Assessing Morbidity and Mortality in Adult Patients With Acute Traumatic Cervical Spinal Cord Injury Using a Modified Risk Analysis Index.

Objective: The Risk Analysis Index (RAI) is a comprehensive assessment of frailty for predicting neurosurgical outcomes. The aim of this study was to assess whether frailty, measured by a modified RAI (mRAI), was an independent predictor of adverse events (AEs), nonroutine discharge (NRD), and in-hospital mortality for patients with acute cervical spinal cord injuries (SCIs).

Methods: A retrospective cohort study was performed using the American College of Surgeons Trauma Quality Programs database. Adult patients with acute cervical SCI from 2016 to 2022 were stratified by mRAI score into 3 groups: Robust (mRAI 0-10), Frail (mRAI 11-20), and Very Frail (mRAI ≥21). Patient demographics, comorbidities, injury type, diagnostic and treatment modality, AEs, and in-hospital mortality were assessed. A multivariate logistic regression analysis was used to identify independent predictors of AEs, NRD, and in-hospital mortality.

Results: 71 048 patients were stratified by mRAI score: 59 796 Robust (84.2%), 9558 Frail (13.5%), and 1694 Very Frail (2.4%). The proportion of SCIs secondary to a fall (Robust: 44.1% vs Frail: 70.2% vs Very Frail: 82.3%; P < .001) and AEs (Robust: 21.5% vs Frail: 24.4% vs Very Frail: 25.0%; P < .001) significantly increased with frailty. Very Frail patients experienced higher NRDs (Robust: 72.3% vs Frail: 85.2% vs Very Frail: 91.0%; P < .001) and in-hospital mortality (Robust: 10.9% vs Frail: 18.3% vs Very Frail: 29.2%; P < .001). On multivariate regression analysis, both Frail (odds ratio [OR]: 1.42; 95% CI: 1.25-1.61; P < .001) and Very Frail (OR: 2.09; 95% CI: 1.46-2.99; P < .001) mRAI scores predicted NRD, but only Frail mRAI score (OR: 1.12; 95% CI: 1.05-1.21; P = .001) was significantly associated with AEs. In addition, Frail (OR: 1.50; 95% CI: 1.36-1.65; P < .001) and Very Frail (OR: 2.79; 95% CI: 2.36-3.29; P < .001) mRAI scores were independent predictors of in-hospital mortality.

Conclusions: Our study suggests that mRAI may be used to assess morbidity and mortality in patients presenting with spinal cord injury.