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