Long-term survival after childhood spinal cord injury

Area of Science:

• Spinal cord injury research
• Public health
• Epidemiology

Background:

• Spinal cord injury (SCI) affects individuals of all ages, but the long-term mortality implications for those injured in childhood are not fully understood.
• Previous research has not consistently compared mortality risks between pediatric and adult SCI populations with similar injury characteristics.

Purpose of the Study:

• To investigate if individuals who sustain a spinal cord injury (SCI) during childhood have a higher mortality risk compared to adults with similar injury severity, age, and sex.
• To quantify the difference in mortality risk associated with age at the time of spinal cord injury.

Main Methods:

• Analysis of a large cohort (25,340 individuals) from the National Spinal Cord Injury Statistical Center and National Shriners Spinal Cord Injury databases.
• Inclusion criteria: non-ventilator dependent, survived >2 years post-injury, data spanning 1973-2004 (274,020 person-years).
• Statistical analysis using pooled repeated observations, examining survival/mortality based on age at injury, current age, sex, race, injury cause, and severity.

Main Results:

• Individuals injured before age 16 had a 31% increased annual odds of mortality compared to those injured at older ages (P=0.013).
• This elevated mortality risk was consistent across varying current ages, sexes, races, injury severities, and injury eras.
• No significant interaction effects were observed between age at injury and other demographic or injury-related factors.

Conclusions:

• Childhood spinal cord injury (SCI) is associated with a slightly reduced life expectancy compared to adult-onset SCI, even when controlling for injury severity and other factors.
• Despite the increased risk, individuals with childhood SCI can achieve substantial life expectancies, varying from 50% to 83% of normal, depending on injury level and deficit.