Optimizing Clinical Decision Making in Acute Traumatic Spinal Cord Injury

Does lack of brain injury mean lack of cognitive impairment in traumatic spinal cord injury?

OBJECTIVE

Traumatic spinal cord injury (tSCI) has implications in many areas, including cognitive functioning. Findings regarding cognitive problems in people with SCI are inconsistent, presumably due to multiple variables than can affect performance, among them emotional variables. The purpose of the current study was to elucidate cognitive sequalae in some individuals with tSCI with no medical record of brain injury, while taking emotional variables into consideration.

DESIGN

Cross-sectional, with two groups.

SETTING

A public rehabilitation center.

PARTICIPANTS

Twenty participants with tSCI at least ten months post injury and twenty non-SCI controls, matched for sex, age, and education.

INTERVENTION

None.

OUTCOME MEASURES

A battery of neuropsychological tests tapping executive functions, memory, attention, and naming abilities, in addition to questionnaires assessing depression and distress.

RESULTS

When emotional variables were statistically controlled, participants with tSCI showed higher levels of depression and distress and scored lower than non-SCI control participants on all cognitive tests except naming. Executive functions were found to have the highest effect size, though no specific ability was sensitive enough to differentiate between the groups in a binary logistic regression analysis.

CONCLUSION

In some individuals with chronic tSCI, lower cognitive ability that is unrelated to emotional distress might result from spinal cord damage and its implications in a population who's medical records show no indication of brain injury. This highlights the importance of conducting cognitive evaluation following SCI, so that deficits can be effectively addressed during rehabilitation.

The Effects of Repeated Administration of the Micellar Complex of Methylprednisolone on the Locomotor Activity of a Terrestrial Snails

We studied the effects of repeated injections of methylprednisolone and its micellar complex with block-copolymer on locomotor activity of a terrestrial snail. It was shown that methylprednisolone solution injected into the hemolymph of the animal produced a direct effect on the muscle system of the animal as soon as 1 h after administration: it slowed down snail locomotion and reduced contractile activity of the foot muscles. The micellar complex of methylprednisolone with block-copolymer prevented this effect during the first 2 days of injection and negatively affected locomotion only in 2 days after injection, the decrease in locomotion in this case was not accompanied by a decrease in contractile activity of the foot muscle.

Regionalization of Spine Trauma Care in an Urban Trauma System in the United States: Decreased Time to Surgery and Hospital Length of Stay

BACKGROUND

The effect of regionalized trauma care (RT) on hospital-based outcomes for traumatic spine injury (TSI) in the United States is unknown.

OBJECTIVE

To test the hypothesis that RT would be associated with earlier time to surgery and decreased length of stay (LOS).

METHODS

TSI patients >14 yr were identified using International Classification of Diseases Ninth Revision Clinical Modification diagnostic codes. Data from 2008 through 2012 were analyzed before and after RT in 2010.

RESULTS

A total of 4072 patients were identified; 1904 (47%) pre-RT and 2168 (53%) post-RT. Injury severity scores, Spine Abbreviated Injury Scale scores, and the percentage of TSIs with spinal cord injury (tSCI) were similar between time periods. Post-RT TSIs demonstrated a lower median intensive care unit (ICU) LOS (0 vs 1 d; P < 0.0001), underwent spine surgery more frequently (13% vs 11%; P = 0.01), and had a higher rate of spine surgery performed within 24 h of admission (65% vs 55%; P = 0.02). In patients with tSCI post-RT, ICU LOS was decreased (1 vs 2 d; P < 0.0001) and ventilator days were reduced (average days: 2 vs 3; P = 0.006). The post-RT time period was an independent predictor for spine surgery performed in less than 24 h for all TSIs (odds ratio [OR] 1.52, 95% confidence interval [CI]: 1.04-2.22, C-stat = 0.65). Multivariate linear regression analysis demonstrated an independent effect on reduced ICU LOS post-RT for TSIs (OR -1.68; 95% CI: -2.98 to 0.39; R2 = 0.74) and tSCIs (OR -2.42, 95% CI: -3.99-0.85; R2 = 0.72).

CONCLUSION

RT is associated with increased surgical rates, earlier time to surgery, and decreased ICU LOS for patients with TSI.

Translating promising strategies for bowel and bladder management in spinal cord injury

Loss of control over voiding following spinal cord injury (SCI) impacts autonomy, participation and dignity, and can cause life-threatening complications. The importance of SCI bowel and bladder dysfunction warrants significantly more attention from researchers in the field. To address this gap, key SCI clinicians, researchers, government and private funding organizations met to share knowledge and examine emerging approaches. This report reviews recommendations from this effort to identify and prioritize near-term treatment, investigational and translational approaches to addressing the pressing needs of people with SCI.

Spinal Cord Injury Clinical Registries: Improving Care across the SCI Care Continuum by Identifying Knowledge Gaps

Timely access and ongoing delivery of care and therapeutic interventions is needed to maximize recovery and function after traumatic spinal cord injury (tSCI). To ensure these decisions are evidence-based, access to consistent, reliable, and valid sources of clinical data is required. The Access to Care and Timing Model used data from the Rick Hansen SCI Registry (RHSCIR) to generate a simulation of healthcare delivery for persons after tSCI and to test scenarios aimed at improving outcomes and reducing the economic burden of SCI. Through model development, we identified knowledge gaps and challenges in the literature and current health outcomes data collection throughout the continuum of SCI care. The objectives of this article were to describe these gaps and to provide recommendations for bridging them. Accurate information on injury severity after tSCI was hindered by difficulties in conducting neurological assessments and classifications of SCI (e.g., timing), variations in reporting, and the lack of a validated SCI-specific measure of associated injuries. There was also limited availability of reliable data on patient factors such as multi-morbidity and patient-reported measures. Knowledge gaps related to structures (e.g., protocols) and processes (e.g., costs) at each phase of care have prevented comprehensive evaluation of system performance. Addressing these knowledge gaps will enhance comparative and cost-effectiveness evaluations to inform decision-making and standards of care. Recommendations to do so were: standardize data element collection and facilitate database linkages, validate and adopt more outcome measures for SCI, and increase opportunities for collaborations with stakeholders from diverse backgrounds.