Acute management of traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study

Abstract

Study design: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS). Objectives: To characterize patient populations and to compare acute management after traumatic spinal cord injury (TSCI). Settings: The Greater Thessaloniki region in Greece and the Greater Stockholm region in Sweden. Methods: Inception cohorts with acute TSCI that were hospitalized during the study period, that is September 2006 to October 2007, were identified. Overall, 81 out of 87 cases consented to inclusion in Thessaloniki and 47 out of 49 in Stockholm. Data from Thessaloniki were collected through physical examinations, medical record reviews and communication with TSCI cases and medical teams. Data from Stockholm were retrieved from the Nordic Spinal Cord Injury Registry. Results: There were no significant differences between study groups with regard to core clinical characteristics. In contrast, there were significant differences in (1) transfer logistics from the scene of trauma to a tertiary-level hospital (number of intermediate admissions, modes of transportation and duration of transfer) and (2) acute key therapeutic interventions, that is, the use of mechanical ventilation (49% in Thessaloniki versus 20% in Stockholm), and performance of tracheostomy (36% in Thessaloniki versus 15% in Stockholm); spinal surgery was performed significantly more often and earlier in Stockholm than in Thessaloniki. Conclusions: Despite largely similar core clinical characteristics, Stockholm and Thessaloniki cases underwent significantly different acute management, most probably to be attributed to adaptations to the differing regional approaches of care one following a systematic approach of SCI care and the other not.

Traumatic spinal cord injuries: evidence from 30 years in a single centre

“…15 Today, in our centre, most patients with acute TSCI undergo surgery early after injury, with the aim of decompressing the spinal cord and/or stabilising the unstable vertebral column. Divanoglou et al 15,16 found in their study that, in Thessaloniki area in Greece, 63 out of 81 cases (78%) were surgically treated for their vertebral lesion after an average time of 10 days, whereas in Stockholm 46 out of 47 (98%) underwent surgery after an average time of 3 days. A surgical stabilisation of the spine may mostly allow the rehabilitation to start earlier and might reduce the risk of complications due to the prolonged forced immobilisation in bed during the acute rehabilitation phase.…”

Medical conditions and outcomes at 1 year after acute traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study

“…9 By contrast, the low incidence of deep venous thrombosis and pulmonary embolism in both regions likely reflects the implemented clinical protocol of systematic administration of anticoagulant prophylaxis. 8 Symptomatic UTIs and pneumonia affected similar proportions between regions. Although some complications become self-evident, some others become evident only in the long term, or in the course of comprehensive monitoring.…”

“…Details on data collection have been provided elsewhere. 8 Functional outcome was assessed with the 'motor part' of FIM, while the communication and the social cognition parts were disregarded. The motor part of FIM is an ordinal scale with values between 13 and 91, in which the higher the score, the more independent the person is on performing Activities of Daily Living.…”

“…7 Furthermore, despite the two groups appearing with similar clinical characteristics on admission, they received statistically significant different acute management. 8 Finally, STATSCIS has reported that 'late' case-mortality rate, that is, mortality occurring during the first year but later than 7 days post-trauma, was dramatically higher in Thessaloniki, reaching nearly 20%, as compared to 0% in Stockholm. 9 In this paper, the two study groups were assessed in terms of (a) outcomes, (b) length of stay (LOS), (c) associated conditions and their management and (d) medical complications during the first year post-trauma.…”

Access to surgical upper extremity care for people with tetraplegia: an international perspective

“…In Stockholm, Sweden, there is an established SCI care program consisting of one hospital-based Spinal Injury Unit, two inpatient rehabilitation centers and one outpatient clinic for lifelong follow-up. In a series of recent articles Divanoglou et al [16][17][18][19] have compared outcomes after traumatic SCI in Sweden to the more fragmented system in Greece. The Swedish group noted improved survival, decreased length of stay and earlier surgical intervention with fewer readmissions compared with the Greek group.…”