Spinal Cord Injury Following Motor Vehicle Accidents

Object The aim of this multicenter, prospective study was to determine the spectrum, incidence, and severity of complications during the initial hospitalization of patients with spinal cord injury. Methods The study was conducted at 9 university-affiliated hospitals that comprise the clinical centers of the North American Clinical Trials Network (NACTN) for Treatment of Spinal Cord Injury. The study population comprised 315 patients admitted to NACTN clinical centers between June 25, 2005, and November 2, 2010, who had American Spinal Injury Association (ASIA) Impairment Scale grades of A–D and were 18 years of age or older. Patients were managed according to a standardized protocol. Results The study population was 79% male with a median age of 44 years. The leading causes of injury were falls (37%) and motor vehicle accidents (28%). The distribution of initial ASIA grades were A (40%), B (16%), C (15%), and D (29%). Fifty-eight percent of patients sustained 1 or more severe, moderate, or mild complications. Complications were associated with more severe ASIA grade: 84% of patients with Grade A and 25% of patients with Grade D had at least 1 complication. Seventy-eight percent of complications occurred within 14 days of injury. The most frequent types of severe and moderate complications were respiratory failure, pneumonia, pleural effusion, anemia, cardiac dysrhythmia, and severe bradycardia. The mortality rate was 3.5% and was associated with increased age and preexisting morbidity. Conclusions Knowledge of the type, frequency, time of occurrence, and severity of specific complications that occur after spinal cord injury can aid in their early detection, treatment, and prevention. The data are of importance in evaluating and selecting therapy for clinical trials.

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Analysis of patients with spinal cord trauma associated with traumatic brain injury

Coluna/Columna ◽

10.1590/s1808-18512014130400459 ◽

2014 ◽

Vol 13 (4) ◽

pp. 302-305 ◽

Cited By ~ 2

Author(s):

João Simão de Melo Neto ◽

Waldir Antônio Tognola ◽

Antonio Ronaldo Spotti ◽

Dionei Freitas de Morais

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Spinal Cord ◽

Brain Injury ◽

Injury Risk ◽

Motor Vehicle ◽

Motor Vehicle Accidents ◽

Vehicle Accidents ◽

Risk Of Death ◽

Cord Injury

Objective: Characterize victims of spinal cord injury (SCI) associated with traumatic brain injury (TBI) and risk factors. Methods: Study conducted with 52 victims of SCI associated with TBI. The variables studied were: sex; age; marital status; occupation; educational level; religion; etiology and the lesion area; neurological condition by the ASIA scale; associated injuries and potential risk factors. Results: The male (85%), aged between 21-30 years (25%), civil status stable union (56%), low level of education (69%) and the Roman Catholic religion (77%) presented the greater number of victims. Motor vehicle accidents (58%) were the main etiology. The cervical segment had higher injury risk (RR=3.48, p<0.0001). The neurological status ASIA-E (52%), the syndromic neck pain (35%) and the rate of mild TBI (65%) were the most frequent. Complications occurred in 13 patients with increased frequency of pneumonia (62%). The length of hospital stay was significantly higher (20±28 days) and 17% of patients died. Men (RR=2.14, p=0.028) and individuals exposed to motor vehicle accidents (RR=1.91, p=0.022) showed a higher risk of these lesions concurrently. Moreover, these patients had 2.48 (p<0.01) higher risk of death than victims of SCI alone. Conclusion: The SCI associated with TBI was more frequent in men, young adults, and individuals exposed to motor vehicle accidents. The cervical spine is more likely to be affected. Furthermore, the length of hospitalization is significantly higher and the subjects analyzed have higher risk of death.

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Spine Trauma

Oxford Textbook of Neuroscience and Anaesthesiology ◽

10.1093/med/9780198746645.003.0021 ◽

2019 ◽

pp. 255-262

Author(s):

Timur M. Urakov ◽

Michael Y. Wang

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Motor Vehicle ◽

Fluid Management ◽

The Elderly ◽

Autonomic Dysreflexia ◽

Spine Trauma ◽

Vehicle Accidents ◽

Cord Injury ◽

Anaesthesia Care

The estimated global incidence of spinal cord injury (SCI) is 250,000 to 500,000 people a year. North America tends to have higher rates of incidence of SCI than Europe. Statistically, young adults and the elderly are more likely to be injured. Motor vehicle accidents are the leading cause of SCI in the world, followed by falls, violence, sports, recreational activities, and iatrogenic sources. This chapter on spine trauma includes elements of anatomy and anaesthesia care for acute cervical spine cord injury (including airway management, blood pressure management, fluid management, hypothermia, monitoring, and steroids). It also covers anaesthesia care for chronic spinal cord injury (including autonomic dysreflexia, physiological changes in chronic SCI patients, and obstetrics).

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Maximum Movement and Cumulative Movement (Travel) to Inform our Understanding of Secondary Spinal Cord Injury and its Application to Collar use in Self-extrication

10.21203/rs.3.rs-1074763/v1 ◽

2021 ◽

Author(s):

Tim Nutbeam ◽

Rob Fenwick ◽

Barbara May ◽

Willem Stassen ◽

Jason Smith ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Healthy Volunteers ◽

Motor Vehicle ◽

Cervical Collar ◽

Spinal Movement ◽

Cord Injury ◽

Total Movement ◽

The Mean ◽

Secondary Spinal Cord Injury

Abstract Background:Motor vehicle collisions remain a common cause of spinal cord injury. Biomechanical studies of spinal movement often lack “real world” context and applicability. Additional data may enhance our understanding of the potential for secondary spinal cord injury. We propose the metric ‘travel’ (total movement) and suggest that our understanding of movement related risk of injury could be improved if travel was routinely reported. We report maximal movement and travel for collar application in vehicle and subsequent self-extrication.Methods:Biomechanical data on application of cervical collar with the volunteer sat in a vehicle were collected using Inertial Measurement Units on 6 healthy volunteers. Maximal movement and travel are reported. These data and a re-analysis of previously published work is used to demonstrate the utility of travel and maximal movement in the context of self-extrication.Results:Data from a total of 60 in-vehicle collar applications across three female and three male volunteers was successfully collected for analysis. The mean age across participants was 50.3 years (range 28–68) and the BMI was 27.7 (range 21.5–34.6). The mean maximal anterior-posterior movement associated with collar application was 2.3mm with a total AP travel of 4.9mm. Travel (total movement) for in-car application of collar and self-extrication was 9.5mm compared to 9.4mm travel for self-extrication without a collar. Conclusion:We have demonstrated the application of ‘travel’ in the context of self-extrication. Total travel is similar across self-extricating healthy volunteers with and without a collar.We suggest that where possible ‘travel’ is collected and reported in future biomechanical studies in this and related areas of research. It remains appropriate to apply a cervical collar to self-extricating casualties when the clinical target is that of movement minimisation.

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Cruciate paralysis

Journal of Neurosurgery ◽

10.3171/jns.1986.65.1.0108 ◽

1986 ◽

Vol 65 (1) ◽

pp. 108-110 ◽

Cited By ~ 13

Author(s):

Daniel Dumitru ◽

James E. Lang

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Rare Case ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Cervical Spinal Cord ◽

Content Type ◽

Vehicle Accident ◽

Cord Injury ◽

Fine Print

✓ A rare case of cruciate paralysis is reported in a 39-year-old man following a motor-vehicle accident. The differentiation of this syndrome from a central cervical spinal cord injury is delineated.

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Utilization of State-Wide Hospital Separations Data and the Injury Impairment Scale to Assess the Incidence of Spinal Cord Injury Arising from Motor Vehicle Traffic Crashes

Traffic Injury Prevention ◽

10.1080/15389580490510291 ◽

2004 ◽

Vol 5 (4) ◽

pp. 362-367 ◽

Cited By ~ 2

Author(s):

PETER J. O'CONNOR

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Motor Vehicle ◽

Traffic Crashes ◽

Vehicle Traffic ◽

Cord Injury

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Incidence of intraoperative hypotension in acute traumatic spinal cord injury and associated factors

Journal of Neurosurgery Spine ◽

10.3171/2019.7.spine19132 ◽

2020 ◽

Vol 32 (1) ◽

pp. 127-132 ◽

Cited By ~ 1

Author(s):

Xavier P. Gaudin ◽

Jacob C. Wochna ◽

Timothy W. Wolff ◽

Sean M. Pugh ◽

Urmil B. Pandya ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Associated Factors ◽

Injury Severity ◽

Motor Vehicle ◽

Spinal Instrumentation ◽

Discharge Disposition ◽

Intraoperative Hypotension ◽

Cord Injury ◽

Asia Score

OBJECTIVEThe importance of maintaining mean arterial pressure (MAP) > 85 mm Hg for patients with acute spinal cord injury (SCI) is well documented, because systemic hypotension greatly increases the risk of secondary SCI. Current literature focuses on the ICU setting; however, there is a paucity of data describing the changes in MAP in the operating room (OR). In the present study, the authors investigated the incidence of intraoperative hypotension for patients with acute traumatic SCI as well as any associated factors that may have impacted these findings.METHODSThis retrospective study was performed at a level 1 trauma center from 2015 to 2016. All patients with American Spinal Injury Association (ASIA) score A–D acute traumatic SCIs from C1 to L1 were identified. Those included underwent spinal instrumentation and/or laminectomy decompression. Associated factors investigated include the following: age, body mass index, trauma mechanism of injury, Injury Severity Score, level of SCI, ASIA score, hospital day of surgery, total OR time, need for laminectomy decompression, use of spinal fixation, surgical positioning, blood loss, use of blood products, length of hospital stay, length of ICU stay, and discharge disposition. Intraoperative minute-by-minute MAP recordings were used to determine time spent in various MAP ranges.RESULTSThirty-two patients underwent a total of 33 operations. Relative to the total OR time, patients spent an average of 51.9% of their cumulative time with an MAP < 85 mm Hg. Furthermore, 100% of the study population recorded at least one MAP measurement < 85 mm Hg. These hypotensive episodes lasted a mean of 103 cumulative minutes per operative case. Analysis of associated factors demonstrated that fall mechanisms of injury led to a statistically significant increase in intraoperative hypotension compared to motor vehicle collisions/motorcycle collisions (p = 0.033). There were no significant differences in MAP recordings when analyzed according to all other associated factors studied.CONCLUSIONSThis is the first study reporting the incidence of intraoperative hypotension for patients with acute traumatic SCIs, and the results demonstrated higher proportions of relative hypotension than previously reported in the ICU setting. Furthermore, the authors identified that every patient experienced at least one MAP below the target value, which was much greater than the initial hypothesis of 50%. Given the findings of this study, adherence to the MAP protocol intraoperatively needs to be improved to minimize the risk of secondary SCI and associated deleterious neurological outcomes.

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Association of venous thromboembolism following pediatric traumatic spinal injuries with injury severity and longer hospital stays

Journal of Neurosurgery Spine ◽

10.3171/2021.3.spine201981 ◽

2021 ◽

pp. 1-7

Author(s):

Blake M. Hauser ◽

Samantha E. Hoffman ◽

Saksham Gupta ◽

Mark M. Zaki ◽

Edward Xu ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Venous Thromboembolism ◽

Lower Extremity ◽

Epidural Hematoma ◽

Pediatric Patients ◽

Injury Severity ◽

Motor Vehicle ◽

Spinal Injuries ◽

Cord Injury

OBJECTIVE Venous thromboembolism (VTE) can cause significant morbidity and mortality in hospitalized patients, and may disproportionately occur in patients with limited mobility following spinal trauma. The authors aimed to characterize the epidemiology and clinical predictors of VTE in pediatric patients following traumatic spinal injuries (TSIs). METHODS The authors conducted a retrospective cohort analysis of children who experienced TSI, including spinal fractures and spinal cord injuries, encoded within the National Trauma Data Bank from 2011 to 2014. RESULTS Of the 22,752 pediatric patients with TSI, 192 (0.8%) experienced VTE during initial hospitalization. Proportionally, more patients in the VTE group (77%) than in the non-VTE group (68%) presented following a motor vehicle accident. Patients developing VTE had greater odds of presenting with moderate (adjusted odds ratio [aOR] 2.6, 95% confidence interval [CI] 1.4–4.8) or severe Glasgow Coma Scale scores (aOR 4.3, 95% CI 3.0–6.1), epidural hematoma (aOR 2.8, 95% CI 1.4–5.7), and concomitant abdominal (aOR 2.4, 95% CI 1.8–3.3) and/or lower extremity (aOR 1.5, 95% CI 1.1–2.0) injuries. They also had greater odds of being obese (aOR 2.9, 95% CI 1.6–5.5). Neither cervical, thoracic, nor lumbar spine injuries were significantly associated with VTE. However, involvement of more than one spinal level was predictive of VTE (aOR 1.3, 95% CI 1.0–1.7). Spinal cord injury at any level was also significantly associated with developing VTE (aOR 2.5, 95% CI 1.8–3.5). Patients with VTE stayed in the hospital an adjusted average of 19 days longer than non-VTE patients. They also had greater odds of discharge to a rehabilitative facility or home with rehabilitative services (aOR 2.6, 95% CI 1.8–3.6). CONCLUSIONS VTE occurs in a low percentage of hospitalized pediatric patients with TSI. Injury severity is broadly associated with increased odds of developing VTE; specific risk factors include concomitant injuries such as cranial epidural hematoma, spinal cord injury, and lower extremity injury. Patients with VTE also require hospital-based and rehabilitative care at greater rates than other patients with TSI.

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