Abstract：
To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades.
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).
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).
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.
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).
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).
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.
摘要：
目的：确定过去40年中外伤性轴下颈脊髓损伤（SCI）患者院内死亡率的现有趋势。
方法：我们搜索了MEDLINE和EMBASE，以评估以下因素在过去四十年中对住院死亡率的作用：神经功能缺损，年龄,手术减压,使用计算机断层扫描（CT）和磁共振成像（MRI），在急性损伤后使用甲基强的松龙，和研究地点(发展中国家与发达国家)。
结果：在重复删除后的3333篇论文中，21项研究符合资格标准。死亡率为17.88%[95%置信区间(CI):12.9-22.87%]。在42年期间，没有观察到死亡率的显着趋势（meta回归系数=0.317；p=0.372）。亚组分析显示，当使用手术进行分层时，急性下轴颈SCI相关死亡率之间没有显着关联。甲基强的松龙的给药，使用MRI和CT成像，研究设计（前瞻性研究与回顾性研究），和研究地点。完全SCI的死亡率明显较高（20.66%，p=0.002）和美国脊髓损伤协会损害量表（AIS）A（20.57％）和B（9.28％）（p=0.028）。
结论：极低水平的证据表明，尽管诊断和治疗取得了进步，但创伤性颈椎下脊髓损伤患者的住院死亡率在过去四十年中并未下降。颈下SCI后的总急性死亡率为17.88％。我们建议根据关键因素报告分层死亡率，如治疗模式，年龄,以及未来研究中损伤的严重程度。
方法：我们搜索了MEDLINE和EMBASE，以评估以下因素在过去四十年中对住院死亡率的作用：神经功能缺损，年龄,手术减压,使用计算机断层扫描（CT）和磁共振成像（MRI），在急性损伤后使用甲基强的松龙，和研究地点(发展中国家与发达国家)。
结果：在重复删除后的3333篇论文中，21项研究符合资格标准。死亡率为17.88%[95%置信区间(CI):12.9-22.87%]。在42年期间，没有观察到死亡率的显着趋势（meta回归系数=0.317；p=0.372）。亚组分析显示，当使用手术进行分层时，急性下轴颈SCI相关死亡率之间没有显着关联。甲基强的松龙的给药，使用MRI和CT成像，研究设计（前瞻性研究与回顾性研究），和研究地点。完全SCI的死亡率明显较高（20.66%，p=0.002）和美国脊髓损伤协会损害量表（AIS）A（20.57％）和B（9.28％）（p=0.028）。
结论：极低水平的证据表明，尽管诊断和治疗取得了进步，但创伤性颈椎下脊髓损伤患者的住院死亡率在过去四十年中并未下降。颈下SCI后的总急性死亡率为17.88％。我们建议根据关键因素报告分层死亡率，如治疗模式，年龄,以及未来研究中损伤的严重程度。
