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Lau G, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Cameron P, Read DJ, Beck B. Association between acute pre-injury alcohol use and 12-month health outcomes for survivors of major trauma: A registry-based study. Injury 2024; 55:111782. [PMID: 39154490 DOI: 10.1016/j.injury.2024.111782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/03/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Alcohol is commonly detected in patients presenting to hospital after major trauma and is a key preventable risk factor for injury. While it has been suggested that alcohol intoxication at the time of injury results in worse acute patient outcomes, there is currently limited knowledge on the impact of alcohol on health outcomes following hospital discharge. The aim of this study was to examine the relationship between acute pre-injury alcohol exposure and the self-reported health outcomes of survivors of major trauma 12-months post-injury. METHODS Data from the Victorian State Trauma Registry (January 1, 2018 to December 31, 2020) were used to identify major trauma patients who: (1) were aged ≥18 years; (2) survived to 12-months post-injury; and (3) had blood alcohol data available in the registry. Logistic regression analyses were used to examine differences in self-reported health status (EQ-5D) and return to work at 12-months post-injury by blood alcohol concentration (BAC) at the time of presentation to hospital. Analyses were adjusted for potential confounders including a range of demographic, hospital and injury characteristics. RESULTS A total of 2957 patients met inclusion criteria, of which 857 (29.0 %) had a BAC >0 and 690 (23.3 %) had a BAC ≥0.05 g/100 mL. After adjusting for potential confounders, having any alcohol detected (i.e., BAC >0) was associated with lower odds of reporting problems on the EQ-5D mobility (aOR = 0.72, 95 %CI = 0.53 to 0.99) and usual activities dimensions (aOR = 0.79, 95 %CI = 0.63 to 0.99). Having a BAC ≥0.05 g/100 mL was only associated with lower adjusted odds of reporting problems on the usual activities dimension (aOR = 0.69, 95 %CI = 0.55 to 0.88) of the EQ-5D. Alcohol detection was not associated with the self-care, pain/discomfort or anxiety/depression dimensions of the EQ-5D, or with return to work in adjusted analyses. CONCLUSION Acute pre-injury alcohol exposure was not associated with increased reporting of problems on the EQ-5D or with return to work at 12-months post-injury. Further research is needed to understand why patients with alcohol detections were sometimes associated with paradoxically better 12-month post-injury outcomes relative to patients without alcohol detections.
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Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Paul M Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - David J Read
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Lau G, Ang JY, Kim N, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Beck B. Approaches and reporting of alcohol and other drug testing for injured patients in hospital-based studies: A systematic review. Drug Alcohol Rev 2024; 43:897-926. [PMID: 38316529 DOI: 10.1111/dar.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
ISSUE Hospital alcohol and/or other drug (AOD) testing is important for identifying AOD-related injuries; however, testing methods vary. This systematic review aimed to examine biological AOD testing methods from hospital-based studies of injured patients and quantify what proportion reported key information on those testing methods. APPROACH Observational studies published in English from 2010 onwards involving biological AOD testing for injured patients presenting to hospital were included. Studies examining single injury causes were excluded. Extracted data included concentration thresholds for AOD detection (e.g., lower limits of detection, author-defined cut-offs), test type (e.g., immunoassay, breathalyser) and approach (e.g., routine, clinical discretion), timing of testing, sample type and the proportion of injured cases tested for AODs. KEY FINDINGS Of 83 included studies, 76 measured alcohol and 37 other drugs. Forty-nine studies defined blood alcohol concentration thresholds (ranging from 0 to 0.1 g/100 mL). Seven studies defined concentration thresholds for other drugs. Testing approach was reported in 39/76 alcohol and 18/37 other drug studies. Sample type was commonly reported (alcohol: n = 69/76; other drugs: n = 28/37); alcohol was typically measured using blood (n = 60) and other drugs using urine (n = 20). Studies that reported the proportion of cases tested (alcohol: n = 53/76; other drugs: n = 28/37), reported that between 0% and 89% of cases were not tested for alcohol and 0% and 91% for other drugs. Timing of testing was often unreported (alcohol: n = 61; other drugs: n = 30). IMPLICATIONS AND CONCLUSION Variation in AOD testing methods alongside incomplete reporting of those methods limits data comparability and interpretation. Standardised reporting of testing methods will assist AOD-related injury surveillance and prevention.
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Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jia Y Ang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nayoung Kim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Paul M Dietze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Ugiliweneza B, Wang D, Rood B, Boakye M, Castillo C, Hetman M. Increased Incidence of Depression and Chronic Pain in Traumatic Spinal Cord Injury Patients With Pre-Injury Alcohol Use Disorder: Longitudinal Analysis of Insurance Claim Database. Neurotrauma Rep 2024; 5:28-36. [PMID: 38249325 PMCID: PMC10797174 DOI: 10.1089/neur.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Alcohol use disorder (AUD) increases risk of traumatic spinal cord injury (SCI) and is associated with depression, anxiety, and chronic pain. Given that these neuropsychiatric morbidities are frequently observed in SCI patients, the effects of pre-injury AUD on risk of depression, anxiety, or chronic pain were analyzed using an insurance claim database. Of 10,591 traumatic SCI patients, 507 had AUD-associated claims in a 12-month period before injury. Those AUD-positive SCI patients showed distinct demographic characteristics, including greater representation of men, younger age, more comorbidities, lower coverage by commercial insurance, and more cervical-level injuries. The AUD group also showed elevated pre-injury comorbidity of depression, anxiety, and chronic pain. However, multi-regression analysis revealed an increased odds ratio (OR) of de novo diagnosis of post-SCI depression in AUD patients 6 months (1.671; 95% confidence interval [CI]: 1.124, 2.483) and 1 year post-injury (1.511; 95% CI: 1.071, 2.131). The OR of de novo post-SCI anxiety was unaffected by pre-injury AUD. Finally, 1 year after SCI, pre-injury AUD increased the OR of de novo diagnosis of post-injury chronic pain (1.545; 95% CI: 1.223, 1.951). Thus, pre-injury AUD may be a risk factor for development of depression and chronic pain after traumatic SCI.
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Affiliation(s)
- Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Dengzhi Wang
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Benjamin Rood
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
- Graduate Program in Biochemistry and Molecular Genetics, University of Louisville, Louisville, Kentucky, USA
| | - Maxwell Boakye
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Camilo Castillo
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Michal Hetman
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky, USA
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, University of Louisville, Louisville, Kentucky, USA
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Glaser EP, Stewart AN, Jagielo-Miller JE, Bailey CS, Prendergast MA, Gensel JC. Effects of Acute Ethanol Intoxication on Spinal Cord Injury Outcomes in Female Mice. J Neurotrauma 2023; 40:2541-2551. [PMID: 37350129 PMCID: PMC10698778 DOI: 10.1089/neu.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Abstract Approximately one in three traumatic spinal cord injuries (SCIs) occurs during or shortly after the consumption of alcohol. A small number of retrospective clinical studies report variable effects of alcohol intoxication on mortality, neurological recovery, and complications after SCI. Some of these studies demonstrate a protective effect of alcohol intoxication on SCI outcomes, whereas others show an increased complication risk. Pre-clinical studies in rat, ferret, and feline SCI models report a detrimental effect of ethanol intoxication on hemorrhage, motor recovery, and biochemical markers of tissue injury. However, no studies to date have investigated the neuropathological consequences of ethanol intoxication at the time of SCI or the reciprocal effect of SCI on ethanol metabolism. Therefore, we combined a pre-clinical mouse model of acute ethanol intoxication and experimental vertebral level T9 contusion SCI to investigate their interactive effects in female mice. We first investigated the effect of SCI on ethanol metabolism and found that T9 SCI does not alter ethanol metabolism. However, we did find that isoflurane anesthesia significantly slowed ethanol metabolism independent of SCI. We also determined how acute ethanol intoxication at the time of SCI alters locomotor recovery and lesion pathology. Using the Basso Mouse Scale (BMS) and CatWalk XT Gait Analysis System, we assessed locomotor recovery for 6 weeks after injury and observed that acute ethanol intoxication at the time of injury did not alter locomotor recovery. We also found no effect of ethanol intoxication on heat hyperalgesia development. There was, however, a detrimental effect of ethanol on tissue sparing after SCI. Therefore, we conclude that acute alcohol intoxication at the time of injury may contribute to the neuropathological consequences of SCI.
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Affiliation(s)
- Ethan P. Glaser
- Department of Physiology, Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Andrew N. Stewart
- Department of Physiology, Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Julia E. Jagielo-Miller
- Department of Physiology, Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Caleb S. Bailey
- Department of Physiology, Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Mark A. Prendergast
- Department of Physiology, Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - John C. Gensel
- Department of Physiology, Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
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Ugiliweneza B, Boakye M, Ohri SS, Whittemore SR, Hetman M. Associations Between Diurnal Timing of Spinal Cord Injury and Its Etiology and Co-Morbidities. J Neurotrauma 2023; 40:1959-1969. [PMID: 36628481 PMCID: PMC10460688 DOI: 10.1089/neu.2022.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Circadian rhythms play a role in time-of-day differences in risk, presenting severity and outcomes of stroke. Injury time-of-day effects, however, on occurrence, presenting severity and acute hospital outcomes have not been yet reported in patients with neurotrauma. Therefore, acute post-spinal cord injury hospitalization records of 759 patients from the prospective NACTN registry that contained information about the time of injury were analyzed. No major demographic differences were observed between groups with time of injury between 6:00-12:00, 12:00-18:00, 18:00-24:00, or 0:00-6:00. Two etiological factors including falls or sports/recreation-related accidents showed significant effects of time of injury with peaks in the 6:00-12:00 or 18:00-24:00 groups, respectively. History of diabetes or drug abuse was also significantly related to injury timing peaking in 6:00-12:00 or 18:00-24:00 groups, respectively. ASIA score-determined presenting severity during the first week post-injury was not significantly affected by timing of injury. Pairwise comparisons, however, revealed worse motor but not sensory ASIA scores after injuries at 24:00-6:00 than any other group. These data suggest diurnal modulation of spinal cord injury risk because of specific mechanisms such as falls or sports-related accidents. Moreover, some co-morbidities may interact with those injury mechanisms as exemplified by the established risk elevation of falls in those with diabetes mellitus. Finally, while diurnal timing of the injury may modulate presenting severity, more patient records are needed to verify those effects.
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Affiliation(s)
- Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center and Departments of University of Louisville School of Medicine, Louisville, Kentucky, USA
- Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Department of Health Management and Systems Science, School of Public Health and Information Sciences, Louisville, Kentucky, USA
| | - Maxwell Boakye
- Kentucky Spinal Cord Injury Research Center and Departments of University of Louisville School of Medicine, Louisville, Kentucky, USA
- Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Sujata Saraswat Ohri
- Kentucky Spinal Cord Injury Research Center and Departments of University of Louisville School of Medicine, Louisville, Kentucky, USA
- Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Scott R. Whittemore
- Kentucky Spinal Cord Injury Research Center and Departments of University of Louisville School of Medicine, Louisville, Kentucky, USA
- Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Anatomical Sciences and Neurobiology, and University of Louisville School of Medicine, Louisville, Kentucky, USA
- Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Michal Hetman
- Kentucky Spinal Cord Injury Research Center and Departments of University of Louisville School of Medicine, Louisville, Kentucky, USA
- Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Anatomical Sciences and Neurobiology, and University of Louisville School of Medicine, Louisville, Kentucky, USA
- Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Ull C, Yilmaz E, Jansen O, Lotzien S, Schildhauer TA, Aach M, Königshausen M. Spinal Cord Injury With Tetraplegia in Young Persons After Diving Into Shallow Water: What Has Changed in the Past 10 to 15 Years? Global Spine J 2021; 11:1238-1247. [PMID: 32909818 PMCID: PMC8453686 DOI: 10.1177/2192568220944124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Retrospective, monocentric, observational study in a tertiary health care center. OBJECTIVES To analyze prehospital and clinical findings, complications, neurological improvement and follow-up in a young person cohort with spinal cord injury (SCI) and tetraplegia according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) A to D after diving into shallow water. METHODS Included were all persons younger than 50 years with SCI after head-first diving into shallow water between June 2001 and June 2019. All persons with SCI were divided into complete tetraplegia (AIS A) and incomplete tetraplegia (AIS B, C, and D) to test differences. RESULTS A total of 59 males (98.7%) and 1 female with a mean age of 27.7 years suffered an SCI. Alcohol use was documented in 25 cases (41.7%). At the time of admission, 33 people (55%) showed a complete tetraplegia (AIS A) and 27 showed an incomplete tetraplegia with 8 AIS B (13.3%), 15 AIS C (25%), and 4 AIS D (6.7%). At the time of discharge, people with initially complete tetraplegia showed a significant improvement from admission to discharge (P ≤ .004). Persons with incomplete tetraplegia were more likely to improve their neurological status compared with complete tetraplegia patients (P ≤ .001). Especially persons with complete tetraplegia suffered from typical SCI-related problems and complications. CONCLUSIONS People with SCI and tetraplegia at the time admission show neurological improvement in 50% of the cases with an overall better outcome in persons with incomplete tetraplegia. The surgical treatment of SCI within 24 hours seems to be associated with a better neurological outcome and a lower level of tetraplegia. The incidence of SCI caused by diving into shallow water remains stable without a significant change, especially in high-risk groups. More education and prevention programs are necessary to avoid these injuries.
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Affiliation(s)
- Christopher Ull
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany,Christopher Ull, Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
| | - Emre Yilmaz
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Oliver Jansen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Sebastian Lotzien
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Thomas A. Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Mirko Aach
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Matthias Königshausen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
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Volovetz J, Roach MJ, Stampas A, Nemunaitis G, Kelly ML. Blood Alcohol Concentration Is Associated With Improved AIS Motor Score After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 26:261-267. [PMID: 33536731 DOI: 10.46292/sci20-00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective To investigate the relationship between blood alcohol concentration (BAC) and neurologic recovery after traumatic spinal cord injury (TSCI) using standardized outcome measures from the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) examination. Method This is a retrospective review of merged, prospectively collected, multicenter data from the Spinal Cord Injury Model Systems Database and institutional trauma databases from five academic medical centers across the United States. Patients with SCI and a documented BAC were analyzed for American Spinal Injury Association Impairment Scale (AIS) motor score, FIM, sensory light touch score, and sensory proprioception score upon admission and discharge from rehabilitation. Linear regression was used for the analysis. Results The study identified 210 patients. Mean age at injury was 47 ± 20.5 years, 73% were male, 31% had an AIS grade A injury, 56% had ≥1 comorbidity, mean BAC was 0.42 ± 0.9 g/dL, and the mean Glasgow Coma Score upon arrival was 13.27 ± 4.0. ISNCSCI motor score gain positively correlated with higher BAC (4.80; confidence interval [CI], 2.39-7.22; p < .0001). FIM motor gain showed a trend toward correlation with higher BAC, although it did not reach statistical significance (3.27; CI, -0.07 to 6.61; p = .055). ISNCSCI sensory light touch score gain and sensory proprioception score gain showed no correlation with BAC (p = .44, p = .09, respectively). Conclusion The study showed a positive association between higher BAC and neurologic recovery in patients with SCI as measured by ISNCSCI motor score gain during rehabilitation. This finding has not been previously reported in the literature and warrants further study to better understand possible protective physiological mechanisms underlying the relationship between BAC and SCI.
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Affiliation(s)
| | - Mary Joan Roach
- Center for Healthcare Research and Policy, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Argyrios Stampas
- Department of Physical Medicine & Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas
| | - Gregory Nemunaitis
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio
| | - Michael L Kelly
- Department of Neurosurgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
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Mirzaeva L, Lobzin S, Tcinzerling N, Sarana A, Gilhus NE, Rekand T. Complications and mortality after acute traumatic spinal cord injury in Saint Petersburg, Russia. Spinal Cord 2020; 58:970-979. [PMID: 32286529 DOI: 10.1038/s41393-020-0458-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES We studied complications during early rehabilitation and their relation to length of stay (LOS) in the hospital as well as to survival in people with traumatic spinal cord injury (TSCI). SETTING All specialized hospitals of Saint Petersburg. METHODS We analysed all charts of patients admitted with acute TSCI to the city hospitals, 2012-2016. Patient characteristics, complications, time and cause of death, and LOS were recorded. Mean values with standard deviations and t-tests were used. We analysed mortality rate using the Kaplan-Meier method and calculated relative risks (RRs). RESULTS A total of 311 patients with TSCI were included. Complications occurred in 34% of patients; most were respiratory complications and pressure ulcers. Complications occurred more often in those with concomitant traumatic brain injury (TBI) (RR = 1.4, 95% CI: 1.2-1.8). All complications prolonged LOS (median, 11 days) and increased mortality in the acute phase (p < 0.001). In the early phase, 15% died, with a median time to death of 13 days. Respiratory complications markedly increased the death rate (RR = 18, 95% CI: 15-22). Mortality rate correlated also with age, TSCI severity and level, and concomitant TBI. Alcohol/drug consumption before TSCI increased the likelihood for complications (RR = 1.7, 95% CI: 1.3-2.1) and mortality (RR = 2.2, 95% CI: 1.6-3.1). CONCLUSION Focus on prevention as well as early and optimal treatment of complications, together with no or low alcohol/drug consumption may reduce mortality in the early phase after TSCI and at the same time shorten LOS.
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Affiliation(s)
- Liudmila Mirzaeva
- Department of Neurology, North-Western State Medical University, Saint Petersburg, Russia
| | - Sergey Lobzin
- Department of Neurology, North-Western State Medical University, Saint Petersburg, Russia
| | - Natalya Tcinzerling
- Department of Neurology, North-Western State Medical University, Saint Petersburg, Russia
| | - Andrey Sarana
- Health Care Committee, Saint Petersburg, Russia.,Saint Petersburg State University, Medical Faculty, Saint Petersburg, Russia
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Tiina Rekand
- Department of Neurology, Haukeland University Hospital, Bergen, Norway. .,Institute for Clinical Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Ahmed N, Greenberg P. Examining the influence of blood alcohol level on the incidence of pneumonia & sepsis complications following traumatic injury. Alcohol 2019; 76:111-115. [PMID: 30684834 DOI: 10.1016/j.alcohol.2018.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 07/15/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The purpose of this study was to examine the impact of blood alcohol concentration (BAC) on the occurrence of pneumonia and sepsis among traumatic injury victims. METHODS Retrospective study data were retrieved from the 2007-2010 National Trauma Data Bank and included all patients ≥14 years of age, with a "blunt" or "penetrating" injury, who were taken to a level 1 or level 2 trauma center, had complete systolic blood pressure and heart rate records, and had a confirmed blood alcohol test at the time of hospital arrival. Patients' characteristics and outcome information were compared between two groups (those with a BAC above the legal limit [>0.08 g/dL] and those with a negative BAC result), followed by propensity score matching and a follow-up paired analysis. RESULTS Of 279,460 patients, 92,960 tested positive for alcohol with a BAC above the legal limit. There were clear demographic differences between the groups (p < 0.001). Therefore, propensity score matching was performed to better balance the groups and the resulting standardized mean differences of less than 10% indicated successful matching. When comparing the occurrence of both pneumonia and sepsis between the matched pairs, there was a statistically significantly higher rate of pneumonia in the alcohol positive patients, 8.0% vs. 7.3%, (p = 0.03), but no significant clinical difference. Additionally, no significant difference was observed for the rate of sepsis across the groups (p = 0.62). CONCLUSION Patients who tested positive for alcohol following a traumatic injury showed a statistically higher incidence of pneumonia, but there was no clinically significant difference. Additionally, there was no significant difference identified in the incidence of sepsis between the BAC groups.
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Morrow KD, Podet AG, Spinelli CP, Lasseigne LM, Crutcher CL, Wilson JD, Tender GC, DiGiorgio AM. A case series of penetrating spinal trauma: comparisons to blunt trauma, surgical indications, and outcomes. Neurosurg Focus 2019; 46:E4. [DOI: 10.3171/2018.12.focus18577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/07/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEWhile blunt spinal trauma accounts for the majority of spine trauma, penetrating injuries affect a substantial number of patients. The goal of this study was to examine the epidemiology of penetrating spine injuries compared with blunt injuries and review the operative interventions and outcomes in the penetrating spine injury group.METHODSThe prospectively maintained trauma database was queried for spinal fractures from 2012 to 2018. Charts from patients with penetrating spine trauma were reviewed.RESULTSA total of 1130 patients were evaluated for traumatic spinal fractures; 154 injuries (13.6%) were secondary to penetrating injuries. Patients with penetrating injuries were significantly younger (29.2 years vs 44.1 years, p < 0.001), more likely male (87.7% vs 69.2%, p < 0.001), and more commonly African American (80.5% vs 33.3%, p < 0.05). When comparing primary insurers, the penetrating group had a significantly higher percentage of patients covered by Medicaid (60.4% vs 32.6%, p < 0.05) or prison (3.9% vs 0.1%, p < 0.05) or being uninsured (17.5% vs 10.3%, p < 0.05). The penetrating group had a higher Injury Severity Score on admission (20.2 vs 15.6, p < 0.001) and longer hospital length of stay (20.1 days vs 10.3 days, p < 0.001) and were less likely to be discharged home (51.3% vs 65.1%, p < 0.05). Of the penetrating injuries, 142 (92.2%) were due to firearms. Sixty-three patients (40.9%) with penetrating injuries had a concomitant spinal cord or cauda equina injury. Of those, 44 (69.8%) had an American Spinal Injury Association Impairment Scale (AIS) grade of A. Ten patients (15.9%) improved at least 1 AIS grade, while 2 patients (3.2%) declined at least 1 AIS grade. Nine patients with penetrating injuries underwent neurosurgical intervention: 5 for spinal instability, 4 for compressive lesions with declining neurological examination results, and 2 for infectious concerns, with some patients having multiple indications. Patients undergoing neurosurgical intervention did not show a significantly greater change in AIS grade than those who did not. No patient experienced a complication directly related to neurosurgical intervention.CONCLUSIONSPenetrating spinal trauma affects a younger, more publicly funded cohort than blunt spinal trauma. These patients utilize more healthcare resources and are more severely injured. Surgery is undertaken for limiting progression of neurological deficit, stabilization, or infection control.
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Affiliation(s)
| | | | - Casey P. Spinelli
- 2School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Agostinello J, Battistuzzo CR, Batchelor PE. Early clinical predictors of pneumonia in critically ill spinal cord injured individuals: a retrospective cohort study. Spinal Cord 2018; 57:41-48. [PMID: 30262877 DOI: 10.1038/s41393-018-0196-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/18/2018] [Accepted: 08/29/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES Pneumonia is the dominant complication following traumatic spinal cord injury (SCI) and profoundly impacts morbidity by prolonging length of stay and worsening neurological outcome. The aims of this study were to determine the key predictors of clinically important pneumonia (CIP); and to examine the impact of CIP on resource utilisation in critically ill acute traumatic SCI individuals between 2010 and 2015. SETTING Alfred and Austin Hospitals (Melbourne, Australia). METHODS Data were extracted from the medical records of 93 cases of acute traumatic SCI resulting in ISNCSCI C3-L1 level of injury requiring admission to the intensive care unit and aged between 15 and 70 years. Patients with life-threatening injuries, not requiring spinal surgery, palliated within 7 days of injury, diagnosis of traumatic central cord syndrome or with poor general health, were excluded. RESULTS A total of 33 episodes of CIP were observed. Median time to CIP diagnosis was 65 h (IQR: 42-93) and median time to spinal surgery was 22 h (IQR: 12-32). Four key predictors were identified; male gender (OR: 18.3, CI: 1.9-174.9, p = 0.001), motor complete injury (OR: 10.1, CI: 1.1-92.1, p = 0.011), presence of chest trauma (OR: 4.5, CI: 1.4-14.4, p = 0.007) and delayed intubation (HR: 6.8, CI: 1.6-28.6, p = 0.009). CONCLUSIONS This study identifies four key predictors involved in elevated pneumonia risk; male gender, motor complete injury, presence of chest trauma and delayed intubation, enabling the future synthesis of a pneumonia prediction tool for use in the acute postinjury period.
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Affiliation(s)
- Jacqui Agostinello
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Royal Parade, VIC, Australia.
| | - Camila R Battistuzzo
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Royal Parade, VIC, Australia
| | - Peter E Batchelor
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Royal Parade, VIC, Australia
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Hosokawa K, Su F, Taccone FS, Post EH, Creteur J, Vincent JL. Effects of acute ethanol intoxication in an ovine peritonitis model. BMC Anesthesiol 2018; 18:70. [PMID: 29921225 PMCID: PMC6009814 DOI: 10.1186/s12871-018-0537-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/30/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute ethanol intoxication has been shown to have contrasting effects on outcomes in sepsis. The aim of this study was to explore the effects of acute ethanol intoxication on hemodynamics, renal function, brain perfusion and lactate/pyruvate in an ovine sepsis model. METHODS Anesthetized, mechanically ventilated female sheep were randomized to an ethanol group (n = 7), which received 1 g/kg ethanol diluted in intravenous (i.v.) saline infusion or a control group (n = 7), which received the same volume of i.v. saline. Both groups received the treatment for a period of 2 h prior to induction of sepsis by intraperitoneal injection of feces. Other treatment included fluid resuscitation but no vasopressors or antibiotics. Global hemodynamics, renal blood flow, brain cortex laser Doppler flowmetry and microdialysis analyses were recorded hourly. RESULTS In the ethanol group, blood ethanol concentrations were 137 ± 29 mg/dL at the time of feces injection and decreased to become undetectable by 12 h. Arterial hypotension occurred earlier in the ethanol than in the control group (8 [7-12] vs. 14 [11-20] hours, p = 0.03). Lactate levels increased to > 2 mmol/L earlier in the ethanol group. Renal dysfunction (9 [6-13] vs. 13 [12-15] hours, p = 0.05) and oliguria (urine output < 0.5 mL/kg/h; 10 [7-12] vs. 13 [12, 13] hours, p = 0.01) developed earlier in the ethanol than in the control group. Brain blood flow and lactate/pyruvate were unaffected. There was no significant difference in survival time. CONCLUSIONS Acute ethanol intoxication in this model of peritonitis resulted in earlier development of shock and renal dysfunction but did not alter brain perfusion and metabolism or short-term survival.
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Affiliation(s)
- Koji Hosokawa
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Fuhong Su
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Emiel Hendrik Post
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey. J Trauma Acute Care Surg 2017; 83:1032-1040. [PMID: 28723840 DOI: 10.1097/ta.0000000000001650] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intoxication often prevents clinical clearance of the cervical spine (Csp) after trauma leading to prolonged immobilization even with a normal computed tomography (CT) scan. We evaluated the accuracy of CT at detecting clinically significant Csp injury, and surveyed participants on related opinions and practice. METHODS A prospective multicenter study (2013-2015) at 17 centers. All adult blunt trauma patients underwent structured clinical examination and imaging including a Csp CT, with follow-up thru discharge. alcohol- and drug-intoxicated patients (TOX+) were identified by serum and/or urine testing. Primary outcomes included the incidence and type of Csp injuries, the accuracy of CT scan, and the impact of TOX+ on the time to Csp clearance. A 36-item survey querying local protocols, practices, and opinions in the TOX+ population was administered. RESULTS Ten thousand one hundred ninety-one patients were prospectively enrolled and underwent CT Csp during the initial trauma evaluation. The majority were men (67%), had vehicular trauma or falls (83%), with mean age of 48 years, and mean Injury Severity Score (ISS) of 11. The overall incidence of Csp injury was 10.6%. TOX+ comprised 30% of the cohort (19% EtOH only, 6% drug only, and 5% both). TOX+ were significantly younger (41 years vs. 51 years; p < 0.01) but with similar mean Injury Severity Score (11) and Glasgow Coma Scale score (13). The TOX+ cohort had a lower incidence of Csp injury versus nonintoxicated (8.4% vs. 11.5%; p < 0.01). In the TOX+ group, CT had a sensitivity of 94%, specificity of 99.5%, and negative predictive value (NPV) of 99.5% for all Csp injuries. For clinically significant injuries, the NPV was 99.9%, and there were no unstable Csp injuries missed by CT (NPV, 100%). When CT Csp was negative, TOX+ led to longer immobilization versus sober patients (mean, 8 hours vs. 2 hours; p < 0.01), and prolonged immobilization (>12 hrs) in 25%. The survey showed marked variations in protocols, definitions, and Csp clearance practices among participating centers, although 100% indicated willingness to change practice based on these data. CONCLUSION For intoxicated patients undergoing Csp imaging, CT scan was highly accurate and reliable for identifying clinically significant spine injuries, and had a 100% NPV for identifying unstable injuries. CT-based clearance in TOX+ patients appears safe and may avoid unnecessary prolonged immobilization. There was wide disparity in practices, definitions, and opinions among the participating centers. LEVEL OF EVIDENCE Diagnostic tests or criteria, level II.
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Marion TE, Rivers CS, Kurban D, Cheng CL, Fallah N, Batke J, Dvorak MF, Fisher CG, Kwon BK, Noonan VK, Street JT. Previously Identified Common Post-Injury Adverse Events in Traumatic Spinal Cord Injury-Validation of Existing Literature and Relation to Selected Potentially Modifiable Comorbidities: A Prospective Canadian Cohort Study. J Neurotrauma 2017; 34:2883-2891. [PMID: 28562167 PMCID: PMC5653096 DOI: 10.1089/neu.2016.4933] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Adverse events (AEs) are common during care in patients with traumatic spinal cord injury (tSCI). Increased risk of AEs is linked to patient factors including pre-existing comorbidities. Our aim was to examine the relationships between patient factors and common post-injury AEs, and identify potentially modifiable comorbidities. Adults with tSCI admitted to a Level I acute specialized spine center between 2006 and 2014 who were enrolled in the Rick Hansen SCI Registry (RHSCIR) and had AE data collected using the Spine Adverse Events Severity system were included. Patient demographic, neurological injury, and comorbidities data were obtained from RHSCIR. Potentially modifiable comorbidities were grouped into health-related conditions, substance use/withdrawal, and psychiatric conditions. Negative binomial regression and multiple logistic regression were used to model the impact of patient factors on the number of AEs experienced and the occurrence of the five previously identified common AEs, respectively. Of the 444 patients included in the study, 24.8% reported a health-related condition, 15.3% had a substance use/withdrawal condition, 8% reported having a psychiatric condition; and 79.3% experienced one or more AEs. Older age (p = 0.004) and more severe injuries (p < 0.001) were nonmodifiable independent variables significantly associated with increased AEs. The AEs experienced by patients were urinary tract infections (42.8%), pneumonia (39.2%), neuropathic pain (31.5%), delirium (18.2%), and pressure ulcers (11.0%). Risk of delirium increased in those with substance use/withdrawal; and pneumonia risk increased with psychiatric comorbidities. Opportunity exists to develop clinical algorithms that include these types of risk factors to reduce the incidence and impact of AEs.
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Affiliation(s)
- Travis E Marion
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Carly S Rivers
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Dilnur Kurban
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | | | - Nader Fallah
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Juliet Batke
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Charles G Fisher
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Brian K Kwon
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | | | - John T Street
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
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Reslan S, Kalpakjian CZ, Hanks RA, Millis SR, Bombardier CH. Rasch analysis of alcohol abuse and dependence diagnostic criteria in persons with spinal cord injury. Spinal Cord 2017; 55:497-501. [PMID: 28244502 DOI: 10.1038/sc.2016.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVE The objective of the study is to examine whether alcohol use disorders should be conceptualized categorically as abuse and dependence as in the 'Diagnostic and Statistical Manual of Mental Disorders' 4th edition or on a single continuum with mild to severe category ratings as in the 'Diagnostic and Statistical Manual of Mental Disorders' 5th edition in people with spinal cord injury (SCI). SETTING United States of America. METHODS Data from 379 individuals who sustained SCI either traumatically or non-traumatically after the age of 18 and were at least 1 year post injury. Rasch analyses used the alcohol abuse and dependence modules of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Non-patient Edition (SCID-I/NP). RESULTS Fifty-seven percent (n=166) of the entire sample endorsed criteria for alcohol abuse, and 25% (n=65) endorsed criteria for alcohol dependence. Fit values were generally acceptable except for one item (for example, alcohol abuse criterion 2), suggesting that the items fit the expectation of unidimensionality. Examination of the principal components analysis did not provide support for unidimensionality. The item-person map illustrates poor targeting of items. CONCLUSIONS Alcohol abuse and dependence criterion appear to reflect a unidimensional construct, a finding that supports a single latent construct or factor consistent with the DSM-5 diagnostic model.
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Affiliation(s)
- S Reslan
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit Medical Center, Detroit, MI, USA
| | - C Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan School of Michigan, Ann Arbor, MI, USA
| | - R A Hanks
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit Medical Center, Detroit, MI, USA.,Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - S R Millis
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - C H Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Pinto SM, Galang G. Concurrent SCI and TBI: Epidemiology, Shared Pathophysiology, Assessment, and Prognostication. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0109-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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