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Mueller G, Berlowitz DJ, Raab AM, Postma K, Gobets D, Huber B, Hund-Georgiadis M, Jordan X, Schubert M, Wildburger R, Brinkhof MWG. Incidence and Risk Factors of Pneumonia in Individuals With Acute Spinal Cord Injury: A Multi-national, Multi-center, Prospective Cohort Study. Arch Phys Med Rehabil 2024; 105:884-891. [PMID: 38032554 DOI: 10.1016/j.apmr.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To describe the occurrence of pneumonia in individuals with acute spinal cord injury (SCI) and identify its key predictors. DESIGN Multi-centric, longitudinal cohort study. SETTING 10 specialized SCI rehabilitation units in Europe and Australia. PARTICIPANTS Eligible were 902 men and women with acute SCI, aged 18 years or older, with cervical or thoracic lesions and not dependent on 24-hour mechanical ventilation; 503 participated in the study (N=503). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We assessed demographics and lesion related parameters at study entry, and any pneumonia events throughout inpatient rehabilitation. Respiratory function, decubitus, and urinary tract infections were assessed at 1, 3, and 6 months post injury as well as at discharge from inpatient rehabilitation. Time to event (pneumonia) analyses were done using the Kaplan-Meier method, and potential predictors for pneumonia were analyzed with multivariable survival models. RESULTS Five hundred three patients with SCI were included, with 70 experiencing at least 1 pneumonia event. 11 participants experienced 2 or more events during inpatient rehabilitation. Most events occurred very early after injury, with a median of 6 days. Pneumonia risk was associated with tetraplegia (hazard ratio [HR]=1.78; 95% confidence interval [CI] 1.00-3.17) and traumatic etiology (HR=3.75; 95% CI 1.30-10.8) American Spinal Injury Impairment Scale (AIS) A (HR=5.30; 95% CI 2.28-12.31), B (HR=4.38; 95% CI 1.77-10.83), or C (HR=4.09; 95% CI 1.71-9.81) lesions. For every 10 cmH2O increase in inspiratory muscle strength, pneumonia risk was reduced by 13% (HR=0.87; 95% CI 0.78-0.97). CONCLUSION Pneumonia is a major complication after SCI with the highest incidence very early after injury. Individuals with traumatic or AIS A, B, or C tetraplegia are at highest risk for pneumonia.
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Affiliation(s)
- Gabi Mueller
- Swiss Paraplegic Research, Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - David J Berlowitz
- Institute for Breathing and Sleep and the University of Melbourne, Austin Health, Melbourne, Australia
| | - Anja M Raab
- School of Health Professions of Bern University of Applied Sciences, Switzerland
| | - Karin Postma
- Rijndam Rehabilitation, Rotterdam, The Netherlands; Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David Gobets
- Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | | | | | | | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | | | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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2
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Kelly-Hedrik M, Abd-El-Barr MM, Aarabi B, Curt A, Howley SP, Harrop JS, Kirshblum S, Neal CJ, Noonan V, Park C, Ugiliweneza B, Tator C, Toups EG, Fehlings MG, Williamson T, Guest JD. Importance of Prospective Registries and Clinical Research Networks in the Evolution of Spinal Cord Injury Care. J Neurotrauma 2023; 40:1834-1848. [PMID: 36576020 DOI: 10.1089/neu.2022.0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Only 100 years ago, traumatic spinal cord injury (SCI) was commonly lethal. Today, most people who sustain SCI survive with continual efforts to improve their quality of life and neurological outcomes. SCI epidemiology is changing as preventative interventions reduce injuries in younger individuals, and there is an increased incidence of incomplete injuries in aging populations. Early treatment has become more intensive with decompressive surgery and proactive interventions to improve spinal cord perfusion. Accurate data, including specialized outcome measures, are crucial to understanding the impact of epidemiological and treatment trends. Dedicated SCI clinical research and data networks and registries have been established in the United States, Canada, Europe, and several other countries. We review four registry networks: the North American Clinical Trials Network (NACTN) SCI Registry, the National Spinal Cord Injury Model Systems (SCIMS) Database, the Rick Hansen SCI Registry (RHSCIR), and the European Multi-Center Study about Spinal Cord Injury (EMSCI). We compare the registries' focuses, data platforms, advanced analytics use, and impacts. We also describe how registries' data can be combined with electronic health records (EHRs) or shared using federated analysis to protect registrants' identities. These registries have identified changes in epidemiology, recovery patterns, complication incidence, and the impact of practice changes such as early decompression. They've also revealed latent disease-modifying factors, helped develop clinical trial stratification models, and served as matched control groups in clinical trials. Advancing SCI clinical science for personalized medicine requires advanced analytical techniques, including machine learning, counterfactual analysis, and the creation of digital twins. Registries and other data sources help drive innovation in SCI clinical science.
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Affiliation(s)
| | | | - Bizhan Aarabi
- University of Maryland School of Medicine, Maryland, USA
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Susan P Howley
- Christopher & Dana Reeve Foundation, Short Hills, New Jersey, USA
| | - James S Harrop
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Steven Kirshblum
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - Christopher J Neal
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Vanessa Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Christine Park
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Charles Tator
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth G Toups
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James D Guest
- Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami, Miami, USA
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3
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Toups EG, Ugiliweneza B, Howley SP, Neal CJ, Harrop JS, Guest JD, Grossman RG, Fehlings MG. North American Clinical Trials Network for Spinal Cord Injury Registry: Methodology and Analysis. J Neurotrauma 2023; 40:1817-1822. [PMID: 37125443 DOI: 10.1089/neu.2022.0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
The North American Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of neurosurgery departments at university affiliated hospitals with medical, nursing, and rehabilitation personnel who are skilled in the assessment, evaluation, and management of SCI. NACTN was established with the goal of consistently advancing the quality of life of people with SCI through clinical trials of new therapies that provide robust evidence of safety and effectiveness. A prospective multi-center Registry was created to collect the natural course of the acute traumatic SCI patient from time of injury to 12 months follow-up. NACTN's network of hospitals enrolls a significant number of patients, defines and adheres to standard protocols, and provides the infrastructure and highly skilled personnel to conduct trials of therapy for SCI. Registry data have been used by academic institutions and by the biotechnology and pharmaceutical sectors to create comparison datasets for Phase I clinical trials of new therapies.
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Affiliation(s)
- Elizabeth G Toups
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Susan P Howley
- Christopher & Dana Reeve Foundation, Short Hills, New Jersey, USA
| | - Chris J Neal
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - James S Harrop
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - James D Guest
- The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Robert G Grossman
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Canada
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4
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Ushirozako H, Suda K, Harmon SM, Komatsu M, Ota M, Shimizu T, Minami A, Takahata M, Iwasaki N, Matsuyama Y. Complications Associated with Preventive Management to Reduce the Risk of COVID-19 Spread After Surgery for Spinal Cord Injury. J Bone Joint Surg Am 2023; Publish Ahead of Print:00004623-990000000-00811. [PMID: 37216434 DOI: 10.2106/jbjs.22.00785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Preventive management to reduce the risk of coronavirus disease-2019 (COVID-19) spread led to delays in active rehabilitation, which may have negatively impacted the outcomes of patients with traumatic spinal cord injury (SCI). Therefore, the aim of this study was to clarify the influence of preventive management on the rate of perioperative complications after surgical treatment for SCI. METHODS This single-center retrospective study examined the cases of 175 patients who had SCI surgery between 2017 and 2021. We could not continue early rehabilitation interventions starting on April 30, 2020, because of our preventive management to reduce the risk of COVID-19 spread. Using a propensity score-matched model, we adjusted for age, sex, American Spinal Injury Association impairment scale score at admission, and risk factors for perioperative complications described in previous studies. Perioperative complication rates were compared between the COVID-19 pandemic and prepandemic groups. RESULTS Of the 175 patients, 48 (the pandemic group) received preventive management. The preliminary analysis revealed significant differences between the unmatched pandemic and prepandemic groups with respect to age (75.0 versus 71.2 years, respectively; p = 0.024) and intraoperative estimated blood loss (152 versus 227 mL; p = 0.013). The pandemic group showed significant delays in visiting the rehabilitation room compared with the prepandemic group (10 versus 4 days from hospital admission; p < 0.001). There were significant differences between the pandemic and prepandemic groups with respect to the rates of pneumonia (31% versus 16%; p = 0.022), cardiopulmonary dysfunction (38% versus 18%; p = 0.007), and delirium (33% versus 13%; p = 0.003). With a propensity score-matched analysis (C-statistic = 0.90), 30 patients in the pandemic group and 60 patients in the prepandemic group were automatically selected. There were significant differences between the matched pandemic and prepandemic groups with respect to the rates of cardiopulmonary dysfunction (47% versus 23%; p = 0.024) and deep venous thrombosis (60% versus 35%; p = 0.028). CONCLUSIONS Even with early surgical intervention, late mobilization and delays in active rehabilitation during the COVID-19 pandemic increased perioperative complications after SCI surgery. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hiroki Ushirozako
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kota Suda
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Satoko Matsumoto Harmon
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Miki Komatsu
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Masahiro Ota
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Tomoaki Shimizu
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Akio Minami
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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5
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Respiratory Complications and Weaning Considerations for Patients with Spinal Cord Injuries: A Narrative Review. J Pers Med 2022; 13:jpm13010097. [PMID: 36675758 PMCID: PMC9861966 DOI: 10.3390/jpm13010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Respiratory complications following traumatic spinal cord injury are common and are associated with high morbidity and mortality. The inability to cough and clear secretions coupled with weakened respiratory and abdominal muscles commonly leads to respiratory failure, pulmonary edema, and pneumonia. Higher level and severity of the spinal cord injury, history of underlying lung pathology, history of smoking, and poor baseline health status are potential predictors for patients that will experience respiratory complications. For patients who may require prolonged intubation, early tracheostomy has been shown to lead to improved outcomes. Prediction models to aid clinicians with the decision and timing of tracheostomy have been shown to be successful but require larger validation studies in the future. Mechanical ventilation weaning strategies also require further investigation but should focus on a combination of optimizing ventilator setting, pulmonary toilet techniques, psychosocial well-being, and an aggressive bowel regimen.
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6
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Vedantam A, Jimsheleishvili G, Harrop JS, Alberga LR, Ahmad FU, Murphy RK, Jackson JB, Rodgers RB, Levi AD. A prospective multi-center study comparing the complication profile of modest systemic hypothermia versus normothermia for acute cervical spinal cord injury. Spinal Cord 2022; 60:510-515. [PMID: 35013548 DOI: 10.1038/s41393-021-00747-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective multi-center trial. OBJECTIVES To characterize the complication profile associated with modest systemic hypothermia after acute cervical SCI in a prospective multi-center study. SETTING Five trauma centers in the United States. METHODS We analyzed data from a prospective, multi-center trial on the use of modest systemic hypothermia for acute cervical SCI. Patients with acute cervical SCI were assigned to receive modest systemic hypothermia (33 C) or standard of care medical treatment. Patients in the hypothermia group were cooled to 33 C and maintained at the target temperature for 48 h. Complication profile and the rate of complications within the first 6 weeks after injury were compared between the two groups. Multiple regression analysis was performed to determine risk factors for complications after injury. RESULTS Fifty patients (hypothermia: 27, control: 23) were analyzed for this study. Median age was significantly lower in the hypothermia arm (39 vs 59 years, p = 0.02). Respiratory complications were the most common (hypothermia: 55.6% vs control: 52.2%, p = 0.81). The rate of deep vein thrombosis was not significantly different between the two groups (hypothermia: 14.8% vs control 17.4%, p = 0.71). The rate of complications was not statistically different between the two groups. CONCLUSION In this prospective multi-center controlled trial, preliminary data show that modest systemic hypothermia was not associated with increased risk of complications within the first 6 weeks after acute cervical SCI. TRIAL INFORMATION The study is registered on clinicaltrials.gov NCT02991690. University of Miami IRB (Central IRB) approval No.: 20160758. Emory University IRB #IRB00093786.
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Affiliation(s)
- Aditya Vedantam
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - George Jimsheleishvili
- The Miami Project to Cure Paralysis, Miami, FL, USA.,Department of Neurological Surgery, University of Miami/Jackson Health System, Miami, FL, USA
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Faiz U Ahmad
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rory K Murphy
- Barrow Brain and Spine and Honor Health, Phoenix, AZ, USA
| | - J Benjamin Jackson
- Department of Orthopedic Surgery, University of South Carolina, Columbia, SC, USA
| | | | - Allan D Levi
- The Miami Project to Cure Paralysis, Miami, FL, USA. .,Department of Neurological Surgery, University of Miami/Jackson Health System, Miami, FL, USA.
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7
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Adegeest CY, van Gent JAN, Stolwijk-Swüste JM, Post MWM, Vandertop WP, Öner FC, Peul WC, Wengel PVT. Influence of severity and level of injury on the occurrence of complications during the subacute and chronic stage of traumatic spinal cord injury: a systematic review. J Neurosurg Spine 2021; 36:632-652. [PMID: 34767527 DOI: 10.3171/2021.7.spine21537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Secondary health conditions (SHCs) are long-term complications that frequently occur due to traumatic spinal cord injury (tSCI) and can negatively affect quality of life in this patient population. This study provides an overview of the associations between the severity and level of injury and the occurrence of SHCs in tSCI. METHODS A systematic search was conducted in PubMed and Embase that retrieved 44 studies on the influence of severity and/or level of injury on the occurrence of SHCs in the subacute and chronic phase of tSCI (from 3 months after trauma). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS In the majority of studies, patients with motor-complete tSCI (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade A or B) had a significantly increased occurrence of SHCs in comparison to patients with motor-incomplete tSCI (AIS grade C or D), such as respiratory and urogenital complications, musculoskeletal disorders, pressure ulcers, and autonomic dysreflexia. In contrast, an increased prevalence of pain was seen in patients with motor-incomplete injuries. In addition, higher rates of pulmonary infections, spasticity, and autonomic dysreflexia were observed in patients with tetraplegia. Patients with paraplegia more commonly suffered from hypertension, venous thromboembolism, and pain. CONCLUSIONS This review suggests that patients with a motor-complete tSCI have an increased risk of developing SHCs during the subacute and chronic stage of tSCI in comparison with patients with motor-incomplete tSCI. Future studies should examine whether systematic monitoring during rehabilitation and the subacute and chronic phase in patients with motor-complete tSCI could lead to early detection and potential prevention of SHCs in this population.
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Affiliation(s)
- Charlotte Y Adegeest
- 1Department of Neurosurgery, Leiden University Medical Center, Leiden.,2Department of Neurosurgery, Haaglanden Medical Center, The Hague
| | - Jort A N van Gent
- 1Department of Neurosurgery, Leiden University Medical Center, Leiden
| | - Janneke M Stolwijk-Swüste
- 3Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht
| | - Marcel W M Post
- 3Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht.,4Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen
| | - William P Vandertop
- 5Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam
| | - F Cumhur Öner
- 6Department of Orthopedic Surgery, University Medical Center Utrecht; and
| | - Wilco C Peul
- 1Department of Neurosurgery, Leiden University Medical Center, Leiden.,2Department of Neurosurgery, Haaglanden Medical Center, The Hague.,7Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center Leiden, Haaglanden Medical Center and Haga Teaching Hospital, The Hague, The Netherlands
| | - Paula V Ter Wengel
- 2Department of Neurosurgery, Haaglanden Medical Center, The Hague.,7Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center Leiden, Haaglanden Medical Center and Haga Teaching Hospital, The Hague, The Netherlands
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8
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Wang XR, Zhang Q, Ding WS, Zhang W, Zhou M, Wang HB. Comparison of clinical outcomes of tracheotomy in patients with acute cervical spinal cord injury at different timing. Clin Neurol Neurosurg 2021; 210:106947. [PMID: 34583275 DOI: 10.1016/j.clineuro.2021.106947] [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] [Received: 08/09/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022]
Abstract
Respiratory failure is the leading cause of early death after acute CSCI. Tracheotomy is an effective approach to reduce mortality and improve the clinical outcomes. However, the optimal timing for tracheotomy remains controversial. Hence, the study aimed to compare the clinical outcomes of tracheotomy in patients with acute cervical spinal cord injury (CSCI) at different timing. A retrospectively review was performed of acute CSCI patients who underwent tracheotomy in the intensive care unit of Haian Hospital between January 2014 and June 2019. 124 CSCI patients were included and stratified into three groups based on the timing of tracheotomy: early group (≤4 days from initial intubation), medium group (4-10 days from initial intubation), and late group (≥10 days from initial intubation). The clinical outcomes and functional outcomes were analyzed. No significant intergroup differences in baseline characteristics were observed. The late group needed significantly longer duration of mechanical ventilation, longer ICU stay, and suffered higher ICU mortality, higher pneumonia after tracheotomy than the early and medium groups. More patients in the early and medium groups successfully weaned from mechanical ventilation. The early and medium groups achieved better improvement of JOA and NDI scores than the late group at one year after surgery and at the final follow-up. Early to medium term tracheotomy may lead to better clinical and functional outcomes in patients with acute CSCI who require prolonged mechanical ventilation.
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Affiliation(s)
- Xiao-Ran Wang
- Department of Intensive Care Unit, Affiliated Haian Hospital of Nantong University, Nantong 226001, China
| | - Qiang Zhang
- Department of Intensive Care Unit, Affiliated Haian Hospital of Nantong University, Nantong 226001, China
| | - Wen-Sen Ding
- Department of Intensive Care Unit, Affiliated Haian Hospital of Nantong University, Nantong 226001, China
| | - Wei Zhang
- Department of Intensive Care Unit, Affiliated Haian Hospital of Nantong University, Nantong 226001, China
| | - Min Zhou
- Department of Intensive Care Unit, Affiliated Haian Hospital of Nantong University, Nantong 226001, China
| | - Hai-Bo Wang
- Department of Intensive Care Unit, Affiliated Haian Hospital of Nantong University, Nantong 226001, China.
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9
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Xie Y, Wang Y, Zhou Y, Liu M, Li S, Bao Y, Jiang W, Tang S, Li F, Xue H, Li L, Gong X, Liu Y, Wang W, Li T. A Nomogram for Predicting Acute Respiratory Failure After Cervical Traumatic Spinal Cord Injury Based on Admission Clinical Findings. Neurocrit Care 2021; 36:421-433. [PMID: 34346037 PMCID: PMC8964578 DOI: 10.1007/s12028-021-01302-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/14/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Acute respiratory failure (ARF) is a common medical complication in patients with cervical traumatic spinal cord injury (TSCI). To identify independent predictors for ARF onset in patients who underwent cervical TSCI without premorbid respiratory diseases and to apply appropriate medical supports based on accurate prediction, a nomogram relating admission clinical information was developed for predicting ARF during acute care period. METHODS We retrospectively reviewed clinical profiles of patients who suffered cervical TSCI and were emergently admitted to Qingdao Municipal Hospital from 2014 to 2020 as the training cohort. Univariate analysis was performed using admission clinical variables to estimate associated factors and a nomogram for predicting ARF occurrence was generated based on the independent predictors from multivariate logistic regression analysis. This nomogram was assessed by concordance index for discrimination and calibration curve with internal-validated bootstrap strategy. Receiver operating characteristic curve was conducted to compare the predictive accuracy between the nomogram and the traditional gold standard, which combines neuroimaging and neurological measurements by using area under the receiver operating characteristic curve (AUC). An additional 56-patient cohort from another medical center was retrospectively reviewed as the test cohort for external validation of the nomogram. RESULTS 162 patients were eligible for this study and were included in the training cohort, among which 25 individuals developed ARF and were recorded to endure more complications. Despite the aggressive treatments and prolonged intensive care unit cares, 14 patients insulted with ARF died. Injury level, American Spinal Injury Association Impairment Scale (AIS) grade, admission hemoglobin (Hb), platelet to lymphocyte ratio, and neutrophil percentage to albumin ratio (NPAR) were independently associated with ARF onset. The concordance index of the nomogram incorporating these predictors was 0.933 in the training cohort and 0.955 in the test cohort, although both calibrations were good. The AUC of the nomogram was equal to concordance index, which presented better predictive accuracy compared with previous measurements using neuroimaging and AIS grade (AUC 0.933 versus 0.821, Delong's test p < 0.001). Similar significant results were also found in the test cohort (AUC 0.955 versus 0.765, Delong's test p = 0.034). In addition, this nomogram was translated to a Web-based calculator that could generate individual probability for ARF in a visualized form. CONCLUSIONS The nomogram incorporating the injury level, AIS grade, admission Hb, platelet to lymphocyte ratio, and NPAR is a promising model to predict ARF in patients with cervical TSCI who are absent from previous respiratory dysfunction. This nomogram can be offered to clinicians to stratify patients, strengthen evidence-based decision-making, and apply appropriate individualized treatment in the field of acute clinical care.
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Affiliation(s)
- Yongfan Xie
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China.,School of Medicine, Qingdao University, No. 308 Ningxia Road, Qingdao, 266011, Shandong, People's Republic of China
| | - Yongyi Wang
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China.,School of Medicine, Qingdao University, No. 308 Ningxia Road, Qingdao, 266011, Shandong, People's Republic of China
| | - Yong Zhou
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China
| | - Mingxing Liu
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China
| | - Shengli Li
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China
| | - Yue Bao
- Department of Neurosurgery, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China.,Department of Neurosurgery, Neuro Intensive Care Unit, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China
| | - Wenbo Jiang
- Department of Neurosurgery, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China.,Department of Neurosurgery, Neuro Intensive Care Unit, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China
| | - Siwei Tang
- Department of Neurosurgery, Neuro Intensive Care Unit, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China
| | - Fangbao Li
- Department of Neurosurgery, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China
| | - Hao Xue
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, No.107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China
| | - Luo Li
- School of Medicine, Qingdao University, No. 308 Ningxia Road, Qingdao, 266011, Shandong, People's Republic of China.,Department of Neurosurgery, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China
| | - Xingyuan Gong
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, People's Republic of China
| | - Yongliang Liu
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, People's Republic of China.
| | - Weimin Wang
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China. .,School of Medicine, Qingdao University, No. 308 Ningxia Road, Qingdao, 266011, Shandong, People's Republic of China.
| | - Tong Li
- Department of Neurosurgery, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China. .,Department of Neurosurgery, Neuro Intensive Care Unit, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China.
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Effects of Respiratory Muscle Training on Baroreflex Sensitivity, Respiratory Function, and Serum Oxidative Stress in Acute Cervical Spinal Cord Injury. J Pers Med 2021; 11:jpm11050377. [PMID: 34062971 PMCID: PMC8147917 DOI: 10.3390/jpm11050377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background: respiratory complications are a leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). We examined the effects of respiratory muscle training (RMT) in patients with acute cervical SCI. Methods: this prospective trial enrolled 44 adults with acute cervical SCI, of which twenty received RMT and twenty-four did not receive RMT. Respiratory function, cardiovascular autonomic function, and reactive oxidative species (ROS) were compared. The experimental group received 40-min high-intensity home-based RMT 7 days per week for 10 weeks. The control group received a sham intervention for a similar period. The primary outcomes were the effects of RMT on pulmonary and cardiovascular autonomic function, and ROS production in individuals with acute cervical SCI. Results: significant differences between the two groups in cardiovascular autonomic function and the heart rate response to deep breathing (p = 0.017) were found at the 6-month follow-up. After RMT, the maximal inspiratory pressure (p = 0.042) and thiobarbituric acid-reactive substances (TBARS) (p = 0.006) improved significantly, while there was no significant difference in the maximal expiratory pressure. Significant differences between the two groups in tidal volume (p = 0.005) and the rapid shallow breathing index (p = 0.031) were found at 6 months. Notably, the SF-36 (both the physical (PCS) and mental (MCS) component summaries) in the RMT group had decreased significantly at the 6-month follow-up, whereas the clinical scores did not differ significantly (p = 0.333) after RMT therapy. Conclusions: High-intensity home-based RMT can improve pulmonary function and endurance and reduce breathing difficulties in patients with respiratory muscle weakness after injury. It is recommended for rehabilitation after spinal cord injury.
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Pizzolato C, Gunduz MA, Palipana D, Wu J, Grant G, Hall S, Dennison R, Zafonte RD, Lloyd DG, Teng YD. Non-invasive approaches to functional recovery after spinal cord injury: Therapeutic targets and multimodal device interventions. Exp Neurol 2021; 339:113612. [DOI: 10.1016/j.expneurol.2021.113612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
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Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation. We sought to investigate factors associated with the development of VAP in critically ill trauma patients. METHODS We conducted a retrospective review of trauma patients admitted to our trauma intensive care unit between 2016 and 2018. Patients with ventilator-associated pneumonia were identified from the trauma database. Data collected from the trauma database included demographics (age, gender and race), mechanism of injury (blunt, penetrating), injury severity (injury severity score "ISS"), the presence of VAP, transfused blood products and presenting vital signs. RESULTS A total of 1403 patients were admitted to the trauma intensive care unit (TICU) during the study period; of these, 45 had ventilator-associated pneumonia. Patients with VAP were older (p = 0.030), and they had a higher incidence of massive transfusion (p = 0.015) and received more packed cells in the first 24 h of admission (p = 0.028). They had a higher incidence of face injury (p = 0.001), injury to sternum (p = 0.011) and injury to spine (p = 0.024). Patients with VAP also had a higher incidence of acute kidney injury (AKI) (p < 0.001) and had a longer ICU (p < 0.001) and hospital length of stay (p < 0.001). Multiple logistic regression models controlling for age and injury severity (ISS) showed massive transfusion (p = 0.017), AKI (p < 0.001), injury to face (p < 0.001), injury to sternum (p = 0.007), injury to spine (p = 0.047) and ICU length of stay (p < 0.001) to be independent predictors of VAP. CONCLUSIONS Among critically ill trauma patients, acute kidney injury, injury to the spine, face or sternum, massive transfusion and intensive care unit length of stay were associated with VAP.
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Raab AM, Brinkhof MWG, Berlowitz DJ, Postma K, Gobets D, Hirschfeld S, Hopman MTE, Huber B, Hund-Georgiadis M, Jordan X, Schubert M, Wildburger R, Mueller G. Respiratory function and respiratory complications in spinal cord injury: protocol for a prospective, multicentre cohort study in high-income countries. BMJ Open 2020; 10:e038204. [PMID: 33154049 PMCID: PMC7646333 DOI: 10.1136/bmjopen-2020-038204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Pneumonia is one of the leading complications and causes of death after a spinal cord injury (SCI). After a cervical or thoracic lesion, impairment of the respiratory muscles decreases respiratory function, which increases the risk of respiratory complications. Pneumonia substantially reduces patient's quality of life, may prolong inpatient rehabilitation time, increase healthcare costs or at worse, lead to early death. Respiratory function and coughing can be improved through various interventions after SCI, but the available evidence as to which aspect of respiratory care should be optimised is inconclusive. Furthermore, ability of respiratory function parameters to predict pneumonia risk is insufficiently established. This paper details the protocol for a large-scale, multicentre research project that aims to evaluate the ability of parameters of respiratory function to predict and understand variation in inpatient risk of pneumonia in SCI. METHODS AND ANALYSIS RESCOM, a prospective cohort study, began recruitment in October 2016 across 10 SCI rehabilitation centres from Australia, Austria, Germany, the Netherlands and Switzerland. Inpatients with acute SCI, with complete or incomplete cervical or thoracic lesions, 18 years or older and not/no more dependent on 24-hour mechanical ventilation within the first 3 months after injury are eligible for inclusion. The target sample size is 500 participants. The primary outcome is an occurrence of pneumonia; secondary outcomes include pneumonia-related mortality and quality of life. We will use the longitudinal data for prognostic models on inpatient pneumonia risk factors. ETHICS AND DISSEMINATION The study has been reviewed and approved by all local ethics committees of all participating centres. Study results will be disseminated to the scientific community through peer-reviewed journals and conference presentations, to the SCI community, other stakeholders and via social media, newsletters and engagement activities. TRIAL REGISTRATION DETAILS ClinicalTrials.gov NCT02891096.
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Affiliation(s)
- Anja M Raab
- Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Martin W G Brinkhof
- Life Course Epidemiology Group, Swiss Paraplegic Research, Nottwil, Switzerland
| | - David J Berlowitz
- Department of Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Postma
- Department of Rehabilitation Medicine, Rijndam Rehabilitation and Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David Gobets
- Department of Rehabilitation Medicine, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | - Sven Hirschfeld
- Department of Spinal Cord Medicine, BG Trauma Hospital, Hamburg, Germany
| | - Maria T E Hopman
- Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Burkhart Huber
- Trauma Surgery, AUVA Rehabilitation Center Häring, Bad Häring, Austria
| | | | - Xavier Jordan
- Spinal Cord Unit, Clinique romande de réadaptation, Sion, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Renate Wildburger
- Allgemeine Unfallversicherungsanstalt, AUVA Rehabilitation Clinic Tobelbad, Tobelbad, Austria
| | - Gabi Mueller
- Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland
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Alimohammadi E, Ahadi P, Rezaee C, Safari-Faramani R, Bagheri SR, Janatolmakan M. Acute traumatic quadriplegia: Predictors of in-hospital and six-month mortality. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620909005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Traumatic spinal cord injury is one of the most disastrous and devastating health burdens all over the world with a high mortality rate. The present study aimed to evaluate the predictors of in-hospital and six-month mortality in these patients. Methods The electronic medical records of 87 consecutive patients with acute complete traumatic quadriplegia were reviewed to extract clinical, radiological, and laboratory data. Simple and multiple logistic regression models were used to estimate crude and adjusted odds with 95% confidence interval (CI) ratios for the predictors of in-hospital mortality and six-month mortality. Results There were 48 males and the mean age was 38.67 ± 12.81; in-hospital and six-month mortality were 21.84% and 11.76%, respectively. Traffic road accidents (67.8%) and falls (12.6%) were the most common causes of injury. The univariate analysis demonstrated advanced age, level of injury, late surgery or no surgical intervention, the lack of methylprednisolone therapy, a higher Charlson comorbidity index, the Injury Severity Score, and the presence of respiratory failure or bradycardia on admission were predictors of in-hospital mortality ( p < 0.05). In the final multiple logistic regression model, the level of injury (OR = 0.02 (0.001,0.35), p = 0.008) and the presence of respiratory failure (OR = 2.37 (0.03,13.88), p = 0.024) were the only predictors of in-hospital mortality. The univariate model showed that the level of injury, respiratory failure on admission, and the Injury Severity Score were the predictors of six-month mortality; however, the level of injury was the only predictor of the six-month mortality (OR = 1.12 (0.99, 1.27), p = 0.028) according to the multiple logistic regression model. Conclusions Several factors could affect in-hospital and six-month mortality in patients with traumatic spinal cord injury. Our findings demonstrated the level of injury and respiratory failure on admission as independent predictors of in-hospital mortality in these patients. Furthermore, the level of injury was the only independent predictor of six-month mortality in the present study.
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Affiliation(s)
- Ehsan Alimohammadi
- Department of Neurosurgery Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran
| | - Paniz Ahadi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Cyrous Rezaee
- Kermanshah University of Medical Sciences, Taleghani Hospital, Kermanshah, Iran
| | - Roya Safari-Faramani
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Department of Neurosurgery Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran
| | - Maryam Janatolmakan
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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15
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Druschel C, Ossami Saidy RR, Grittner U, Nowak CP, Meisel A, Schaser KD, Niedeggen A, Liebscher T, Kopp MA, Schwab JM. Clinical decision-making on spinal cord injury-associated pneumonia: a nationwide survey in Germany. Spinal Cord 2020; 58:873-881. [PMID: 32071433 PMCID: PMC7223654 DOI: 10.1038/s41393-020-0435-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 11/13/2022]
Abstract
STUDY DESIGN Survey study. OBJECTIVES Spinal cord injury (SCI)-associated pneumonia (SCI-AP) is associated with poor functional recovery and a major cause of death after SCI. Better tackling SCI-AP requires a common understanding on how SCI-AP is defined. This survey examines clinical algorithms relevant for diagnosis and treatment of SCI-AP. SETTING All departments for SCI-care in Germany. METHODS The clinical decision-making on SCI-AP and the utility of the Centers for Disease Control and Prevention (CDC) criteria for diagnosis of 'clinically defined pneumonia' were assessed by means of a standardized questionnaire including eight case vignettes of suspected SCI-AP. The diagnostic decisions based on the case information were analysed using classification and regression trees (CART). RESULTS The majority of responding departments were aware of the CDC-criteria (88%). In the clinical vignettes, 38-81% of the departments diagnosed SCI-AP in accordance with the CDC-criteria and 7-41% diagnosed SCI-AP in deviation from the CDC-criteria. The diagnostic agreement was not associated with the availability of standard operating procedures for SCI-AP management in the departments. CART analysis identified radiological findings, fever, and worsened gas exchange as most important for the decision on SCI-AP. Frequently requested supplementary diagnostics were microbiological analyses, C-reactive protein, and procalcitonin. For empirical antibiotic therapy, the departments used (acyl-)aminopenicillins/β-lactamase inhibitors, cephalosporins, or combinations of (acyl-)aminopenicillins/β-lactamase inhibitors with fluoroquinolones or carbapenems. CONCLUSIONS This survey reveals a diagnostic ambiguity regarding SCI-AP despite the awareness of CDC-criteria and established SOPs. Heterogeneous clinical practice is encouraging the development of disease-specific guidelines for diagnosis and management of SCI-AP.
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Affiliation(s)
- Claudia Druschel
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Orthopaedic and Trauma Surgery, Universitätsklinikum Carl-Gustav Carus, Dresden, Germany
| | - Ramin R Ossami Saidy
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Claus P Nowak
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Andreas Meisel
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Klaus-Dieter Schaser
- Department of Orthopaedic and Trauma Surgery, Universitätsklinikum Carl-Gustav Carus, Dresden, Germany
| | - Andreas Niedeggen
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Berlin, Germany
| | - Thomas Liebscher
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Berlin, Germany
| | - Marcel A Kopp
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
- Berlin Institute of Health, QUEST-Center for Transforming Biomedical Research, Berlin, Germany.
| | - Jan M Schwab
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Spinal Cord Medicine (Paraplegiology), The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
- Belford Center for Spinal Cord Injury, Departments of Neuroscience and Physical Medicine and Rehabilitation, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
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Predictors of respiratory complications in patients with C5-T5 spinal cord injuries. Spinal Cord 2020; 58:1249-1254. [PMID: 32581306 PMCID: PMC7312109 DOI: 10.1038/s41393-020-0506-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/08/2022]
Abstract
Study design Retrospective chart audit. Objectives Describing the respiratory complications and their predictive factors in patients with acute traumatic spinal cord injuries at C5–T5 level during the initial hospitalization. Setting Hospital Vall d’Hebron, Barcelona. Methods Data from patients admitted in a reference unit with acute traumatic injuries involving levels C5–T5. Respiratory complications were defined as: acute respiratory failure, respiratory infection, atelectasis, non-hemothorax pleural effusion, pulmonary embolism or haemoptysis. Candidate predictors of these complications were demographic data, comorbidity, smoking, history of respiratory disease, the spinal cord injury characteristics (level and ASIA Impairment Scale) and thoracic trauma. A logistic regression model was created to determine associations between potential predictors and respiratory complications. Results We studied 174 patients with an age of 47.9 (19.7) years, mostly men (87%), with low comorbidity. Coexistent thoracic trauma was found in 24 (19%) patients with cervical and 35 (75%) with thoracic injuries (p < 0.001). Respiratory complications were frequent (53%) and were associated to longer hospital stay: 83.1 (61.3) and 45.3 (28.1) days in patients with and without respiratory complications (p < 0.001). The strongest predictors of respiratory complications were: previous respiratory disease (OR 5.4, 95% CI: 1.5–19.2), complete motor function impairment (AIS A–B) (OR 4.7, 95% CI: 2.4–9.5) and concurrent chest trauma (OR 3.73, 95% CI: 1.8–7.9). Conclusions Respiratory complications are common in traumatic spinal cord injuries between C5–T5. We identified previous respiratory disease, complete motor function impairment and the coexistence of thoracic trauma as predictors of respiratory complications. Identification of patients at risk might help clinicians to implement preventive strategies.
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Jiang F, Jaja BNR, Kurpad SN, Badhiwala JH, Aarabi B, Grossman RG, Harrop JS, Guest JD, Schär RT, Shaffrey CI, Boakye M, Toups EG, Wilson JR, Fehlings MG. Acute Adverse Events After Spinal Cord Injury and Their Relationship to Long-term Neurologic and Functional Outcomes: Analysis From the North American Clinical Trials Network for Spinal Cord Injury. Crit Care Med 2019; 47:e854-e862. [PMID: 31389834 DOI: 10.1097/ccm.0000000000003937] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There are few contemporary, prospective multicenter series on the spectrum of acute adverse events and their relationship to long-term outcomes after traumatic spinal cord injury. The goal of this study is to assess the prevalence of adverse events after traumatic spinal cord injury and to evaluate the effects on long-term clinical outcome. DESIGN Multicenter prospective registry. SETTING Consortium of 11 university-affiliated medical centers in the North American Clinical Trials Network. PATIENTS Eight-hundred one spinal cord injury patients enrolled by participating centers. INTERVENTIONS Appropriate spinal cord injury treatment at individual centers. MEASUREMENTS AND MAIN RESULTS A total of 2,303 adverse events were recorded for 502 patients (63%). Penalized maximum logistic regression models were fitted to estimate the likelihood of neurologic recovery (ASIA Impairment Scale improvement ≥ 1 grade point) and functional outcomes in subjects who developed adverse events at 6 months postinjury. After accounting for potential confounders, the group that developed adverse events showed less neurologic recovery (odds ratio, 0.55; 95% CI, 0.32-0.96) and was more likely to require assisted breathing (odds ratio, 6.55; 95% CI, 1.17-36.67); dependent ambulation (odds ratio, 7.38; 95% CI, 4.35-13.06) and have impaired bladder (odds ratio, 9.63; 95% CI, 5.19-17.87) or bowel function (odds ratio, 7.86; 95% CI, 4.31-14.32) measured using the Spinal Cord Independence Measure subscores. CONCLUSIONS Results from this contemporary series demonstrate that acute adverse events are common and are associated with worsened long-term outcomes after traumatic spinal cord injury.
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Affiliation(s)
- Fan Jiang
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Blessing N R Jaja
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shekar N Kurpad
- Division of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jetan H Badhiwala
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Bizhan Aarabi
- Division of Neurosurgery, Shock Trauma, University of Maryland, Baltimore, MD
| | | | - James S Harrop
- Division of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jim D Guest
- Division of Neurosurgery, University of Miami, Miami, FL
| | - Ralph T Schär
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Chris I Shaffrey
- Division of Neurosurgery, University of Virginia, Chalottesville, VA
| | - Max Boakye
- Division of Neurosurgery, University of Louisville, Louisville, KY
| | | | - Jefferson R Wilson
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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Yusuf AS, Mahmud MR, Alfin DJ, Gana SI, Timothy S, Nwaribe EE, Dalhat NK, Aruna AA, Idris MM. Clinical Characteristics and Challenges of Management of Traumatic Spinal Cord Injury in a Trauma Center of a Developing Country. J Neurosci Rural Pract 2019; 10:393-399. [PMID: 31595109 PMCID: PMC6779583 DOI: 10.1055/s-0039-1695696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Traumatic spinal cord injury (TSCI) is a major burden in trauma care worldwide. Most victims are young, and the injury results in economic loss and psychological and social burden on the individual and the society. The outcome depends on the severity of primary spinal cord injury, interventions to prevent secondary insults to the damaged cord, and access to a specialized care. The lack of standard prehospital care and dedicated facilities for spine care coupled with challenges of inadequate health insurance coverage impact negatively on the outcome of care in patients with spinal cord injury in our practice. Objectives This study was performed to determine the clinical profile of patients with TSCI and to highlight the factors that determine the early outcome in a resource-constrained trauma center. Materials and Methods This study was a retrospective review of trauma registry and medical records of all the patients with acute TSCI at the National Trauma Center Abuja from September 2014 to December 2016. Results A total of 133 patients with TSCI were studied. Most of these patients were young men with a mean age of 36 years. Most injury (72.2%) occurred following motor vehicular crash affecting mainly the cervical spinal cord (62.0%). None of the patients received standard prehospital care. Only 41.4% of the patients were transported to the hospital in an ambulance. About half (52.6%) of the patients suffered complete spinal cord injury (the American Spinal Injury Association [ASIA] A), and pressure ulcer was the most common complication (23.3%). Only 42% of the patients that needed surgical intervention were operated, mainly due to the inability to pay for the service. The ASIA grade on admission was the most significant determinant factor of morbidity and mortality. Conclusion Optimal care of patients with TSCI was hindered by inadequate facilities and economic constraints.
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Affiliation(s)
- Ayodeji Salman Yusuf
- Department of Surgery, Neurosurgery Unit, National Hospital Abuja, Abuja, Nigeria
| | - Muhammad Raji Mahmud
- Department of Surgery, Neurosurgery Unit, National Hospital Abuja, Abuja, Nigeria
| | - Dumura Jeneral Alfin
- Department of Surgery, Neurosurgery Unit, National Hospital Abuja, Abuja, Nigeria
| | - Samue Isa Gana
- Department of Surgery, Neurosurgery Unit, National Hospital Abuja, Abuja, Nigeria
| | - Samaila Timothy
- Department of Surgery, Neurosurgery Unit, National Hospital Abuja, Abuja, Nigeria
| | | | - Nasir Kurfi Dalhat
- Department of Surgery, Neurosurgery Unit, National Hospital Abuja, Abuja, Nigeria
| | - Ajibade Afeez Aruna
- Department of Surgery, Neurosurgery Unit, National Hospital Abuja, Abuja, Nigeria
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Risk Factors on Hospital Arrival for Acute Respiratory Distress Syndrome Following Pediatric Trauma. Crit Care Med 2019; 46:e1088-e1096. [PMID: 30119074 DOI: 10.1097/ccm.0000000000003379] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine risk factors identifiable at hospital arrival associated with acute respiratory distress syndrome development among critically injured children. DESIGN Retrospective cohort study. SETTING Level I or II adult or pediatric trauma centers contributing to the National Trauma Data Bank from 2007 to 2016. PATIENTS Patients less than 18 years admitted to an ICU with traumatic injury. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We determined associations between patient, injury, and clinical characteristics present at hospital arrival with development of acute respiratory distress syndrome recorded as a hospital complication. Acute respiratory distress syndrome occurred in 1.8% of 146,058 critically injured children (n = 2,590). The only demographic factor associated with higher risk of developing acute respiratory distress syndrome on multivariable analysis was African American race (relative risk, 1.42 vs white; 95% CI, 1.13-1.78). Injury characteristics included firearm injuries (relative risk 1.93; 1.50-2.48) and motor vehicle crashes (relative risk, 1.91; 1.57-2.31) relative to falls; spine (relative risk, 1.39; 1.20-1.60), chest (relative risk, 1.36; 1.22-1.52), or lower extremity injuries (relative risk, 1.26; 1.10-1.44); amputations (relative risk, 2.10; 1.51-2.91); and more severe injury (relative risk, 3.69 for Injury Severity Score 40-75 vs 1-8; 2.50-5.44). Clinical variables included abnormal respiratory status (intubated relative risk, 1.67; 1.23-2.26 and hypopnea relative risk, 1.23; 1.05-1.45 and tachypnea relative risk, 1.26; 1.10-1.44) and lower Glasgow Coma Scale score (relative risk, 5.61 for Glasgow Coma Scale score 3 vs 15; 4.44-7.07). CONCLUSIONS We provide the first description of the incidence of and risk factors for acute respiratory distress syndrome among pediatric trauma patients. Improved understanding of the risk factors associated with acute respiratory distress syndrome following pediatric trauma may help providers anticipate its development and intervene early to improve outcomes for severely injured children.
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Jaja BNR, Jiang F, Badhiwala JH, Schär R, Kurpad S, Grossman RG, Harrop JS, Guest JD, Toups EG, Shaffrey CI, Aarabi B, Boakye M, Fehlings MG, Wilson JR. Association of Pneumonia, Wound Infection, and Sepsis with Clinical Outcomes after Acute Traumatic Spinal Cord Injury. J Neurotrauma 2019; 36:3044-3050. [PMID: 31007137 DOI: 10.1089/neu.2018.6245] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
< 0.001). There were no statistical differences between participants with or without PWS with respect to time from injury to surgery, and administration of steroids. Dominance analysis showed injury level, baseline AIS grade, and subject pre-morbid medical status collectively accounted for 77.7% of the predicted variance of PWS. Regression analysis indicated subjects with PWS demonstrated higher odds for respiratory (odds ratio [OR] 3.91, 95% confidence interval [CI]: 1.42-10.79) and ambulatory (OR 3.94, 95% CI: 1.50-10.38) support at 6 month follow-up in adjusted analysis. This study has shown an association between PWS occurring during acute admission and poorer functional outcomes following SCI.
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Affiliation(s)
- Blessing N R Jaja
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fan Jiang
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jetan H Badhiwala
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Schär
- Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shekar Kurpad
- Division of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - James S Harrop
- Division of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jim D Guest
- Division of Neurosurgery, University of Miami, Miami, Florida
| | | | - Chris I Shaffrey
- Division of Neurosurgery, University of Virginia, Chalottesville, Virginia
| | - Bizhan Aarabi
- Division of Neurosurgery, Shock Trauma, University of Maryland, Baltimore, Maryland
| | - Max Boakye
- Division of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - Michael G Fehlings
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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21
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Khorasanizadeh M, Yousefifard M, Eskian M, Lu Y, Chalangari M, Harrop JS, Jazayeri SB, Seyedpour S, Khodaei B, Hosseini M, Rahimi-Movaghar V. Neurological recovery following traumatic spinal cord injury: a systematic review and meta-analysis. J Neurosurg Spine 2019; 30:683-699. [PMID: 30771786 DOI: 10.3171/2018.10.spine18802] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/11/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Predicting neurological recovery following traumatic spinal cord injury (TSCI) is a complex task considering the heterogeneous nature of injury and the inconsistency of individual studies. This study aims to summarize the current evidence on neurological recovery following TSCI by use of a meta-analytical approach, and to identify injury, treatment, and study variables with prognostic significance. METHODS A literature search in MEDLINE and EMBASE was performed, and studies reporting follow-up changes in American Spinal Injury Association (ASIA) Impairment Scale (AIS) or Frankel or ASIA motor score (AMS) scales were included in the meta-analysis. The proportion of patients with at least 1 grade of AIS/Frankel improvement, and point changes in AMS were calculated using random pooled effect analysis. The potential effect of severity, level and mechanism of injury, type of treatment, time and country of study, and follow-up duration were evaluated using meta-regression analysis. RESULTS A total of 114 studies were included, reporting AIS/Frankel changes in 19,913 patients and AMS changes in 6920 patients. Overall, the quality of evidence was poor. The AIS/Frankel conversion rate was 19.3% (95% CI 16.2-22.6) for patients with grade A, 73.8% (95% CI 69.0-78.4) for those with grade B, 87.3% (95% CI 77.9-94.8) for those with grade C, and 46.5% (95% CI 38.2-54.9) for those with grade D. Neurological recovery was significantly different between all grades of SCI severity in the following order: C > B > D > A. Level of injury was a significant predictor of recovery; recovery rates followed this pattern: lumbar > cervical and thoracolumbar > thoracic. Thoracic SCI and penetrating SCI were significantly more likely to result in complete injury. Penetrating TSCI had a significantly lower recovery rate compared to blunt injury (OR 0.76, 95% CI 0.62-0.92; p = 0.006). Recovery rate was positively correlated with longer follow-up duration (p = 0.001). Studies with follow-up durations of approximately 6 months or less reported significantly lower recovery rates for incomplete SCI compared to studies with long-term (3-5 years) follow-ups. CONCLUSIONS The authors' meta-analysis provides an overall quantitative description of neurological outcomes associated with TSCI. Moreover, they demonstrated how neurological recovery after TSCI is significantly dependent on injury factors (i.e., severity, level, and mechanism of injury), but is not associated with type of treatment or country of origin. Based on these results, a minimum follow-up of 12 months is recommended for TSCI studies that include patients with neurologically incomplete injury.
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Affiliation(s)
| | - Mahmoud Yousefifard
- 2Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Eskian
- 1Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences
| | - Yi Lu
- 3Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maryam Chalangari
- 1Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences
| | - James S Harrop
- 4Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia
- 5Neurosurgery, Delaware Valley Regional Spinal Cord Injury Center, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | - Simin Seyedpour
- 1Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences
| | - Behzad Khodaei
- 1Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences
| | - Mostafa Hosseini
- 6Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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22
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Raab AM, Krebs J, Pfister M, Perret C, Hopman M, Mueller G. Respiratory muscle training in individuals with spinal cord injury: effect of training intensity and -volume on improvements in respiratory muscle strength. Spinal Cord 2019; 57:482-489. [PMID: 30700854 DOI: 10.1038/s41393-019-0249-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To investigate the effect of training intensity and -volume on improvements in respiratory muscle strength in individuals with spinal cord injury (SCI). SETTING SCI rehabilitation center in Switzerland. METHODS Inpatients with SCI, lesion level C4-T12, who had at least 10 individualized inspiratory muscle training sessions with respiratory function measurements before and after the training period. Multiple regression analysis with natural logarithmic (ln) transformation of the outcome values was used to examine the effect of training intensity and -volume, lesion level and completeness, and baseline respiratory muscle strength on improvements in respiratory muscle strength. RESULTS Overall, 67 individuals were analyzed. Variation in PImax was explained by PImax at baseline and training intensity. This adjusted effect size suggested a 7% (95% CI 2.8 to 11.6%) increase in PImax per 10 units of increase in training intensity. Controlling for the variation in baseline PEmax, the effect of training intensity on PEmax was conditional on AIS (p < 0.021). While individuals with motor complete lesions showed a 6.8% (95% CI 2.1 to 11.7%) increase in PEmax per 10 units of increase in training intensity, the corresponding adjusted effect size in those with motor incomplete lesions was 0.1% (95% CI -4.3 to 4.5%). The full models explained 57 and 60% of the variance of lnPImax and lnPEmax, respectively. CONCLUSION The intensity of inspiratory muscle training was more relevant than training volume for the improvement of respiratory muscle strength in individuals with SCI. Thus, training intensity should be chosen as high as possible.
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Affiliation(s)
- Anja M Raab
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland.
| | - Jörg Krebs
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Mirjam Pfister
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland.,Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland.,Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Switzerland
| | - Claudio Perret
- Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Maria Hopman
- Department of Physiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Gabi Mueller
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
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23
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Ye I, Tang R, White SJ, Cheung ZB, Cho SK. Predictors of 30-Day Postoperative Pulmonary Complications After Open Reduction and Internal Fixation of Vertebral Fractures. World Neurosurg 2018; 123:e288-e293. [PMID: 30496929 DOI: 10.1016/j.wneu.2018.11.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 11/18/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The purpose of this study was to identify predictors of 30-day postoperative pulmonary complications after open reduction and internal fixation (ORIF) of vertebral fractures. METHODS We performed a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2014. Adult patients who underwent ORIF of vertebral fractures were included and divided into 2 groups based on the occurrence of 30-day postoperative pulmonary complications. Baseline patient and operative characteristics were compared between the 2 groups. Multivariate regression (MVR) analysis was performed to identify independent risk factors for pulmonary complications. RESULTS A total of 900 patients were included in our cohort. The overall 30-day pulmonary complication rate was 5.67%. Patients who had a pulmonary complication after vertebral ORIF were more often men and more often had diabetes, functional dependence, American Society of Anesthesiologists score classification of 3 or higher, pulmonary comorbidity, renal comorbidity, and preoperative anemia. The pulmonary complication group also had a higher incidence of 30-day mortality, prolonged hospitalization, pneumonia, cardiac complications, urinary tract infection, blood transfusion, and sepsis. The MVR analysis found that pulmonary comorbidity (odds ratio [OR], 5.3; 95% confidence interval [CI], 2.5-11.5; P < 0.001), diabetes (OR, 2.1; 95% CI, 1.0-4.2; P = 0.037), partial or dependent functional status (OR, 4.7; 95% CI, 2.2-10.2; P < 0.001), and cervical spine involvement (OR, 3.6; 95% CI, 1.7-8.0; P = 0.001) were independent predictors of pulmonary complications. CONCLUSIONS Early identification of risk factors for postoperative pulmonary complications is important in the evaluation of patients with vertebral fractures for surgical decision-making, preoperative optimization, and subsequent postoperative care to improve patient outcomes and minimize morbidity.
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Affiliation(s)
- Ivan Ye
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ray Tang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samuel J White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zoe B Cheung
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samuel K Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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24
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Wilson JR, Jaja BN, Kwon BK, Guest JD, Harrop JS, Aarabi B, Shaffrey CI, Badhiwala JH, Toups EG, Grossman RG, Fehlings MG. Natural History, Predictors of Outcome, and Effects of Treatment in Thoracic Spinal Cord Injury: A Multi-Center Cohort Study from the North American Clinical Trials Network. J Neurotrauma 2018; 35:2554-2560. [DOI: 10.1089/neu.2017.5535] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Jefferson R. Wilson
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Blessing N.R. Jaja
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brian K. Kwon
- Division of Spine Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - James D. Guest
- Division of Neurosurgery, University of Miami, Miami, Florida
| | - James S. Harrop
- Division of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Bizhan Aarabi
- Division of Neurosurgery, Shock Trauma, University of Maryland, Baltimore, Maryland
| | | | - Jetan H. Badhiwala
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Michael G. Fehlings
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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25
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Richard-Denis A, Feldman DE, Thompson C, Mac-Thiong JM. The impact of acute management on the occurrence of medical complications during the specialized spinal cord injury acute hospitalization following motor-complete cervical spinal cord injury. J Spinal Cord Med 2018; 41:388-396. [PMID: 28724333 PMCID: PMC6055977 DOI: 10.1080/10790268.2017.1350331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT/OBJECTIVE Determine the impact of early admission and complete perioperative management in a specialized spinal cord injury (SCI) trauma center (SCI-center) on the occurrence of medical complications following tetraplegia. DESIGN A retrospective comparative cohort study of prospectively collected data involving 116 individuals was conducted. Group 1 (N=87) was early managed in a SCI-center promptly after the trauma, whereas Group 2 (N=29) was surgically and preoperatively managed in a non-specialized (NS) center before being transferred to the SCI-center. Bivariate comparisons and multivariate logistic regression analyses were used to assess the relationship between the type of acute care facility and the occurrence of medical complications. Length of stay (LOS) in acute care was also compared. SETTING Single Level-1 trauma center. PARTICIPANTS Individuals with acute traumatic motor-complete cervical SCI. INTERVENTIONS Not applicable Outcome measures: The occurrence of complications during the SCI-center stay. RESULTS There was a similar rate of complications between the two groups. However, the LOS was greater in Group 2 (p=0.04). High cervical injuries (C1-C4) showed an important tendency to increase the likelihood of developing a complication, while high cervical injuries and increased trauma severity increased the odds of developing respiratory complications. CONCLUSION Although complication rates were similar in non-specialized and specialized centers, peri-operative management in a non-specialized center required a longer length of stay. Prompt transfer to a SCI-center may optimize the care trajectory by favoring earlier transfer to rehabilitation.
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Affiliation(s)
- Andréane Richard-Denis
- Hôpital du Sacré-Coeur, Montréal, Canada,Faculty of Medicine, University of Montreal, Montreal, Canada,Correspondence to: Andréane Richard-Denis, MD, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin Ouest, Montréal, Quebec, Canada, H4J 1C5.
| | | | | | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Coeur, Montréal, Canada,Faculty of Medicine, University of Montreal, Montreal, Canada,Hôpital Sainte-Justine, Montreal, Canada
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26
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Raab AM, Krebs J, Perret C, Pfister M, Hopman M, Mueller G. Evaluation of a clinical implementation of a respiratory muscle training group during spinal cord injury rehabilitation. Spinal Cord Ser Cases 2018; 4:40. [PMID: 29736265 PMCID: PMC5920082 DOI: 10.1038/s41394-018-0069-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate the clinical implementation of a respiratory muscle training group during rehabilitation of individuals with spinal cord injury. SETTING Spinal cord injury rehabilitation center. METHODS Individuals with complete or incomplete lesions during inpatient rehabilitation, level C4-T12.Ten or more training sessions of either an inspiratory or a combined in- and expiratory muscle training were performed in a group setting with respiratory function measurements before and after the training period. RESULTS Analysis of 79 persons. Inspiratory muscle training was performed for 7 weeks with a median of 3.1 training sessions per week. Median training intensity was at 33% of baseline PImax and 58 repetitions were performed per training session. Respiratory mucle strength parameters improved by 18-68% of baseline values and lung function parameters by 11-31% after inspiratory muscle training.The combined respiratory muscle training was performed for 13 weeks with a median of 2.8 sessions per week and 88 repetitions per training session. Median inspiratory training resistance was at 39% of baseline PImax and median expiratory training resistance was at 27% of baseline PEmax. Respiratory muscle strength parameters improved by 14-51% of baseline values and lung function parameters improved by 15-34% after the combined in- and expiratory muscle training. CONCLUSION Respiratory resistance training improved respiratory function of individuals with acute spinal cord injury. Even if the combined respiratory muscle training was performed with more repetitions per training and nearly twice as long, relative improvements of respiratory function parameters were comparable with isolated inspiratory muscle training.
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Affiliation(s)
- Anja M. Raab
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Jörg Krebs
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Claudio Perret
- Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Mirjam Pfister
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
- Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Maria Hopman
- Department of Physiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Gabi Mueller
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
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27
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Bonavita J, Torre M, Capirossi R, Baroncini I, Brunelli E, Chiarottini G, Maietti E, Olivi S, Molinari M, Scivoletto G. Outcomes Following Ischemic Myelopathies and Traumatic Spinal Injury. Top Spinal Cord Inj Rehabil 2018; 23:368-376. [PMID: 29339912 DOI: 10.1310/sci2304-368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: As the general population ages, the rising prevalence of vascular lesions of the spinal cord will become significant. Purpose: The aim of this study was to compare the neurological and functional outcomes of patients with ischemic spinal cord injury (ISCI) and traumatic spinal cord injury (TSCI). Methods: We conducted a retrospective study in a spinal cord unit of 2 rehabilitation hospitals. We studied 168 patients with a TSCI and 72 with an ISCI. At admission and discharge, patients were evaluated by American Spinal Injury Association Impairment Scale (AIS) standards and Spinal Cord Independence Measure (SCIM). Length of stay, occurrence of complications, and discharge dispositions were also recorded. Linear and logistic regression models were used to analyze the effects of the etiology of the lesion, AIS level at admission, and level of the lesion. Results: Patients with an ISCI were older and experienced fewer cervical lesions and fewer complete lesions than patients with TSCI. By linear and logistic regression, etiology was a predictor (together with lesion features) of functional (SCIM improvement and SCIM at discharge) outcome, with traumatic patients having better outcome than ischemic ones. Age, AIS level, and lesion level were the chief predictors of length of stay, occurrence of complications, and discharge dispositions. Conclusions: A diagnosis of ischemia and trauma could be a determinant of functional recovery in SCI patients.
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Affiliation(s)
- Jacopo Bonavita
- Spinal Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Monica Torre
- Spinal Unit, IRCCS Fondazione S. Lucia, Rome, Italy.,Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Rita Capirossi
- Spinal Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | | | - Elisa Brunelli
- Spinal Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Giorgia Chiarottini
- Specialization School in Physical Medicine and Rehabilitation, Tor Vergata University, Rome, Italy
| | - Elisa Maietti
- Center for Clinical Epidemiology of the School of Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Olivi
- Spinal Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | | | - Giorgio Scivoletto
- Spinal Unit, IRCCS Fondazione S. Lucia, Rome, Italy.,Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione S. Lucia, Rome, Italy
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28
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Aarabi B, Sansur CA, Ibrahimi DM, Simard JM, Hersh DS, Le E, Diaz C, Massetti J, Akhtar-Danesh N. Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury. Neurosurgery 2017; 80:610-620. [PMID: 28362913 DOI: 10.1093/neuros/nyw053] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 11/14/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Evidence indicates that, over time, patients with spinal cord injury (SCI) improve neurologically in various degrees. We sought to further investigate indicators of grade conversion in cervical SCI. OBJECTIVE To detect predictors of ASIA impairment scale (AIS) grade conversion in SCI following surgical decompression. METHODS In a retrospective study, demographics, clinical, imaging, and surgical data from 100 consecutive patients were assessed for predictors of AIS grade conversion. RESULTS American Spinal Injury Association motor score was 17.1. AIS grade was A in 52%, B in 29%, and C in 19% of patients. Surgical decompression took place on an average of 17.6 h following trauma (≤12 h in 51 and >12 h in 49). Complete decompression was verified by magnetic resonance imaging (MRI) in 73 patients. Intramedullary lesion length (IMLL) on postoperative MRI measured 72.8 mm, and hemorrhage at the injury epicenter was noted in 71 patients. Grade conversion took place in 26.9% of AIS grade A patients, 65.5% of AIS grade B, and 78.9% of AIS grade C. AIS grade conversion had statistical relationship with injury severity score, admission AIS grade, extent of decompression, presence of intramedullary hemorrhage, American Spinal Injury Association motor score, and IMLL. A stepwise multiple logistic regression analysis indicated IMLL was the sole and strongest indicator of AIS grade conversion (odds ratio 0.950, 95% CI 0.931-0.969). For 1- and 10-mm increases in IMLL, the model indicates 4% and 40% decreases, respectively, in the odds of AIS grade conversion. CONCLUSION Compared with other surrogates, IMLL remained as the only predictor of AIS grade conversion.
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Affiliation(s)
- Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.,R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles A Sansur
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - David M Ibrahimi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - J Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - David S Hersh
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elizabeth Le
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Cara Diaz
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer Massetti
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Noori Akhtar-Danesh
- School of Nursing and Depart-ment of Clinical Epidemiology and Bio-statistics, McMaster University, Hamilton, Ontario, Canada
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29
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Scivoletto G, Torre M, Iosa M, Porto MR, Molinari M. Prediction Model for the Presence of Complications at Admission to Rehabilitation After Traumatic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2017; 24:151-156. [PMID: 29706759 DOI: 10.1310/sci17-00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Complications frequently occur in patients with spinal cord injury (SCI) during acute care or rehabilitation and have an impact on rehabilitation outcomes. Purpose: The aim of this study was to determine the occurrence and risk factors for complications in recently injured SCI patients. Methods: Two hundred fifty patients with traumatic injuries with and without complications were counted for the following dichotomous parameters: gender (male/female), associated lesions (presence/absence), surgery (yes/no), American Spinal Injury Association Impairment Scale (AIS) grade (A/other categories), lesion level (lumbar/other levels), and lesion-to-admission time (less than/longer than 1 month). The odds ratio (OR) and 95% confidence interval were computed for all the parameters that influenced the presence of complications at admission. These factors have been included in a binary logistic regression analysis (forward stepwise). Results: Complications at admission were observed in 104 patients (41.6%), especially for males, lesion-to-admission time longer than 1 month, presence of associated lesions, AIS grade A, and motor completeness, whereas lumbar lesions were associated with a reduced presence of complications at admission. In the regression analysis, 4 factors entered into the model: motor completeness, lesion-to-admission time, associated lesions, and gender. The final model explained 74% of the variance of data. Conclusions: Despite advances in the acute management of patients with SCI, the study unveiled a high percentage of patients with complications at admission to rehabilitation. The risk factors identified in the study allow determination of the population of subjects who are at higher risk of developing complications and need special management.
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Affiliation(s)
- Giorgio Scivoletto
- Spinal Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Monica Torre
- Spinal Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Maria Rosaria Porto
- Specialization School in Physical Medicine and Rehabilitation, Tor Vergata University, Rome, Italy
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30
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Montoto-Marqués A, Trillo-Dono N, Ferreiro-Velasco ME, Salvador-de la Barrera S, Rodriguez-Sotillo A, Mourelo-Fariña M, Galeiras-Vázquez R, Meijide-Failde R. Risks factors of mechanical ventilation in acute traumatic cervical spinal cord injured patients. Spinal Cord 2017; 56:206-211. [PMID: 29057991 DOI: 10.1038/s41393-017-0005-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Descriptive retrospective study. OBJECTIVES To analyze risk factors associated with mechanical ventilation (MV) in cases of acute traumatic Cervical Spinal Cord Injury (tCSCI). SETTING Unidad de Lesionados Medulares, Complejo Hospitalario Universitario A Coruña, in Galicia (Spain). METHODS The study included patients with tCSCI who were hospitalized between January 2010 and December 2014. The following variables were analyzed: age, gender, etiology, neurological level, ASIA (American Spinal Injury Association) grade, associated injuries, injury severity score (ISS), ASIA motor score (AMS) at admission and mortality. RESULTS A total of 146 patients met the study's inclusion criteria. The majority were men (74.7%) with mean age of 62.6 (s.d. ± 18.8) years. Sixty patients (41.1%) required MV. Mean age of ventilated vs. non-ventilated patients was 57.3 vs. 65.7. Men were more likely to require MV than women, ASIA grades A and B were also more likely to need MV than grades C and D, as well as patients with associated injuries. The AMS of patients receiving MV was lower than that of those who did not require MV (20.1 vs. 54.3). Moreover, the ISS was higher in patients receiving MV (31.2 vs. 13.4). An AMS ≤ 37 and an ISS ≥ 13 increased the risk of requiring MV by a factor of 11.98 and 7.28, respectively. CONCLUSIONS Isolated factors associated with a greater risk of MV in tCSCI were: age, gender, ASIA grade, ISS and AMS. However, the only factor with a significant discriminatory ability to determine the need for MV was the AMS at admission.
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Affiliation(s)
- Antonio Montoto-Marqués
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain. .,Departamento de Medicina, Universidade da Coruña, A Coruña, Spain.
| | - Natalia Trillo-Dono
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | | | | | - Antonio Rodriguez-Sotillo
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Mónica Mourelo-Fariña
- Unidad de Cuidados Intensivos, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Rita Galeiras-Vázquez
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Rosa Meijide-Failde
- Departamento de Medicina, Universidade da Coruña, INIBIC, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
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Weinberg DS, Hedges BZ, Belding JE, Moore TA, Vallier HA. Risk factors for pulmonary complication following fixation of spine fractures. Spine J 2017; 17:1449-1456. [PMID: 28495240 DOI: 10.1016/j.spinee.2017.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/27/2017] [Accepted: 05/02/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have suggested pulmonary complications are common among patients undergoing fixation for traumatic spine fractures. This leads to prolonged hospital stay, worse functional outcomes, and increased economic burden. However, only limited prognostic information exists regarding which patients are at greatest risk for pulmonary complications. PURPOSE This study aimed to identify factors predictive of perioperative pulmonary complications in patients undergoing fixation of spine fractures. STUDY DESIGN/SETTING A retrospective review in a level 1 trauma center was carried out. PATIENT SAMPLE The patient sample comprised 302 patients with spinal fractures who underwent operative fixation. OUTCOME MEASURES The outcome measures were postoperative pulmonary complications (physiological and functional measures). MATERIALS AND METHODS Demographic and injury features were recorded, including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, mechanism of injury, injury characteristics, and neurologic status. Treatment details, including surgery length, timing, and approach were reviewed. Postoperative pulmonary complications were recorded after a minimum of 6 months' follow-up. RESULTS Forty-seven pulmonary complications occurred in 42 patients (14%), including pneumonia (35), adult respiratory distress syndrome (ARDS) (10), and pulmonary embolism (2). Logistic regression found spinal cord injury (SCI) to be most predictive of pulmonary complications (odds ratio [OR]=4.4, 95% confidence interval [CI] 1.9-10.1), followed by severe chest injury (OR 2.7, 95% CI 1.1-6.9), male gender (OR 2.7, 95% CI 1.1-6.8), and ASA classification (OR 2.3, 95% CI 1.4-4.0). Pulmonary complications were associated with significantly longer hospital stays (23.9 vs. 7.7 days, p<.01), stays in the intensive care unit (ICU) (19.9 vs. 3.4 days, p<.01), and increased ventilator times (13.8 days vs. 1.9 days, p<.01). CONCLUSIONS Several factors predicted development of pulmonary complications after operative spinal fracture, including SCI, severe chest injury, male gender, and higher ASA classification. Practitioners should be especially vigilant for of postoperative complications and associated injuries following upper-thoracic spine fractures. Future study must focus on appropriate interventions necessary for reducing complications in these high-risk patients.
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Affiliation(s)
- Douglas S Weinberg
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH 44109, USA
| | - Brian Z Hedges
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH 44109, USA
| | - Jonathan E Belding
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH 44109, USA
| | - Timothy A Moore
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH 44109, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH 44109, USA.
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Kim M, Choi I, Park JH, Jeon SR, Rhim SC, Roh SW. Airway Management Protocol After Anterior Cervical Spine Surgery: Analysis of the Results of Risk Factors Associated With Airway Complication. Spine (Phila Pa 1976) 2017; 42:E1058-E1066. [PMID: 28538443 DOI: 10.1097/brs.0000000000002236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective comparative cohort analysis. OBJECTIVE To evaluate the effect of postoperative airway management protocol (ASAN Extubation Protocol, AEP) on incidence of airway complications for patients undergoing anterior cervical spine surgery (ACSS). BACKGROUND Postoperative airway compromise remains crucial for patients undergoing ACSS. Despite the potential severity of these complications, the data in the published literature addressing this issue is sparse. METHODS A retrospective cohort study was performed regarding airway complications (postoperative airway edema requiring unplanned reintubation or tracheostomy) between groups of patients undergoing ACSS before and after applying our standardized protocol (AEP) for postoperative extubation. The AEP was developed based on 5 clinical risk factors reported having relation to airway complication. Postoperative patients with any oneor more risk factors were kept intubated for at least overnight and extubation was conducted according to the amount of prevertebral soft tissue swelling. RESULTS A total of 538 ACSS patients were identified from 2008 to 2016. The nonprotocol group (before protocol application, 275 patients) and the Protocol group (after protocol, 263 patients) were compared; airway complication rates were significantly different between two groups (nonprotocol: 3.64% (10/275) vs. PROTOCOL 0.76% (2/263), P = 0.024). The possible factors that may increase airway complication include operative indications (P = 0.002), trauma (P = 0.000), medical comorbidity risk (P = 0.011), combined anterior and posterior surgery (P = 0.002), and operation time longer than 5 hours (P = 0.045). In multivariate analysis, medical comorbidity risk, trauma, and airway protocol adoption were significant factors. AEP reduced the airway complication rate by odds ratio 0.125 (P = 0.013). CONCLUSION Postoperative airway complication is not very common after ACSS. AEP contributed to reduce the incidence of airway complications. The potentially life-threatening event of loss of airway patency, even though it is a rare complication, should be cautiously analyzed with identification of risk factors before the surgery. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Moinay Kim
- Graduate School of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Il Choi
- Department of Neurological Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi-Do, Republic of Korea
| | - Jin H Park
- Department of Neurological Surgery, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung C Rhim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung W Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Abstract
PURPOSE OF REVIEW To review the acute and chronic systemic complications of spinal cord injury and discuss treatment recommendations. RECENT FINDINGS The psychological, social, economic, and permanent neurologic effects associated with spinal cord injury (SCI) have universally persisted over time. Treating acute complications and preventing secondary injury can influence outcome, highlighting the importance of proper management of this patient population. Spinal cord injury (SCI) is due to traumatic or non-traumatic causes. Outcome depends on the level of injury and degree of sensorimotor deficits. After the primary injury occurs, it is crucial to detect and treat secondary mechanisms of injury. Correct method of intubation, preventing avoidable complications, and treating cardiovascular, pulmonary, renal, and infectious systemic complications are crucial as they all impact morbidity and mortality in SCI patients.
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Richard-Denis A, Ehrmann Feldman D, Thompson C, Bourassa-Moreau É, Mac-Thiong JM. Costs and Length of Stay for the Acute Care of Patients with Motor-Complete Spinal Cord Injury Following Cervical Trauma. Am J Phys Med Rehabil 2017. [DOI: 10.1097/phm.0000000000000659] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guirgis AH, Menon VK, Suri N, Chatterjee N, Attallah E, Saad MY, Elshaer S. Early Versus Late Tracheostomy for Patients with High and Low Cervical Spinal Cord Injuries. Sultan Qaboos Univ Med J 2016; 16:e458-e463. [PMID: 28003892 DOI: 10.18295/squmj.2016.16.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/08/2016] [Accepted: 08/25/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries (CSCIs). METHODS This retrospective study included 69 adult CSCI patients who underwent bedside percutaneous tracheostomies at the Intensive Care Unit of Khoula Hospital, Muscat, Oman, between January 2011 and October 2015. The tracheostomy was considered early if the procedure took place within one week of the CSCI. The impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit (ICU) stay among patients with high (C1-C2 vertebrae) and low (C3-C7 vertebrae) CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were also examined. RESULTS Patients with a high CSCI who underwent an early tracheostomy spent significantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy (9.3 ± 7.2 days versus 13.7 ± 3.2 days; P = 0.041). Low CSCI patients who received an early tracheostomy also experienced significantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy (12.1 ± 10.4 days versus 25.2 ± 17.7 days; P = 0.035). Moreover, ICU mortality was significantly lower for high CSCI patients who underwent an early tracheostomy (P = 0.015). However, there was no association between length of ICU stay and either type of CSCI or timing of the tracheostomy procedure. CONCLUSION An early tracheostomy is beneficial in reducing the duration of mechanical ventilation among patients with CSCIs, irrespective of the level of injury.
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Affiliation(s)
- Akram H Guirgis
- Department of Anaesthesia & Intensive Care Unit, Khoula Hospital, Muscat, Oman
| | | | - Neelam Suri
- Department of Anaesthesia & Intensive Care Unit, Khoula Hospital, Muscat, Oman
| | - Nilay Chatterjee
- Department of Anaesthesia & Intensive Care Unit, Khoula Hospital, Muscat, Oman
| | - Emil Attallah
- Department of Anaesthesia & Intensive Care Unit, Khoula Hospital, Muscat, Oman
| | - Maged Y Saad
- Department of Anaesthesia & Intensive Care Unit, Khoula Hospital, Muscat, Oman
| | - Shereen Elshaer
- Department of Community Medicine, Mansoura University, Mansoura, Egypt
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Stricsek G, Ghobrial G, Wilson J, Theofanis T, Harrop JS. Complications in the Management of Patients with Spine Trauma. Neurosurg Clin N Am 2016; 28:147-155. [PMID: 27886876 DOI: 10.1016/j.nec.2016.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
More than 50% of patients diagnosed with acute, traumatic spinal cord injury will experience at least 1 complication during their hospitalization. Age, severity of neurological injury, concurrent traumatic brain injury, comorbid illness, and mechanism of injury are all associated with increasing risk of complication. More than 75% of complications will occur within 2 weeks of injury. The complications associated with SCI carry a significant risk of morbidity and mortality; their early identification and management is critical in the care of the SCI patient.
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Affiliation(s)
- Geoffrey Stricsek
- Division of Spine and Peripheral Nerve Surgery, Department of Neurologic Surgery, Thomas Jefferson University, 909 Walnut Street - Third Floor, Philadelphia, PA 19107, USA
| | - George Ghobrial
- Division of Spine and Peripheral Nerve Surgery, Department of Neurologic Surgery, Thomas Jefferson University, 909 Walnut Street - Third Floor, Philadelphia, PA 19107, USA
| | - Jefferson Wilson
- Division of Spine and Peripheral Nerve Surgery, Department of Neurologic Surgery, Thomas Jefferson University, 909 Walnut Street - Third Floor, Philadelphia, PA 19107, USA
| | - Thana Theofanis
- Division of Spine and Peripheral Nerve Surgery, Department of Neurologic Surgery, Thomas Jefferson University, 909 Walnut Street - Third Floor, Philadelphia, PA 19107, USA
| | - James S Harrop
- Division of Spine and Peripheral Nerve Surgery, Department of Neurologic Surgery, Thomas Jefferson University, 909 Walnut Street - Third Floor, Philadelphia, PA 19107, USA; Department of Orthopedic Surgery, Thomas Jefferson University, 909 Walnut Street - Third Floor, Philadelphia, PA 19107, USA.
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Pereira RN, Abreu MFR, Gonçalves CB, Corrêa WFS, Mizuhira DR, Moreno MA. Respiratory muscle strength and aerobic performance of wheelchair basketball players. MOTRIZ: REVISTA DE EDUCACAO FISICA 2016. [DOI: 10.1590/s1980-6574201600030002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Early Trauma-Induced Coagulopathy is Associated with Increased Ventilator-Associated Pneumonia in Spinal Cord Injury Patients. Shock 2016; 45:502-5. [DOI: 10.1097/shk.0000000000000531] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Rogers WK, Todd M. Acute spinal cord injury. Best Pract Res Clin Anaesthesiol 2016; 30:27-39. [DOI: 10.1016/j.bpa.2015.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/02/2015] [Accepted: 11/18/2015] [Indexed: 12/31/2022]
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40
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Liebscher T, Niedeggen A, Estel B, Seidl RO. Airway complications in traumatic lower cervical spinal cord injury: A retrospective study. J Spinal Cord Med 2015; 38:607-14. [PMID: 25117865 PMCID: PMC4535803 DOI: 10.1179/2045772314y.0000000254] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To investigate risk factors for pneumonia in patients with traumatic lower cervical spinal cord injury. DESIGN Observational study, retrospective study. SETTING Spinal cord unit in a maximum care hospital. METHODS Thirty-seven patients with acute isolated traumatic spinal cord injury at levels C4-C8 and complete motor function injury (AIS A, B) treated from 2004 to 2010 met the criteria for inclusion in our retrospective analysis. The following parameters were considered: ventilation-specific parameters, re-intubation, creation of a tracheostomy, pneumonia, antibiotic treatment, and length of intensive care unit (ICU) stay and total hospitalization. RESULTS Among the patients, 81% had primary invasive ventilation. In 78% of cases a tracheostomy was created; 3% of these cases were discharged with invasive ventilation and 28% with a tracheostomy without ventilation. Pneumonia according to Centers for Disease Control criteria occurred in 51% of cases within 21±32 days of injury, and in 3% at a later date. The number of pre-existing conditions was significantly associated with pneumonia. Length of ICU stay was 25±34 days, and average total hospital duration was 230±144 days. Significant factors affecting the duration of ventilation were the number of pre-existing conditions and tetraplegia-specific complications. CONCLUSIONS Our results confirm that patients with traumatic lower cervical spinal cord injuries defined by lesion level and AIS constitute a homogeneous group. This group is characterized by a high rate of pneumonia during the first 4 weeks after injury. The number of pre-existing general conditions and spinal injury-specific comorbidities are the only risk factors identified for the development of pneumonia and/or duration of ventilation.
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Affiliation(s)
- Thomas Liebscher
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital, Berlin, Germany,Correspondence to: Thomas Liebscher, Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Warener Straße 7, 12683 Berlin, Germany.
| | - Andreas Niedeggen
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital, Berlin, Germany
| | - Barbara Estel
- Clinic for Anesthesiology and Intensive Medicine, Trauma Hospital, Berlin, Germany
| | - Rainer O. Seidl
- Department of Otolaryngology, Trauma Hospital, Berlin, Germany
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Hawryluk G, Whetstone W, Saigal R, Ferguson A, Talbott J, Bresnahan J, Dhall S, Pan J, Beattie M, Manley G. Mean Arterial Blood Pressure Correlates with Neurological Recovery after Human Spinal Cord Injury: Analysis of High Frequency Physiologic Data. J Neurotrauma 2015; 32:1958-67. [PMID: 25669633 DOI: 10.1089/neu.2014.3778] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Current guidelines for the care of patients with acute spinal cord injuries (SCIs) recommend maintaining mean arterial pressure (MAP) values of 85-90 mm Hg for 7 days after an acute SCI however, little evidence supports this recommendation. We sought to better inform the relationship between MAP values and neurological recovery. A computer system automatically collected and stored q1 min physiological data from intensive care unit monitors on patients with SCI over a 6-year period. Data for 100 patients with acute SCI were collected. 74 of these patients had American Spinal Injury Association Impairment Scale (AIS) grades determined by physical examination on admission and at time of hospital discharge. Average MAP values as well as the proportion of MAP values below thresholds were explored for values from 120 mm Hg to 40 mm Hg in 1 mm Hg increments; the relationship between these measures and outcome was explored at various time points up to 30 days from the time of injury. A total of 994,875 q1 min arterial line blood pressure measurements were recorded for the included patients amid 1,688,194 min of recorded intensive care observations. A large proportion of measures were below 85 mm Hg despite generally acceptable average MAP values. Higher average MAP values correlated with improved recovery in the first 2-3 days after SCI while the proportion of MAP values below the accepted threshold of 85 mm Hg seemed a stronger correlate, decreasing in strength over the first 5-7 days after injury. This study provides strong evidence supporting a correlation between MAP values and neurological recovery. It does not, however, provide evidence of a causal relationship. Duration of hypotension may be more important than average MAP. It provides support for the notion of MAP thresholds in SCI recovery, and the highest MAP values correlated with the greatest degree of neurological recovery. The results are concordant with current guidelines in suggesting that MAP thresholds >85 mm Hg may be appropriate after acute SCI.
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Affiliation(s)
- Gregory Hawryluk
- 1 Department of Neurosurgery, University of Utah , Salt Lake City, Utah.,3 Department of Brain and Spinal Cord Injury Center (BASIC), University of California , San Francisco, San Francisco, California.,4 Department of Neurosurgery, University of California , San Francisco, San Francisco, California
| | - William Whetstone
- 2 Department of Emergency Medicine, University of California , San Francisco, San Francisco, California
| | - Rajiv Saigal
- 3 Department of Brain and Spinal Cord Injury Center (BASIC), University of California , San Francisco, San Francisco, California.,4 Department of Neurosurgery, University of California , San Francisco, San Francisco, California
| | - Adam Ferguson
- 3 Department of Brain and Spinal Cord Injury Center (BASIC), University of California , San Francisco, San Francisco, California.,4 Department of Neurosurgery, University of California , San Francisco, San Francisco, California
| | - Jason Talbott
- 5 Department of Radiology, University of California , San Francisco, San Francisco, California
| | - Jacqueline Bresnahan
- 3 Department of Brain and Spinal Cord Injury Center (BASIC), University of California , San Francisco, San Francisco, California.,4 Department of Neurosurgery, University of California , San Francisco, San Francisco, California
| | - Sanjay Dhall
- 3 Department of Brain and Spinal Cord Injury Center (BASIC), University of California , San Francisco, San Francisco, California.,4 Department of Neurosurgery, University of California , San Francisco, San Francisco, California
| | - Jonathan Pan
- 6 Department of Anaesthesia, University of California , San Francisco, San Francisco, California
| | - Michael Beattie
- 3 Department of Brain and Spinal Cord Injury Center (BASIC), University of California , San Francisco, San Francisco, California.,4 Department of Neurosurgery, University of California , San Francisco, San Francisco, California
| | - Geoffrey Manley
- 3 Department of Brain and Spinal Cord Injury Center (BASIC), University of California , San Francisco, San Francisco, California.,4 Department of Neurosurgery, University of California , San Francisco, San Francisco, California
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Development and validation of a risk prediction model for tracheostomy in acute traumatic cervical spinal cord injury patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:975-84. [PMID: 25542384 DOI: 10.1007/s00586-014-3731-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE Tracheostomy may become indispensable for patients with acute traumatic cervical spinal cord injuries. However, the early prediction of a tracheostomy is often difficult. Previous prediction models using the pulmonary function test (PFT) have limitations because some severely injured patients could not provide acceptable PFT results. We aim to develop an alternative model for predicting tracheostomy using accessible data obtained from the bedside. METHOD Clinical, neurological and radiological data from 345 consecutive patients with acute tetraplegia were retrospectively reviewed. We applied multiple logistic regression analysis (MLRA) and classification and regression tree (CART) analysis to develop the prediction model for tracheostomy. By train-test cross-validation, we used the sensitivity, specificity, area under the receiver operating characteristics curve (AUC) and correction rate to evaluate the performance of these models. RESULTS According to the American Spinal Injury Association (ASIA) standards, an admission ASIA motor score (AAMS) ≤ 22, ASIA grade A and presence of respiratory complications were identified as independent predictors of tracheostomy by both models. The model derived by CART suggested that the highest signal change (HSC) in the spinal cord on magnetic resonance imaging (MRI) also affected a patient's requirement for a tracheostomy, while MLRA demonstrated that tracheostomy was also influenced by the presence of an ASIA grade B injury. The CART model had a sensitivity of 73.7%, specificity of 89.7%, AUC of 0.909 and overall correction rate of 87.3%. The sensitivity, specificity, AUC and correction rate of the MLRA model were 81.8, 86.4, 0.889 and 85.7%, respectively. CONCLUSIONS We suggest using the CART model in clinical applications. Patients with AAMS ≤ 1 exhibit an increased likelihood of requiring a tracheostomy. For patients with an AAMS in the range of 2-22, surgeons should consider giving these patients a tracheostomy once respiratory complications occur. Surgeons should be cautious to give a tracheostomy to patients with an AAMS ≥ 23, if the patient experiences an incomplete spinal cord injury and the HSC in the spinal cord is at C3 level or lower based on MRI. For other patients, close observation is necessary; generally, patients with complete SCI might require a tracheostomy more frequently.
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Wagner AK. A Rehabilomics framework for personalized and translational rehabilitation research and care for individuals with disabilities: Perspectives and considerations for spinal cord injury. J Spinal Cord Med 2014; 37:493-502. [PMID: 25029659 PMCID: PMC4166184 DOI: 10.1179/2045772314y.0000000248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Despite many people having similar clinical presentation, demographic factors, and clinical care, outcome can differ for those sustaining significant injury such as spinal cord injury (SCI) and traumatic brain injury (TBI). In addition to traditional demographic, social, and clinical factors, variability also may be attributable to innate (including genetic, transcriptomic proteomic, epigenetic) biological variation that individuals bring to recovery and their unique response to their care and environment. Technologies collectively called "-omics" enable simultaneous measurement of an enormous number of biomolecules that can capture many potential biological contributors to heterogeneity of injury/disease course and outcome. Due to the nature of injury and complex disease, and its associations with impairment, disability, and recovery, rehabilitation does not lend itself to a singular "protocolized" plan of therapy. Yet, by nature and by necessity, rehabilitation medicine operates as a functional model of "Personalized Care". Thus, the challenge for successful programs of translational rehabilitation care and research is to identify viable approaches to examine broad populations, with varied impairments and functional limitations, and to identify effective treatment responses that incorporate personalized protocols to optimize functional recovery. The Rehabilomics framework is a translational model that provides an "-omics" overlay to the scientific study of rehabilitation processes and multidimensional outcomes. Rehabilomics research provides novel opportunities to evaluate the neurobiology of complex injury or chronic disease and can be used to examine methods and treatments for person-centered care among populations with disabilities. Exemplars for application in SCI and other neurorehabilitation populations are discussed.
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Affiliation(s)
- Amy K. Wagner
- Correspondence to: Amy K. Wagner, MD Department of Physical Medicine and Rehabilitation, Safar Center for Resuscitation Research, University of Pittsburgh, 3471 5th Avenue Suite 202, Pittsburgh, PA 15213, USA.
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Huang YH, Ou CY. Magnetic resonance imaging predictors for respiratory failure after cervical spinal cord injury. Clin Neurol Neurosurg 2014; 126:30-4. [PMID: 25194681 DOI: 10.1016/j.clineuro.2014.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 08/03/2014] [Accepted: 08/09/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients after cervical spinal cord injury (CSCI) may experience ventilator-dependent respiratory failure during the acute hospitalization period. The aim of the study is to identify imaging factors that predict respiratory failure after acute CSCI. MATERIALS AND METHODS We enrolled 108 patients diagnosed with CSCI in 4 years. The definition of respiratory failure consisted of the requirement of a definitive airway and the assistance of mechanical ventilation. Objective neurological function was determined using the classification of the American Spinal Injury Association (ASIA). We evaluated the characteristics of magnetic resonance imaging (MRI) of the cervical spine. RESULTS Respiratory failure occurred in 8 (7.40%) of 108 CSCI patients. The ASIA classification of the 108 patients were A (6), B (3), C (60), D (27), and E (12), and the 8 respiratory failure patients were A (3), B (1), and C (4). Seven of 8 patients with respiratory failure and 78 of 100 patients without respiratory failure had a neurological level of C5 or above by the ASIA standards (p=1.000). The imaging level of injury at C3 by MRI was identified in 5 of 8 patients that developed respiratory failure and more frequent than injury at the lower cervical levels (p<0.001). The presence of spinal cord edema was another predictor of respiratory failure (p=0.009). CONCLUSION MRI can accurately localize CSCI and identify those patients at risk of respiratory failure. Imaging level of injury at C3 and presence of spinal cord edema are both predictors. To prevent secondary cord injury from prolonged hypoxia and facilitate pulmonary care, definitive airways should be established early in high risk patients.
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Affiliation(s)
- Yu-Hua Huang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Yu Ou
- Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
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Firempong AO, Shaheen MA, Pan D, Drazin D. Racial and ethnic disparities in the incidence and mortality from septic shock and respiratory failure among elective neurosurgery patients. Neurol Res 2014; 36:857-65. [DOI: 10.1179/1743132814y.0000000343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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