Characteristics and Survival of Patients with Acute Traumatic Spinal Cord Injury Above T6 with Prolonged Intensive Care Unit Stays

Esmorís-Arijón, Inés; Galeiras, Rita; Barrera, S. Salvador de la; Fariña, Mónica Mourelo; Pértega-Díaz, Sonia

doi:10.1016/j.wneu.2021.06.055

Cited by 5 publications

(8 citation statements)

References 25 publications

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“…When considering the number of days in the ICU, our study found an average of 30.7 days (6–127 days). Esmorís-Arijón et al 12 found a similar number of ICU days for patients with SCIs above T6 (23.8 days). Our patient’s longer hospital LOS is likely associated with the number of complications experienced by patients in our population.…”

Section: Discussionmentioning

confidence: 76%

“…7,10,11 Many of these complications can occur simultaneously, oftentimes leading to an extensive hospital course with prolonged time in the intensive care unit (ICU). 12 Protracted hospital course can result in a significant burden to the health care system with significant resource utilization. 13 In addition to these burdens, these devasting injuries have profound psychological impacts on patients and family members of those affected.…”

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confidence: 99%

“…Medical complications include respiratory, cardiac, urologic, musculoskeletal, and pressure-related injuries 7,10,11 . Many of these complications can occur simultaneously, oftentimes leading to an extensive hospital course with prolonged time in the intensive care unit (ICU) 12 . Protracted hospital course can result in a significant burden to the health care system with significant resource utilization 13 .…”

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confidence: 99%

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Hospital Course and Complications of Subaxial Cervical Trauma Patients With Tetraplegia or Paraplegia

Scott,

Patel,

Lucasti

et al. 2023

Clinical Spine Surgery

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Study Design: A single-institution, retrospective cohort study Objective: The objective was to present demographic characteristics, mechanism of injuries, lengths of stay, intensive care unit (ICU) days, discharge locations, and causes of 90-day readmission for patients with subaxial spinal cord injuries resulting in paraplegia or tetraplegia. Summary of Background Data: Spinal cord injuries resulting in paraplegia or tetraplegia are rare injuries with debilitating outcomes. Numerous advances have occurred in caring for these patients, but patients still experience multiple complications. The severity of these injuries and numerous complications result in prolonged hospital stays and the need for extensive rehabilitation. Methods: Twelve patients with subaxial spinal cord injury resulting in paraplegia or tetraplegia from a level 1 adult trauma center were reviewed. The primary outcomes included hospital length of stay, ICU days, intrahospital complications, 90-day readmission rates, and discharge location. We reviewed the literature for these outcomes in spinal cord injuries. Results: For patients with subaxial spinal cord injuries resulting in paraplegia and tetraplegia, the average age was 36.0 years, and most were male [91.7% (11/12)]. The most common mechanism of injury was gunshot wounds[41.7% (5/12)]. Patients spent an average of 46.3 days in the hospital and 30.7 days in the ICU. Respiratory complications were the most common (9 patients). Fifty percent of patients (6/12) were discharged to the inpatient spinal cord rehab center, and 16.7% (2/12) expired while in the hospital. Two patients (20.0%) were readmitted within 90 days of discharge. Conclusions: Most patients with subaxial spinal cord injuries resulting in paraplegia or tetraplegia were young males with high-energy traumas. Many patients had intrahospital complications, and most were discharged to the hospital spinal rehab center. These findings likely stem from the severity of paraplegia and tetraplegia injuries and the need for rehabilitation.

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Section: Discussionmentioning

confidence: 76%

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confidence: 99%

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confidence: 99%

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Hospital Course and Complications of Subaxial Cervical Trauma Patients With Tetraplegia or Paraplegia

Scott,

Patel,

Lucasti

et al. 2023

Clinical Spine Surgery

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“…2 Due to severe incapacitation of the limbs below the injured segment after SCI, SCI not only causes considerable physical suffering and mental distress to patients themselves, but also incurs substantial economic burdens for families and society. 3 According to incomplete statistics, SCI affects more than 2 million people worldwide. Therefore, finding ways to repair damage to spinal cord tissue is a common goal in modern medicine.…”

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confidence: 99%

“…Among all the directly or indirectly causal external factors resulting in SCI, the trauma, which including traffic accidents, falls and sports/recreation, are the most common etiologies of SCI [ 2 ]. Due to severe incapacitation of the limbs below the injured segment after SCI, SCI not only causes considerable physical suffering and mental distress to patients themselves, but also incurs substantial economic burdens for families and society [ 3 ]. According to incomplete statistics, SCI affects more than 2 million people worldwide.…”

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confidence: 99%

Commentary on “Established and Emerging Therapies in Acute Spinal Cord Injury”

Kong

2022

Neurospine

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Spinal cord injury (SCI) is a severe neurological disease commonly caused by traumas or variety diseases which can lead to complete or incomplete neural function deficiency. 1 Among all the directly or indirectly causal external factors resulting in SCI, the trauma, which including traffic accidents, falls and sports/recreation, are the most common etiologies of SCI. 2 Due to severe incapacitation of the limbs below the injured segment after SCI, SCI not only causes considerable physical suffering and mental distress to patients themselves, but also incurs substantial economic burdens for families and society. 3 According to incomplete statistics, SCI affects more than 2 million people worldwide. Therefore, finding ways to repair damage to spinal cord tissue is a common goal in modern medicine. Of course, understanding the molecular and cellular mechanisms contributing to the pathophysiology of SCI is essential for developing more effective therapeutic interventions.In the current study, Dr. Gadot et al. 4 have provided thoroughly review of the SCI, which including the mechanisms of SCI injury, SCI patient's clinical presentation, and established acute management strategies. All these subsections have focused the classical view about the mainly pathological changes during the SCI process, and novel understanding for SCI, as well as ongoing studies carried by worldwide.In general, the pathophysiological types of SCI are characterized as acute, secondary and chronic phases. 5 Primary damage to the spinal cord occurs as a direct result of the initial trauma, such as compression, shearing, laceration, transection, stretch, or distraction, leading to immediate hemorrhage or vasospasm and rapid cell death. 6 Concomitantly, Secondary injury closely follows in an ongoing way characterized by further damage to neuronal and glial cells and is accompanied by paralysis, intense pain, and progressive neurological damage. 7 This phase usually occurs within minutes after injury and can last for weeks even months. The concomitant and consecutive pathological events in this phase involve the immune response, inflammation, apoptotic cell death, and formation of cystic cavitations and astroglial scars. 8 Authors have provided novel reviews on these aspect in the section of "experimental acute management strategies" which containing 5 subsections for discussed and explored the details in each cited literatures in the categories of current novel understandings of SCI pathophysiology.

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Guidelines for neuroprognostication in adults with traumatic spinal cord injury

Mahanes,

Muehlschlegel,

Wartenberg

et al. 2023

Neurocrit Care

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Background Traumatic spinal cord injury (tSCI) impacts patients and their families acutely and often for the long term. The ability of clinicians to share prognostic information about mortality and functional outcomes allows patients and their surrogates to engage in decision-making and plan for the future. These guidelines provide recommendations on the reliability of acute-phase clinical predictors to inform neuroprognostication and guide clinicians in counseling adult patients with tSCI or their surrogates. Methods A narrative systematic review was completed using Grading of Recommendations Assessment, Development, and Evaluation methodology. Candidate predictors, including clinical variables and prediction models, were selected based on clinical relevance and presence of an appropriate body of evidence. The Population/Intervention/Comparator/Outcome/Timing/Setting question was framed as “When counseling patients or surrogates of critically ill patients with traumatic spinal cord injury, should < predictor, with time of assessment if appropriate > be considered a reliable predictor of < outcome, with time frame of assessment >?” Additional full-text screening criteria were used to exclude small and lower quality studies. Following construction of an evidence profile and summary of findings, recommendations were based on four Grading of Recommendations Assessment, Development, and Evaluation criteria: quality of evidence, balance of desirable and undesirable consequences, values and preferences, and resource use. Good practice recommendations addressed essential principles of neuroprognostication that could not be framed in the Population/Intervention/Comparator/Outcome/Timing/Setting format. Throughout the guideline development process, an individual living with tSCI provided perspective on patient-centered priorities. Results Six candidate clinical variables and one prediction model were selected. Out of 11,132 articles screened, 369 met inclusion criteria for full-text review and 35 articles met eligibility criteria to guide recommendations. We recommend pathologic findings on magnetic resonance imaging, neurological level of injury, and severity of injury as moderately reliable predictors of American Spinal Cord Injury Impairment Scale improvement and the Dutch Clinical Prediction Rule as a moderately reliable prediction model of independent ambulation at 1 year after injury. No other reliable or moderately reliable predictors of mortality or functional outcome were identified. Good practice recommendations include considering the complete clinical condition as opposed to a single variable and communicating the challenges of likely functional deficits as well as potential for improvement and for long-term quality of life with SCI-related deficits to patients and surrogates. Conclusions These guidelines provide recommendations about the reliability of acute-phase predictors of mortality, functional outcome, American Spinal Injury Association Impairment Scale grade conversion, and recovery of independent ambulation for consideration when counseling patients with tSCI or their surrogates and suggest broad principles of neuroprognostication in this context.

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Characteristics and Survival of Patients with Acute Traumatic Spinal Cord Injury Above T6 with Prolonged Intensive Care Unit Stays

Cited by 5 publications

References 25 publications

Hospital Course and Complications of Subaxial Cervical Trauma Patients With Tetraplegia or Paraplegia

Hospital Course and Complications of Subaxial Cervical Trauma Patients With Tetraplegia or Paraplegia

Commentary on “Established and Emerging Therapies in Acute Spinal Cord Injury”

Guidelines for neuroprognostication in adults with traumatic spinal cord injury

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