Incidence and severity of acute complications after spinal cord injury.

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2012-09

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Abstract

Object

The aim of this multicenter, prospective study was to determine the spectrum, incidence, and severity of complications during the initial hospitalization of patients with spinal cord injury.

Methods

The study was conducted at 9 university-affiliated hospitals that comprise the clinical centers of the North American Clinical Trials Network (NACTN) for Treatment of Spinal Cord Injury. The study population comprised 315 patients admitted to NACTN clinical centers between June 25, 2005, and November 2, 2010, who had American Spinal Injury Association (ASIA) Impairment Scale grades of A-D and were 18 years of age or older. Patients were managed according to a standardized protocol.

Results

The study population was 79% male with a median age of 44 years. The leading causes of injury were falls (37%) and motor vehicle accidents (28%). The distribution of initial ASIA grades were A (40%), B (16%), C (15%), and D (29%). Fifty-eight percent of patients sustained 1 or more severe, moderate, or mild complications. Complications were associated with more severe ASIA grade: 84% of patients with Grade A and 25% of patients with Grade D had at least 1 complication. Seventy-eight percent of complications occurred within 14 days of injury. The most frequent types of severe and moderate complications were respiratory failure, pneumonia, pleural effusion, anemia, cardiac dysrhythmia, and severe bradycardia. The mortality rate was 3.5% and was associated with increased age and preexisting morbidity.

Conclusions

Knowledge of the type, frequency, time of occurrence, and severity of specific complications that occur after spinal cord injury can aid in their early detection, treatment, and prevention. The data are of importance in evaluating and selecting therapy for clinical trials.

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Humans, Pneumonia, Pleural Effusion, Respiratory Insufficiency, Spinal Cord Injuries, Bradycardia, Anemia, Severity of Illness Index, Injury Severity Score, Incidence, Prospective Studies, Accidents, Traffic, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Arrhythmias, Cardiac

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https://hdl.handle.net/10161/28876

Published Version (Please cite this version)

10.3171/2012.5.aospine12127

Publication Info

Grossman, Robert G, Ralph F Frankowski, Keith D Burau, Elizabeth G Toups, John W Crommett, Michele M Johnson, Michael G Fehlings, Charles H Tator, et al. (2012). Incidence and severity of acute complications after spinal cord injury. Journal of neurosurgery. Spine, 17(1 Suppl). pp. 119–128. 10.3171/2012.5.aospine12127 Retrieved from https://hdl.handle.net/10161/28876.

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Shaffrey

Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.

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