Mortality and causes of death of traumatic spinal cord injury in Finland

Elina Johansson; Eerika Koskinen; Mika Helminen; Aki Vainionpää; Teemu M Luoto

doi:10.1038/s41393-024-01047-9

Mortality and causes of death of traumatic spinal cord injury in Finland

Spinal Cord. 2024 Oct 30. doi: 10.1038/s41393-024-01047-9. Online ahead of print.

Authors

Elina Johansson¹, Eerika Koskinen², Mika Helminen³, Aki Vainionpää⁴, Teemu M Luoto⁵

Affiliations

¹ Department of Neurology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland. [email protected].
² Department of Neurology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland.
³ Tays Research Services, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, and Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland.
⁴ Department of Rehabilitation, Seinäjoki Central Hospital, Seinäjoki, Finland.
⁵ Department of Neurosurgery, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, and Tampere University, Tampere, Finland.

PMID: 39478103
DOI: 10.1038/s41393-024-01047-9

Abstract

Study design: Prospective cohort study.

Objectives: To study the mortality rates of TSCI patients compared to matched controls and to examine possible TSCI-related mortality risk factors and causes of death.

Setting: Oulu and Tampere University Hospital, Finland.

Methods: All consecutive patients with a new TSCI were included in a prospective study (n = 344, 2012-16). All patients were followed until death or the end of 2019. Patients were compared to a control group formed by randomly choosing gender, age, municipality, and calendar time-matched controls (5 controls/TSCI patient). Standardized mortality ratios (SMR) were calculated using general population mortality rates. Mortality information was extracted from the Statistics of Finland (Helsinki, Finland).

Results: TSCI patients had an increased mortality (SMR = 2.9) compared with the Finnish population. During the observation period, 26% of TSCI patients and 12% of the matched controls died. Of the TSCI patient deaths, 51% occurred within the first two years postinjury. Increased age, severity of TSCI (as per International SCI Core Data Set) and fall were related to mortality (p < 0.05). The two most common etiologies of death were: circulatory (30%), and pulmonary diseases (28%). Pneumonia was the single most frequent disease leading to death among TSCI patients.

Conclusions: During the first years after injury, the mortality of the patients with TSCI is double compared to the controls. Most deaths occur within two years postinjury. Elderly patients with more severe fall-related injury have the highest mortality risk. Circulatory diseases and pulmonary diseases, especially pneumonia, are the foremost causes of death after TSCI.