Predicting complicated outcomes in spinal cord injury patients with urinary tract infection: Development and internal validation of a risk model

Si, Sheng; Yan, Yan; Fuller, Brian M.; Liang, Stephen Y.

doi:10.1080/10790268.2018.1436117

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…This is in line with recently published literature with a rate of UTI up to 68%. [36][37][38][39] Profound alterations in urodynamic function and reliance on urinary catherization for bladder management increases the risk of UTI among participants living with SCI and tetraplegia. The clean intermittent catherization (CIC) is considered to be the gold standard in the management of NLUTD in persons with SCI.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Injury With Tetraplegia in Young Persons After Diving Into Shallow Water: What Has Changed in the Past 10 to 15 Years?

Ull

Yılmaz

Jansen

et al. 2020

Global Spine Journal

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Study Design: Retrospective, monocentric, observational study in a tertiary health care center. Objectives: To analyze prehospital and clinical findings, complications, neurological improvement and follow-up in a young person cohort with spinal cord injury (SCI) and tetraplegia according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) A to D after diving into shallow water. Methods: Included were all persons younger than 50 years with SCI after head-first diving into shallow water between June 2001 and June 2019. All persons with SCI were divided into complete tetraplegia (AIS A) and incomplete tetraplegia (AIS B, C, and D) to test differences. Results: A total of 59 males (98.7%) and 1 female with a mean age of 27.7 years suffered an SCI. Alcohol use was documented in 25 cases (41.7%). At the time of admission, 33 people (55%) showed a complete tetraplegia (AIS A) and 27 showed an incomplete tetraplegia with 8 AIS B (13.3%), 15 AIS C (25%), and 4 AIS D (6.7%). At the time of discharge, people with initially complete tetraplegia showed a significant improvement from admission to discharge ( P ≤ .004). Persons with incomplete tetraplegia were more likely to improve their neurological status compared with complete tetraplegia patients ( P ≤ .001). Especially persons with complete tetraplegia suffered from typical SCI-related problems and complications. Conclusions: People with SCI and tetraplegia at the time admission show neurological improvement in 50% of the cases with an overall better outcome in persons with incomplete tetraplegia. The surgical treatment of SCI within 24 hours seems to be associated with a better neurological outcome and a lower level of tetraplegia. The incidence of SCI caused by diving into shallow water remains stable without a significant change, especially in high-risk groups. More education and prevention programs are necessary to avoid these injuries.

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Section: Discussionmentioning

confidence: 99%

Spinal Cord Injury With Tetraplegia in Young Persons After Diving Into Shallow Water: What Has Changed in the Past 10 to 15 Years?

Ull

Yılmaz

Jansen

et al. 2020

Global Spine Journal

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“…A UTI can have significant consequences, including comorbidity, prolonged hospitalisation, interference with rehabilitation programmes and deconditioning (DeJong et al, 2013;Hollenbeak & Schilling, 2018;Li et al, 2019;Ploypetch et al, 2013;Si et al, 2019;Togan et al, 2014). Furthermore, repeated use of antibiotics for UTI treatments increases the risk of developing antibiotic-resistant bacteria (Krebs et al, 2016;Shin et al, 2008).…”

Section: Ta B L E 1 Risk Factors For Urinary Tract Infection In Patients With Spinal Cord Injury Investigated Previouslymentioning

confidence: 99%

Incidence and risk factors of urinary tract infections in hospitalised patients with spinal cord injury

Kim

Cho

et al. 2021

Journal of Clinical Nursing

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Aims and objectives: To investigate the incidence of urinary tract infection and analyse its risk factors among hospitalised patients with spinal cord injury.Background: While the incidence of urinary tract infection varies widely according to the healthcare setting and patients' clinical characteristics, formal reports are limited in quantity. There has been no consensus regarding the risk factors for urinary tract infection.Design: A retrospective descriptive study.Methods: Electronic medical records of 964 subjects between 2010-2017 were reviewed. Urinary tract infection status was examined to identify newly occurred cases.Data included demographic and clinical characteristics, hydration status and length of hospitalisation. The reporting of the study followed the EQUATOR Network's STROBE checklist.Results: Of the sample, 31.7% had urinary tract infection (95% confidence interval:1.288 to 1.347, p < .001). Sex, completeness of injury, type of bladder emptying, detrusor function and urethral pressure were significant factors affecting urinary tract infection. Patients who were male and those with injury classifications A, B and C had higher risk of urinary tract infection. Patients with urinary or suprapubic indwelling catheters, as well as those with areflexic detrusor combined with normotonic urethral pressure or overactive detrusor combined with normotonic urethral pressure, showed higher risk. Length of hospitalisation in patients with urinary tract infection was greater than that in uninfected patients, which implies the importance of prevention of urinary tract infection. Conclusions: Nurses should carefully assess risk factors to prevent urinary tract infection in patients with spinal cord injury in the acute and sub-acute stages of the disease trajectory and provide individualised nursing care. Relevance to clinical practice: This study contributes evidence for up-to-date clinical nursing practice for the comprehensive management of urinary tract infection. This can lead to improvements in nursing care quality and patient outcomes, including length of hospitalisation. | 2069 KIM et al. | INTRODUC TI ONUrinary tract infection (UTI) is currently the most common infection following spinal cord injury (SCI) (

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“…More importantly, critical SCI patients may suffer from a higher mortality due to renal failure, respiratory failure, hemodynamic instability, sepsis from urinary tract infection, life-threatening autonomic hyper-reflexia etc. [3][4][5][6][7][8] . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

Section: Introductionmentioning

confidence: 99%

“…More importantly, critical SCI patients may suffer from a higher mortality due to renal failure, respiratory failure, hemodynamic instability, sepsis from urinary tract infection, life-threatening autonomic hyper-reflexia etc. [3][4][5][6][7][8] Prognostication plays an important part in clinical practice, which can contribute to the decision-making of clinical management for doctors and assist the communication with the patients and their families. For critical patients in the intensive care unit (ICU), discharge destination may be one of the most important concerns [9], [10].…”

Section: Introductionmentioning

confidence: 99%

Discharge prediction of critical patients with spinal cord injury: a machine learning study with 1485 cases

Fan

Liu²,

Yang

et al. 2021

Preprint

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Objectives: Prognostication of spinal cord injury (SCI) is vital, especially for critical patients who need intensive care. The study aims to develop machine-learning (ML) classifiers for discharge prediction of SCI patients in the intensive care unit (ICU). Methods: Clinical data of patients diagnosed with SCI were extracted from the publicly available ICU database. A total of 105 ML classifiers were initially developed to predict the discharge destination (dead, further medical care, home), and then the top 3 classifiers with the best performance were stacked into an ensemble classifier (Esb-Clf). To balance the accuracy and the feasibility, the complete Esb-Clf was finally simplified with top 10 features (simplified Esb-Clf). The micro-average area under the curve (AUC) was used to compare the prediction performance of difference ML classifiers and 6 doctors' artificial prediction. Results: A total of 1485 SCI patients were used for the early and the recent prediction of discharge destination. In the early prediction, the micro-average AUC of the Esb-Clf and the simplified Esb-Clf was 0.846 and 0.835 during the independent testing, respectively. While in the recent prediction, the micro-average AUC of the Esb-Clf and the simplified Esb-Clf was 0.898 and 0.892. Performance of both the Esb-Clf and the simplified Esb-Clf were superior to the doctors' in the early and the recent prediction. Conclusions: ML classifiers can discriminate the discharge destination of SCI patients with high accuracy, feasibility and interpretability. Whether the simplified Esb-Clf as an online predictive tool is applicable to guiding clinical management needs further verification.

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Predicting complicated outcomes in spinal cord injury patients with urinary tract infection: Development and internal validation of a risk model

Abstract: Clinical variables present on hospital admission with UTI may help identify SCI patients at risk for complicated outcomes and inform future clinical decision-making.

Cited by 6 publications

References 19 publications

Spinal Cord Injury With Tetraplegia in Young Persons After Diving Into Shallow Water: What Has Changed in the Past 10 to 15 Years?

Spinal Cord Injury With Tetraplegia in Young Persons After Diving Into Shallow Water: What Has Changed in the Past 10 to 15 Years?

Incidence and risk factors of urinary tract infections in hospitalised patients with spinal cord injury

Discharge prediction of critical patients with spinal cord injury: a machine learning study with 1485 cases

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