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

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.