Acute Adverse Events After Spinal Cord Injury and Their Relationship to Long-term Neurologic and Functional Outcomes: Analysis From the North American Clinical Trials Network for Spinal Cord Injury.

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2019-11

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Abstract

Objectives

There are few contemporary, prospective multicenter series on the spectrum of acute adverse events and their relationship to long-term outcomes after traumatic spinal cord injury. The goal of this study is to assess the prevalence of adverse events after traumatic spinal cord injury and to evaluate the effects on long-term clinical outcome.

Design

Multicenter prospective registry.

Setting

Consortium of 11 university-affiliated medical centers in the North American Clinical Trials Network.

Patients

Eight-hundred one spinal cord injury patients enrolled by participating centers.

Interventions

Appropriate spinal cord injury treatment at individual centers.

Measurements and main results

A total of 2,303 adverse events were recorded for 502 patients (63%). Penalized maximum logistic regression models were fitted to estimate the likelihood of neurologic recovery (ASIA Impairment Scale improvement ≥ 1 grade point) and functional outcomes in subjects who developed adverse events at 6 months postinjury. After accounting for potential confounders, the group that developed adverse events showed less neurologic recovery (odds ratio, 0.55; 95% CI, 0.32-0.96) and was more likely to require assisted breathing (odds ratio, 6.55; 95% CI, 1.17-36.67); dependent ambulation (odds ratio, 7.38; 95% CI, 4.35-13.06) and have impaired bladder (odds ratio, 9.63; 95% CI, 5.19-17.87) or bowel function (odds ratio, 7.86; 95% CI, 4.31-14.32) measured using the Spinal Cord Independence Measure subscores.

Conclusions

Results from this contemporary series demonstrate that acute adverse events are common and are associated with worsened long-term outcomes after traumatic spinal cord injury.

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Journal article

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North American Clinical Trials Network Collaborators, Humans, Pneumonia, Spinal Cord Injuries, Hypotension, Skin Ulcer, Suppositories, Urinary Catheterization, Respiration, Artificial, Length of Stay, Abbreviated Injury Scale, Registries, Depression, Adult, Middle Aged, North America, Female, Male, Mobility Limitation, Urinary Bladder, Neurogenic

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https://hdl.handle.net/10161/28183

Published Version (Please cite this version)

10.1097/ccm.0000000000003937

Publication Info

Jiang, Fan, Blessing NR Jaja, Shekar N Kurpad, Jetan H Badhiwala, Bizhan Aarabi, Robert G Grossman, James S Harrop, Jim D Guest, et al. (2019). Acute Adverse Events After Spinal Cord Injury and Their Relationship to Long-term Neurologic and Functional Outcomes: Analysis From the North American Clinical Trials Network for Spinal Cord Injury. Critical care medicine, 47(11). pp. e854–e862. 10.1097/ccm.0000000000003937 Retrieved from https://hdl.handle.net/10161/28183.

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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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