scholarly journals Early Trauma Indicators and Rehabilitation Outcomes in Traumatic Spinal Cord Injury

2020 ◽  
Vol 26 (4) ◽  
pp. 253-260
Author(s):  
Chloe Slocum ◽  
Cristina Shea ◽  
Richard Goldstein ◽  
Ross Zafonte
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Outcome Measures ◽  
Ventilatory Support ◽  
Inpatient Rehabilitation ◽  
Model Systems ◽  
Neurologic Recovery ◽  
Rehabilitation Outcomes ◽  
Cord Injury ◽  
Early Trauma

Objectives: To investigate the relationship between early trauma indicators and neurologic recovery after traumatic SCI using standardized outcome measures from the ISNCSCI examination and standardized functional outcome measures for rehabilitation populations. Methods: This is a retrospective review of merged, prospectively collected, multicenter data from the Spinal Cord Injury Model Systems (SCIMS) database and institutional trauma databases from five academic medical centers across the United States. Functional status at inpatient rehabilitation discharge and change in severity and level of injury from initial SCI to inpatient rehabilitation discharge were analyzed to assess neurologic recovery for patients with traumatic SCI. Linear and logistic regression with multiple imputation were used for the analyses. Results: A total of 209 patients were identified. Mean age at injury was 47.2 ± 18.9 years, 72.4% were male, 22.4% of patients had complete injuries at presentation to the emergency department (ED), and most patients were admitted with cervical SCI. Mean systolic blood pressure (SBP) was 124.1 ± 29.6 mm Hg, mean ED heart rate was 83.7 ± 19.9 bpm, mean O2 saturation was 96.8% ± 4.0%, and mean Glasgow Coma Scale (GCS) score was 13.3 ± 3.9. The average Injury Severity Score (ISS) in this population was 22.4. Linear regression analyses showed that rehabilitation discharge motor FIM was predicted by motor FIM on admission and ISS. Requiring ventilatory support on ED presentation was negatively associated with improvement of ASIA Impairment Scale (AIS) grade at rehabilitation discharge compared with AIS grade after initial injury. Emergency room physiologic measures (SBP, pulse, oxygen saturation) did not predict discharge motor FIM or improvement in AIS grade or neurological level of injury. Conclusion: Our study showed a positive association between discharge FIM and ISS and a negative association between ventilatory support at ED presentation and AIS improvement. The absence of any significant association between other physiologic or clinical variables at ED presentation with rehabilitation outcomes suggests important areas for future clinical research.

Longitudinal Trends and Prevalence of Bowel Management in Individuals With Spinal Cord Injury

2021 ◽  
Vol 27 (4) ◽  
pp. 53-67
Author(s):  
Nicholas Dietz ◽  
Kwadwo Sarpong ◽  
Beatrice Ugiliweneza ◽  
Dengzhi Wang ◽  
Sevda S. Aslan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Inpatient Rehabilitation ◽  
Model Systems ◽  
Significant Shift ◽  
Post Injury ◽  
Bowel Management ◽  
Cord Injury ◽  
Over Time

Background: Neurogenic bowel dysfunction (NBD) following spinal cord injury (SCI) represents a major source of morbidity, negatively impacting quality of life and overall independence. The long-term changes in bowel care needs are not well-reported, preventing consensus on the natural course and optimal management of NBD following injury. Objectives: To understand the changes in bowel management needs over time following SCI. Methods: A retrospective observational study using the National Spinal Cord Injury Model Systems database evaluated the degree of independence with bowel management at discharge from inpatient rehabilitation across time (1988–2016). The prevalence and consecutive trajectory of bowel management was also evaluated at discharge and at each 5-year follow-up period, for 25 years. Results: The majority of individuals discharged from inpatient rehabilitation (n = 17,492) required total assistance with bowel management, a trend that significantly increased over time. However, by 5-years post injury, there was a significant shift in bowel management needs from total assistance to modified independence. In those with consecutive 25-year follow-up data (n = 11,131), a similar shift in bowel management to a less dependent strategy occurred even at chronic time points post injury, primarily in individuals with paraplegia and classified as motor and sensory complete. Conclusion: The findings of this study highlight the need for providing continued multipronged interventions (e.g., rehabilitative, educational, psycho-social) at the different stages of SCI to support individuals not only in the immediate years after discharge but also well into the chronic stages after injury.

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