Article | Published:

A prediction model to identify people with spinal cord injury who are at high risk of dying within 5 years of discharge from hospital in Bangladesh

Spinal Cordvolume 57pages198205 (2019) | Download Citation

Abstract

Study design

Mixed retrospective and prospective cohort study.

Objectives

To determine 5-year survival after hospitalisation with spinal cord injury (SCI) in Bangladesh and to develop a prediction model to identify people at high risk of dying within 5 years.

Setting

Bangladesh.

Methods

Medical records were used to identify people with SCI admitted to a hospital in Bangladesh in 2011. Participants or their family members were contacted >5 years after discharge to determine vital status or date of death. Survival from time of discharge was estimated with Kaplan–Meier curves. A linear model of the log odds of death within 5 years of discharge was constructed and internally validated.

Results

Of the 345 people who were admitted and survived to discharge in 2011, 342 (99%) were accounted for 5 years later: 74 (22%) had died (survival = 78%; 95% CI 74–82%). Sixty nine of the 223 participants who were wheelchair-dependent at discharge had died (survival = 69%; 95% CI 62–75%). A parsimonious model predicted survival as a function of age and mode of mobility at discharge (wheelchair-dependent or ambulant). The odds of dying increased by a factor of 1.6 (95% CI, 1.3–2.0) with every decade of age and by a factor of 12.6 (95% CI, 4.8–32.9) if wheelchair-dependent. The model had good calibration and discrimination.

Conclusion

The risk of dying after discharge from hospital with SCI in Bangladesh is high, especially among older, wheelchair-dependent people. A simple prediction model discriminates those at high risk of dying within 5 years.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    World Health Organization. International perspectives on spinal cord injury. Geneva: World Health Organisation; 2013.

  2. 2.

    Chamberlain JD, Meier S, Mader L, von Groote PM, Brinkhof MW. Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology. 2015;44:182–98.

  3. 3.

    van den Berg ME, Castellote JM, de Pedro-Cuesta J, Mahillo-Fernandez I. Survival after spinal cord injury: a systematic review. J Neurotrauma. 2010;27:1517–28.

  4. 4.

    Barman A, Shanmugasundaram D, Bhide R, Viswanathan A, Magimairaj HP, Nagarajan G, et al. Survival in persons with traumatic spinal cord injury receiving structured follow-up in South India. Arch Phys Med Rehabil. 2014;95:642–8.

  5. 5.

    Nwadinigwe CU, Iloabuchi TC, Nwabude IA. Traumatic spinal cord injuries (SCI): a study of 104 cases. Niger J Med. 2004;13:161–5.

  6. 6.

    Kawu A, Alimi M, Gbadegesin S, Salami O, Olawepo A, Adebule G. Risk Factors Predicting Mortality in Spinal Cord Injury in Nigeria. WebmedCentral ORTHOPAEDICS 2010;1(9):WMC00807 https://doi.org/10.9754/journal.wmc.2010.00807.

  7. 7.

    Leite V, de Souza D, Imamura1 M, Battistella L. Post-discharge mortality in patients with traumatic spinal cord injury in a Brazilian hospital – a retrospective cohort. Spinal Cord. 2018. https://doi.org/10.1038/s41393-018-0183-y.

  8. 8.

    Hossain M, Rahman M, Herbert R, Quadir M, Bowden J, Harvey L. Two-year survival following discharge from hospital after spinal cord injury in Bangladesh. Spinal Cord. 2016;54:132–6.

  9. 9.

    Catz A, Thaleisnik M, Fishel B, Ronen J, Spasser R, Fredman B, et al. Survival following spinal cord injury in Israel. Spinal Cord. 2002;40:595–8.

  10. 10.

    O’Connor PJ. Survival after spinal cord injury in Australia. Arch Phys Med Rehabil. 2005;86:37–47.

  11. 11.

    Royston P, Moons KG, Altman DG, Vergouwe Y. Prognosis and prognostic research: developing a prognostic model. BMJ. 2009;338:b604.

  12. 12.

    Nattino G, Lemeshow S, Phillips G, Finazzi S, Bertolini G. Assessing the calibration of dichotomous outcome models with the calibration belt. Stata J. 2017;17:1003–14.

  13. 13.

    Steyerberg E. Clinical prediction models: a practical approach to development, validation, and updating. New York, NY: Springer; 2009.

  14. 14.

    Zakrasek EC, Creasey G, Crew JD. Pressure ulcers in people with spinal cord injury in developing nations. Spinal Cord. 2015;53:7–13.

  15. 15.

    Hossain MS, Harvey LA, Liu H, Islam MS, Rahman MA, Muldoon S, et al. Protocol for process evaluation of CIVIC randomised controlled trial: Community based InterVentions to prevent serIous Complications following spinal cord injury in Bangladesh. BMJ Open. 2018;8:e24226.

  16. 16.

    Hossain MS, Harvey LA, Rahman MA, Muldoon S, Bowden JL, Islam MS. et al. Community-based InterVentions to prevent serIous Complications (CIVIC) following spinal cord injury in Bangladesh: protocol of a randomised controlled trial. BMJ Open 2016; 6: e010350. doi:010310.011136/bmjopen-012015-010350.

  17. 17.

    Michael M, Roth K. Against all odds: a qualitative study of rehabilitation of persons with spinal cord injury in Afghanistan. Spinal Cord. 2012;50:864–8.

  18. 18.

    Imai K, Kadowaki T, Aizawa Y. Standardized indices of mortality among persons with spinal cord injury: accelerated aging process. Ind Health. 2004;42:213–8.

  19. 19.

    Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87.

  20. 20.

    Rabanal KS, Meyer HE, Pylypchuk R, Mehta S, Selmer RM, Jackson RT. Performance of a Framingham cardiovascular risk model among Indians and Europeans in New Zealand and the role of body mass index and social deprivation. Open Heart. 2018;5:e000821.

  21. 21.

    Nattino G, Finazzi S, Bertolini G. A new test and graphical tool to assess the goodness of fit of logistic regression models. Stat Med. 2016;35:709–20.

Download references

Acknowledgements

We thank the staff and patients from the Centre for the Rehabilitation of the Paralysed who were involved in this study. We also thank the staff of the Community Based Rehabilitation/Social Welfare departments and the Medical Admission Unit for their diligent record keeping.

Author contributions

MSH conceived the research question, designed the study, collected the data, analysed the data, interpreted the data and wrote the manuscript. LAH and RDH conceived the research question, designed the study, analysed the data, interpreted the data and wrote the manuscript. MSI and MAR collected the data and contributed to the research question, the design of the study, the interpretation of the data and the write-up of the manuscript. JVG contributed to the research question, the interpretation of the data and the write-up of the manuscript.

Funding

This work was supported by Bridging Support Grants from The University of Sydney [171654 and 2013-00033].

Author information

Affiliations

  1. Centre for the Rehabilitation of the Paralysed, Savar, Bangladesh

    • Mohammad Sohrab Hossain
    • , Md. Shofiqul Islam
    •  & Md. Akhlasur Rahman
  2. John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, Sydney, NSW, Australia

    • Mohammad Sohrab Hossain
    • , Lisa A. Harvey
    •  & Joanne V. Glinsky
  3. Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia

    • Robert D. Herbert

Authors

  1. Search for Mohammad Sohrab Hossain in:

  2. Search for Lisa A. Harvey in:

  3. Search for Md. Shofiqul Islam in:

  4. Search for Md. Akhlasur Rahman in:

  5. Search for Joanne V. Glinsky in:

  6. Search for Robert D. Herbert in:

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of ethics

Ethical permission was received from the Centre for the Rehabilitation of the Paralysed Ethics Committee (approval number CRP-R&E-0401-218) prior to the commencement of the study. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers/animals were followed during the course of this research.

Corresponding author

Correspondence to Lisa A. Harvey.

About this article

Publication history

Received

Revised

Accepted

Published

Issue Date

DOI

https://doi.org/10.1038/s41393-018-0211-y