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

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.

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

2020 ◽  
Vol 32 (1) ◽  
pp. 127-132 ◽  
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.

scholarly journals Serum Albumin Predicts Long-Term Neurological Outcomes After Acute Spinal Cord Injury

2017 ◽  
Vol 32 (1) ◽  
pp. 7-17 ◽  
Author(s):  
Bobo Tong ◽  
Catherine R. Jutzeler ◽  
Jacquelyn J. Cragg ◽  
Lukas Grassner ◽  
Jan M. Schwab ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Trials ◽  
Lower Extremity ◽  
Serum Albumin ◽  
Injury Severity ◽  
International Standards ◽  
Neurological Outcomes ◽  
Cord Injury

Background. There is a need to identify reliable biomarkers of spinal cord injury recovery for clinical practice and clinical trials. Objective. Our objective was to correlate serum albumin levels with spinal cord injury neurological outcomes. Methods. We performed a secondary analysis of patients with traumatic spinal cord injury (n = 591) participating in the Sygen clinical trial. Serum albumin concentrations were obtained as part of routine blood chemistry analysis, at trial entry (24-72 hours), 1, 2, and 4 weeks after injury. The primary outcomes were “marked recovery” and lower extremity motor scores, derived from the International Standards for the Neurological Classification of Spinal Cord Injury. Data were analyzed with multivariable logistic and linear regression to adjust for potential confounders. Results. Serum albumin was significantly associated with spinal cord injury neurological outcomes. Higher serum albumin concentrations at 1, 2, and 4 weeks were associated with higher 52-week lower extremity motor score. Similarly, the odds of achieving “marked neurological recovery” was greater for individuals with higher serum albumin concentrations. The association between serum albumin concentrations and neurological outcomes was independent of initial injury severity, treatment with GM-1, and polytrauma. Conclusions. In spinal cord injury, serum albumin is an independent marker of long-term neurological outcomes. Serum albumin could serve as a feasible biomarker for prognosis at the time of injury and stratification in clinical trials.

scholarly journals Falls from Height: Ambulation Following Spinal Cord Injury and Lower Extremity Polytrauma

2021 ◽  
pp. 101137
Author(s):  
Alexis Gutierrez ◽  
Rachel Blue ◽  
Patricia Zadnik-Sullivan ◽  
Blair Ashley ◽  
Samir Mehta ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Lower Extremity ◽  
Cord Injury

scholarly journals Upper vs Lower Extremity Arterial Function After Spinal Cord Injury

2006 ◽  
Vol 29 (2) ◽  
pp. 138-146 ◽  
Author(s):  
Lee Stoner ◽  
Manning Sabatier ◽  
Leslie VanhHiel ◽  
Danielle Groves ◽  
David Ripley ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Lower Extremity ◽  
Arterial Function ◽  
Cord Injury

MR Imaging for Assessing Injury Severity and Prognosis in Acute Traumatic Spinal Cord Injury

2019 ◽  
Vol 57 (2) ◽  
pp. 319-339 ◽  
Author(s):  
Jason F. Talbott ◽  
John Russell Huie ◽  
Adam R. Ferguson ◽  
Jacqueline C. Bresnahan ◽  
Michael S. Beattie ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mr Imaging ◽  
Injury Severity ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury

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

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.

scholarly journals Design and Experimental Evaluation of a Vertical Lift Walker for Sit-to-Stand Transition Assistance

2012 ◽  
Vol 6 (1) ◽  
Author(s):  
Thomas C. Bulea ◽  
Ronald J. Triolo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Lower Extremity ◽  
Grip Force ◽  
Hand Function ◽  
Electrical Power ◽  
Lower Extremity Weakness ◽  
Sit To Stand ◽  
Cord Injury ◽  
Vertical Lift

A walker capable of providing vertical lift support can improve independence and increase mobility of individuals living with spinal cord injury (SCI). Using a novel lifting mechanism, a walker has been designed to provide sit-to-stand assistance to individuals with partially paralyzed lower extremity muscles. The design was verified through experiments with one individual with SCI. The results show the walker is capable of reducing the force demands on the upper and lower extremity muscles during sit-to-stand transition compared to standard walkers. The walker does not require electrical power and no grip force or harness is necessary during sit-to-stand operation, enabling its use by individuals with limited hand function. The design concept can be extended to aid other populations with lower extremity weakness.

Sign in / Sign up

Export Citation Format

Share Document