Survival in 222 Patients With Severe CSCI: An 8-Year Epidemiologic Survey in Western China

Liu, Chenxin; Yang, Xuan; Meng, Bing; Zhao, Xiaolei; Xiong, Zhi‐Gang; Yan, Feng; Wei, Lei; Wu, Zixiang

doi:10.1016/j.apmr.2018.12.030

Cited by 3 publications

(5 citation statements)

References 45 publications

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“…The quality of evidence was not limited by inconsistency or indirectness, but was limited by imprecision with wide confidence intervals throughout. While there is low quality evidence that suggests that the risk of longer-term all-cause mortality (at least 1 year after tSCI) increases with age [ 44 – 48 ], the age at which this increase is seen varies substantially between studies, follow-up periods vary, confidence intervals are wide, and comparator groups vary. Survival at a year or more postinjury remains > 50% for almost all age groups [ 44 , 45 , 47 ], although one study [ 45 ] reported a five-year survival of 40.4% among those individuals aged 75 or older.…”

Section: Recommendations: Clinical Variables As Predictorsmentioning

confidence: 99%

“…While there is low quality evidence that suggests that the risk of longer-term all-cause mortality (at least 1 year after tSCI) increases with age [ 44 – 48 ], the age at which this increase is seen varies substantially between studies, follow-up periods vary, confidence intervals are wide, and comparator groups vary. Survival at a year or more postinjury remains > 50% for almost all age groups [ 44 , 45 , 47 ], although one study [ 45 ] reported a five-year survival of 40.4% among those individuals aged 75 or older. With one exception [ 46 ], acute in-hospital mortality was included in the cumulative mortality rates reported at later intervals.…”

Section: Recommendations: Clinical Variables As Predictorsmentioning

confidence: 99%

“…All studies reported cumulative mortality, encompassing in-hospital and post-discharge mortality. Concomitant injury was defined by chest trauma [ 44 ], ISS [ 45 ], or GCS [ 45 , 47 ], and patient population also varied by level and severity of injury. None found a significant impact of concomitant injury on long-term survival after tSCI.…”

Section: Recommendations: Clinical Variables As Predictorsmentioning

confidence: 99%

“…Another found no significant difference in cumulative mortality at 1 year for cervical versus thoracolumbar injury [ 47 ]. The remaining two studies found increased mortality in patients with upper cervical injury (C1-C4); the comparison group was patients with lower cervical injury in one study [ 44 ] and all levels of injury in the other [ 46 ]. Even among patients with injuries at C4 or above, approximately 60–70% were still alive 8 to 10 years post injury [ 44 , 46 ], limiting the utility of NLI as a predictor of long-term mortality.…”

Section: Recommendations: Clinical Variables As Predictorsmentioning

confidence: 99%

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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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Section: Recommendations: Clinical Variables As Predictorsmentioning

confidence: 99%

Section: Recommendations: Clinical Variables As Predictorsmentioning

confidence: 99%

Section: Recommendations: Clinical Variables As Predictorsmentioning

confidence: 99%

Section: Recommendations: Clinical Variables As Predictorsmentioning

confidence: 99%

See 2 more Smart Citations

Guidelines for neuroprognostication in adults with traumatic spinal cord injury

Mahanes,

Muehlschlegel,

Wartenberg

et al. 2023

Neurocrit Care

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show abstract

“…Recent years have witnessed a constantly rising incidence of spinal cord injury (SCI), with more injuries in older people from less violent tauma 1 . These injuries more frequently involve the cervical spine and more often lead to an incomplete neurologic dysfunction 2 .…”

Section: Introductionmentioning

confidence: 99%

Establishment of Central Cord Syndrome Model in C57BL/6J Mouse

Yilizati-Yilihamu Elzat,

Fan,

Feng

2023

JoVE

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Animal models of central cord syndrome (CCS) could substantially benefit preclinical research. Identifiable anatomical pathways can give minimally invasive exposure approaches and reduce extra injury to experimental animals during operation, enabling the maintenance of consistent and stable anatomical morphology during experiments to minimize behavioral and histological differences between individuals to improve the reproducibility of experiments. In this study, the C6 level spinal cord was exposed using a spinal cord injury coaxial platform (SCICP) and combination with a minimally invasive technique. With the assistance of a vertebral stabilizator, we fixed the vertebrae and compressed the spinal cords of C57BL/6J mice with 5 g/mm 2 and 10 g/mm 2 weights with SCICP to induce different degrees of C6 spinal cord injury. In line with the previous description of CCS, the results reveal that the lesion in this model is concentrated in the gray matter around the central cord, enabling further research into CCS. Finally, histological results are provided as a reference for the readers.

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Survival in 222 Patients With Severe CSCI: An 8-Year Epidemiologic Survey in Western China

Cited by 3 publications

References 45 publications

Guidelines for neuroprognostication in adults with traumatic spinal cord injury

Guidelines for neuroprognostication in adults with traumatic spinal cord injury

Establishment of Central Cord Syndrome Model in C57BL/6J Mouse

JoVE Video Dataset

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