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Paraplegia : mortality and specialized follow-up care

Online since 23.07.2020
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Patients with spinal cord injuries who interupt their specialized follow-up care see a drop in life expectancy.

The SwiSCI study centre (Swiss research in paraplegia) of which the Clinique romande de réadaptation (CRR) actively participates recently published a report which proves that the interuption of on-going specialized care has an important impact of the mortality rate of spinal cord injury victims. 

A rate of mortality nearly 4 times higher

The study analized, in a retrospective manner, data collected via the epidemiolgical  platform of SwiSCI from the four Swiss paraplegia centres. The vital status  (VS) was obtained either directly by consulting medical files or by contacting the local authorities of the last known residence, in a considerably large secondary tracing effort. A refined statistical model was made possible to identify the risk factors leading to the interruption of specialialized monitoring, as well as the resulting mortality risks. Out of the 1924 files analyzed, 1608 were able to be tracked down, the vital status of 704 subjects were able to be identified via their medical files, and 804 out of the remaining 904 (nearly 90%) by the local authority concerned. Two conclusions can be drawn from this study: 

 1. The risk of death following spinal cord trauma (TSCI) is nearly 4 times more frequent with patients who have stopped all specialized follow-up care. 

 2. One of the major risk factors leading to the interruption of specialized follow-up care in patients suffering from non-traumatic spinal cord injuries (NTSCI) is the distance from home to the closest specialized centre at over 30 minutes (risk increased by 1,5 times). 

 These two major conclusions highlight the importance of specialized follow-up care offered by the centres for paraplegia (the CRR is the only one in the French speaking part of Switzerland dedicated to this pathology) as well as the important role played by local follow-up care, as close as possible to home, in order to avoid as many specialized follow-up care interruptions as possible, with the consequences that these can have on the death rate of these patients. The choice of receiving medical follow-up care is free, but if this reality puts patients' health at risk, efforts must be made to avoid this. Now we need to analyse this discovery further to better understand and anticipate the mechanisms leading to an interruption in specialized follow-up care. 

Link to the complete report (only in English) : https://bmjopen.bmj.com/content/10/7/e035752.long

SwiSCI what is it? 

SwiSCI : Swiss Spinal Cord Injury Cohort Study is the largest study carried out on Swiss spinal cord injury patients. SwiSCI cooperates with the four paraplegia centres in Switzerland  (The Swiss paraplegia centres in Nottwil, REHAB in Bâle, Clinique universitaire Balgrist in Zurich and the CRR in Sion), various Swiss institutions and their departments dedicated to spinal cord injuries. Thanks to strong collaboration between international experts and scientists, the SwiSCI has become one of the main European studies concerning spinal cord injuries. For further information https://www.swisci.ch/fr/voila-swisci/l-etude 

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