Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2020;26(4):253-260.
doi: 10.46292/sci20-00017. Epub 2021 Jan 20.

Early Trauma Indicators and Rehabilitation Outcomes in Traumatic Spinal Cord Injury

Chloe Slocum  1   2 , Cristina Shea  1   2 , Richard Goldstein  1   2 , Ross Zafonte  1   2
Affiliations
Multicenter Study

Early Trauma Indicators and Rehabilitation Outcomes in Traumatic Spinal Cord Injury

Chloe Slocum et al. Top Spinal Cord Inj Rehabil. 2020.

Abstract

Objectives: To investigate the relationship between early trauma indicators and neurologic recovery after traumatic SCI using standardized outcome measures from the ISNCSCI examination and standardized functional outcome measures for rehabilitation populations.

Methods: This is a retrospective review of merged, prospectively collected, multicenter data from the Spinal Cord Injury Model Systems (SCIMS) database and institutional trauma databases from five academic medical centers across the United States. Functional status at inpatient rehabilitation discharge and change in severity and level of injury from initial SCI to inpatient rehabilitation discharge were analyzed to assess neurologic recovery for patients with traumatic SCI. Linear and logistic regression with multiple imputation were used for the analyses.

Results: A total of 209 patients were identified. Mean age at injury was 47.2 ± 18.9 years, 72.4% were male, 22.4% of patients had complete injuries at presentation to the emergency department (ED), and most patients were admitted with cervical SCI. Mean systolic blood pressure (SBP) was 124.1 ± 29.6 mm Hg, mean ED heart rate was 83.7 ± 19.9 bpm, mean O2 saturation was 96.8% ± 4.0%, and mean Glasgow Coma Scale (GCS) score was 13.3 ± 3.9. The average Injury Severity Score (ISS) in this population was 22.4. Linear regression analyses showed that rehabilitation discharge motor FIM was predicted by motor FIM on admission and ISS. Requiring ventilatory support on ED presentation was negatively associated with improvement of ASIA Impairment Scale (AIS) grade at rehabilitation discharge compared with AIS grade after initial injury. Emergency room physiologic measures (SBP, pulse, oxygen saturation) did not predict discharge motor FIM or improvement in AIS grade or neurological level of injury.

Conclusion: Our study showed a positive association between discharge FIM and ISS and a negative association between ventilatory support at ED presentation and AIS improvement. The absence of any significant association between other physiologic or clinical variables at ED presentation with rehabilitation outcomes suggests important areas for future clinical research.

Keywords: assisted ventilation; hypotension; outcomes; spinal cord injury; trauma.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest Dr. Zafonte received royalties from Oakstone for an educational CD, Physical Medicine and Rehabilitation — A Comprehensive Review, and from Springer/Demos Publishing for serving as co-editor of the text Brain Injury Medicine. Dr Zafonte serves on the Scientific Advisory Board of Myomo, Oxeia Biopharma, ElMINDA, and Biodirection. He also evaluates patients in the MGH Brain and Body-TRUST Program, which is funded by the NFL Players Association. The other authors report no conflicts of interest.

References

    1. Kennedy P, Lude P, Taylor N. Quality of life, social participation, appraisals and coping post spinal cord injury: A review of four community samples. Spinal Cord. 2006;44(2):95–105. - PubMed
    1. Burns AS, Ditunno JF. Establishing prognosis and maximizing functional outcomes after spinal cord injury: A review of current and future directions in rehabilitation management. Spine (Phila Pa 1976) 2001;26(24 suppl):S137–145. - PubMed
    1. Richard-Denis A, Beauséjour M, Thompson C, Nguyen BH, Mac-Thiong JM. Early predictors of global functional outcome after traumatic spinal cord injury: A systematic review. J Neurotrauma. 2018;35(15):1705–1725. - PubMed
    1. National Spinal Cord Injury Statistical Center. Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham; 2019.
    1. National Trauma Data Bank National Trauma Data Bank 2016 Annual Report. 2016 https://www.facs.org/-/media/files/quality-programs/trauma/ntdb/ntdb-ann...

Publication types

LinkOut - more resources