In-Hospital Mortality Rate in Subaxial Cervical Spinal Cord Injury Patients: A Systematic Review and Meta-Analysis Publisher Pubmed



Sadeghinaini M¹ ; Yousefifard M² ; Ghodsi Z³ ; Azarhomayoun A^{3, 4} ; Kermanian F⁵ ; Golpayegani M³ ; Alizadeh SD^{3, 6} ; Hosseini M⁷ ; Shokraneh F⁸ ; Komlakh K⁹ ; Vaccaro AR¹⁰ ; Jiang F¹¹ ; Fehlings MG^{12, 13} ; Rahimimovaghar V^{3, 14, 15, 16, 17, 18, 19} Show Affiliations
Source: Acta Neurochirurgica Published:2023

Abstract

Purpose: To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades. Methods: We searched MEDLINE and EMBASE to assess the role of the following factors on in-hospital mortality over the last four decades: neurological deficit, age, surgical decompression, use of computed tomography (CT) and magnetic resonance imaging (MRI), use of methylprednisolone in the acute post-injury period, and study location (developing versus developed countries). Results: Among 3333 papers after deduplication, 21 studies met the eligibility criteria. The mortality rate was 17.88% [95% confidence interval (CI): 12.9–22.87%]. No significant trend in mortality rate was observed over the 42-year period (meta-regression coefficient = 0.317; p = 0.372). Subgroup analysis revealed no significant association between acute subaxial cervical SCI–related mortality when stratified by use of surgery, administration of methylprednisolone, use of MRI and CT imaging, study design (prospective versus retrospective study), and study location. The mortality rate was significantly higher in complete SCI (20.66%, p = 0.002) and American Spinal Injury Association impairment scale (AIS) A (20.57%) and B (9.28%) (p = 0.028). Conclusion: A very low level of evidence showed that in-hospital mortality in patients with traumatic subaxial cervical SCI did not decrease over the last four decades despite diagnostic and therapeutic advancements. The overall acute mortality rate following subaxial cervical SCI is 17.88%. We recommend reporting a stratified mortality rate according to key factors such as treatment paradigms, age, and severity of injury in future studies. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.