Risk Factors for Organ Dysfunction and Failure in Patients with Acute Traumatic Cervical Spinal Cord Injury

Stein, Deborah M.; Menaker, Jay; McQuillan, Karen; Handley, Christopher J.; Aarabi, Bizhan; Scalea, Thomas M.

doi:10.1007/s12028-010-9359-9

Cited by 54 publications

(25 citation statements)

References 51 publications

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“…Prevention of complications is a major goal of SCI management, especially during the acute hospitalization phase. [8][9][10] With traumatic SCI, the effect of surgical timing on complications in patients remains controversial, although recent studies tend to recommend early surgery. [11][12][13] A recent study identified surgical timing as a predictor of complications 14 after traumatic SCI, but the authors did not specifically investigate the effect of early surgical intervention on complication occurrence in a uniquely complete SCI population.…”

Section: Introductionmentioning

confidence: 99%

Non-Neurological Outcomes after Complete Traumatic Spinal Cord Injury: The Impact of Surgical Timing

Bourassa-Moreau

Mac-Thiong

Feldman

et al. 2013

Journal of Neurotrauma

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It remains unclear whether the benefits of early surgical timing are significant in neurologically complete spinal cord injury (SCI). We wanted to compare the effects of early and late surgical timing on non-neurological outcomes in persons with traumatic complete SCI. All cases of traumatic complete SCI referred to a single institution between 2000 and 2011 were retrospectively reviewed. The occurrence of pneumonia, urinary tract infection (UTI), pressure ulcer (PU), and all other postoperative complications were recorded. Cost of acute hospitalization was calculated for each patient based on administrative data. Patients operated on within 24 h of the trauma were compared with patients operated on later than 24 h after the trauma. The effects of surgical timing on complication rate and cost of hospitalization were adjusted for potential confounding variables using multiple regression analyses. Fifty-five patients were operated on ≤ 24 h from injury and 142 were operated on >24 h from injury. Baseline demographic and clinical variables were comparable between the two groups. Pneumonia, UTI, and the presence of any complications were significantly higher in the group operated on >24 h post-trauma. Cost of hospitalization was higher among patients operated >24h post-trauma (≤ 24 h: 22,828$ vs. >24 h: 29,714$). Surgical timing >24 h was a predictor of pneumonia, UTI, total complications. and higher cost of hospitalization after controlling for other confounding variables. This study shows that surgical decompression and stabilization ≤ 24 h following a complete SCI may be a cost-effective strategy to reduce the postoperative complication rate.

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Section: Introductionmentioning

confidence: 99%

Non-Neurological Outcomes after Complete Traumatic Spinal Cord Injury: The Impact of Surgical Timing

Bourassa-Moreau

Mac-Thiong

Feldman

et al. 2013

Journal of Neurotrauma

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“…Concomitant injuries such as pulmonary contusions and pneumothoraces can be seen in the polytrauma patient. Up to 65 % of patients with cervical SCI will have evidence of respiratory dysfunction on admission to the intensive care unit (ICU) [30]. Supplemental oxygen should be supplied to all patients with cervical SCI if necessary, as hypoxemia is extremely detrimental to patients with neurological injury.…”

Section: Breathingmentioning

confidence: 99%

Emergency Neurological Life Support: Traumatic Spine Injury

et al. 2015

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Traumatic spine injuries (TSIs) carry significantly high risks of morbidity, mortality, and exorbitant health care costs from associated medical needs following injury. For these reasons, TSI was chosen as an ENLS protocol. This article offers a comprehensive review on the management of spinal column injuries using the best available evidence. Alhough the review focuses primarily on cervical spinal column injuries, thoracolumbar injuries are briefly discussed as well. The initial emergency department clinical evaluation of possible spinal fractures and cord injuries, along with the definitive early management of confirmed injuries, is also covered.

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“…Below C5, respiration is severely impaired but diaphragm function is maintained. Also, the incidence of organ dysfunction is more strongly associated with American Spinal Injury Association motor scores that incorporate the severity of injury besides the level of injury (Stein et al, 2010). In the acute setting, lower than C5 cervical injuries are associated with about 70% decreases in VC, MIP, and MEP.…”

Section: Cervical Spinal Cord Injurymentioning

confidence: 99%