Predictors of clinical complications in patients with spinomedullary injury

Translation and validation into Portuguese of the international spinal cord injury pulmonary function basic data set

INTRODUCTION

Spinal cord injury (SCI) is a serious disabling syndrome, and the clinical picture depends on the level and extent of the injury. The International Spinal Cord Society (ISCoS) and the American Spinal Cord Association (ASIA) have developed instruments (Data Sets) to assess the various aspects of the SCI. In 2012, the International SCI Pulmonary Function Basic Data Set was elaborated. It is composed of four questions and spirometry for the collection of lung function basic data.

OBJECTIVE

The objective was to translate and validate the International SCI Pulmonary Function Basic Data Set to the Portuguese language.

METHODS

The entire methodology followed the recommendations of the ISCoS and ASIA. Two translations of the original version into Portuguese were performed, and after consensus among the translators, the Portuguese version was sent for back-translation. After back-translation and comparison with the original version, the final Portuguese version was obtained. For the second phase of the study, 30 SCI individuals were selected. Two interviewers applied the questionnaire in two distinct moments.

RESULTS

All results presented constant, excellent, or perfectly concordant data, except for the third question in the inter-rater comparison, where the Kappa coefficient showed value reasonable in the first interview and good in the second.

CONCLUSION

The translation into Brazilian Portuguese of the "International SCI Pulmonary Function Basic Data Set" created a valid and highly reliable instrument, like the original without linguistic and cultural disagreements that allow its use in the evaluation of patients with SCI in Brazil.

Spinal cord injury in elderly patients admitted to a tertiary hospital

BACKGROUND

Spinal cord injury (SCI) has a negative impact on quality of life and healthcare costs. In recent years with the age pyramid inversion, there has been a high prevalence of SCI in the elderly. These patients must be studied in order to invest in the prevention and treatment of SCI in these patients.

OBJECTIVE

To identify the characteristics and clinical aspects of spinal cord injury (SCI) in the elderly.

METHODS

Retrospective study of elderly patients (≥ 60 years of age) with a clinical diagnosis of SCI. Clinical and socio-demographic variables were collected from medical records.

RESULTS

Sixty-two elderly patients were studied (56% men). The patients were analyzed according to gender. Women presented compression fractures associated with thoracolumbar transition, while men presented with listhesis associated with cervical lesions and increased complications. It was found that the need for surgical intervention was higher in men. Among many characteristics that differed between the elderly and younger people (< 60 years; n = 259), in the morphological diagnosis, we observed that compression fractures and dislocation fractures were more highly associated with ages ≥ 60 and < 60, respectively. After SCI, the elderly have a higher risk for late hemodynamic instability.

CONCLUSION

Elderly individuals with SCI have distinct characteristics and clinical factors related to gender and age.

Characteristics and clinical aspects of patients with spinal cord injury undergoing surgery

Objective

To identify the characteristics of patients with spinal cord injury (SCI) undergoing surgery.

Methods

Previously, 321 patients with SCI were selected. Clinical and socio-demographic variables were collected.

Results

A total of 211 patients were submitted to surgery. Fall and injuries in the upper cervical and lumbosacral regions were associated with conservative treatment. Patients with lesions in the lower cervical spine, worse neurological status, and unstable injuries were associated with surgery. Individuals undergoing surgery were associated with complications after treatment. The authors assessed whether age influenced the characteristics of patients submitted to surgery. Subjects with <60 years of age were associated with motorcycle accidents and the morphologies of injury were fracture-dislocation. Elderly individuals were associated to fall, SCI in the lower cervical spine and the morphology of injury was listhesis. Subsequently, the authors analyzed the gender characteristics in these patients. Women who suffered car accidents were associated to surgery. Women were associated with paraparesis and the morphologic diagnosis was fracture-explosion, especially in the thoracolumbar transition and lumbosacral regions. Men who presented traumatic brain injury and thoracic trauma were related to surgery. These individuals had a worse neurological status and were associated to complications. Men and the cervical region were most affected, thereby, these subjects were analyzed separately (n = 92). The presence of complications increased the length of hospital stay. The simultaneous presence of morphological diagnosis, worst neurological status, tetraplegia, sensory, and motor alterations were associated with complications. Pneumonia and chest trauma were associated with mortality.

Conclusion

These factors enable investments in prevention, rehabilitation, and treatment.