion: The first-year mortality rate among traumatic SCIs is higher than the general population in Taiwan; it is still a room to be improved. Furthermore, the mortality is associated with age at injury, type of injury cause, and injury severity.