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Kankam SB, Okon II, Habibzadeh A, Rehman IU, Toriola O, Gbayisomore TJ, Okesanya OJ, Jalloh M. Navigating challenges in spine surgery in Nigeria: the current state and strategies for advancing spine care. Neurosurg Rev 2024; 47:265. [PMID: 38856859 DOI: 10.1007/s10143-024-02503-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 05/26/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
The provision of specialized spine care in Nigeria presents a pressing challenge amid limited resources and geographical disparities. This correspondence offers a comprehensive roadmap for improving spine surgery and care within the country. We examine the current state of spinal health infrastructure, highlighting barriers such as limited access to specialists and facilities, particularly in rural areas, and financial constraints for patients. Innovations in spinal treatment, including the adoption of minimally invasive techniques and advancements in surgical modalities, are discussed alongside persistent challenges such as disparities in access and equipment costs. Training and education of spine surgeons emerge as critical areas requiring attention, with a shortage of qualified professionals exacerbated by inadequate training programs and resource constraints. We advocate for fostering local and international collaborations to address these gaps, emphasizing the role of partnerships in capacity building and knowledge exchange. Additionally, we explore the potential of public-private partnerships and investments to enhance the Nigerian spine healthcare system, calling for strategic initiatives to modernize infrastructure and improve accessibility. Finally, we propose a strategic blueprint encompassing infrastructure enhancement, training programs, research initiatives, policy advocacy, and public awareness campaigns. Through concerted efforts from local stakeholders and international partners, we envision a future where spine care in Nigeria is comprehensive, accessible, and of high quality, leading to improved health outcomes and a higher quality of life for those affected by spinal conditions.
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Affiliation(s)
- Samuel Berchi Kankam
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Inibehe Ime Okon
- Brain & Spine, Department of Neurosurgery, Hospital of the Babcock University, Ilishan-Remo, Ogun State, Nigeria
| | - Adrina Habibzadeh
- School of Medicine, Fasa University of Medical Science, Tehran, Iran
| | - Ibad Ur Rehman
- Shifa College of Medicine, Shifa Tameer e-Millat University, Islamabad, Pakistan
| | | | | | - Olalekan John Okesanya
- Department of Public Health and Maritime Transport, University of Thessaly, Volos, Greece
| | - Mohamed Jalloh
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Bárbara-Bataller E, Méndez-Suárez JL, Alemán-Sánchez C, Peñaloza-Polo P, Sánchez-Enríquez J, Saavedra-Santana P. Predictive factors of destination at discharge after spinal cord injury. Neurologia 2024; 39:432-441. [PMID: 37116694 DOI: 10.1016/j.nrleng.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 09/24/2021] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION One of the main goals of the rehabilitation of patients with spinal cord injury (SCI) is the reintegration of the individual to their family, social, and work setting. The objective of this study was to identify the factors that determine the discharge destination after a traumatic spinal cord injury. MATERIAL AND METHODS We conducted a retrospective descriptive study of 305 patients with SCI who completed the rehabilitation treatment at the spinal injury unit of Hospital Insular de Gran Canaria between 2001 and 2018. RESULTS During the study period, we observed an increase in the number of patients referred to long-term care centres, from 9.14% between 2001 and 2010 to 18.4% between 2011 and 2018 (P < .01). Of 20 variables that presented a significant association with destination at discharge in the univariate study, 7 presented a significant association in the multivariate study: age (OR: 1.05; 95% CI, 1.02-1.08), living with a partner (OR: 0.26; 95% CI, 0.09-0.76), residing on another island (OR: 3.57; 95% CI, 1.32-9.63), smoking (OR: 3.44; 95% CI, 1.26-9.44), diabetes (OR: 6.51; 95% CI, 1.46-29.02), history of psychiatric disorders (OR: 3.79; 95% CI, 1.31-10.93), and scores on the Spinal Cord Independence Measure-III (SCIM-III) (OR: 0.48; 95% CI, 0.33-0.69). CONCLUSIONS Our findings identified advanced age, living on the island of Tenerife, not being married, smoking, type 2 diabetes mellitus, history of psychiatric disorders, and low SCIM-III scores as predictive factors of referral to a long-term care centre in patients with traumatic SCI in the Canary Islands.
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Affiliation(s)
- E Bárbara-Bataller
- Unidad de Lesionados Medulares, Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain.
| | - J L Méndez-Suárez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - C Alemán-Sánchez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - P Peñaloza-Polo
- Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - J Sánchez-Enríquez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - P Saavedra-Santana
- Área de Estadística e Investigación Operativa del Departamento de Matemáticas de la Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
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Badhiwala JH, Witiw CD, Wilson JR, da Costa LB, Nathens AB, Fehlings MG. Treatment of Acute Traumatic Central Cord Syndrome: A Study of North American Trauma Centers. Neurosurgery 2024; 94:700-710. [PMID: 38038474 DOI: 10.1227/neu.0000000000002767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/25/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Central cord syndrome (CCS) is expected to become the most common traumatic spinal cord injury, yet its optimal management remains unclear. This study aimed to evaluate variability in nonoperative vs operative treatment for CCS between trauma centers in the American College of Surgeons Trauma Quality Improvement Program, identify patient- and hospital-level factors associated with treatment, and determine the association of treatment with outcomes. METHODS Adults with CCS were identified from the Trauma Quality Improvement Program database (2014-2016). Mixed-effects modeling with a random intercept for trauma centers was used to examine the adjusted association of patient- and hospital-level variables with nonoperative treatment. The random-effects output of the model assessed the risk-adjusted variability in nonoperative treatment across centers. Outlier hospitals were identified, and the median odds ratio was calculated. The adjusted effect of nonoperative treatment on mortality, morbidity, and hospital length of stay (LOS) was examined at the patient and hospital level by mixed-effects regression. RESULTS Three thousand, nine hundred twenty-eight patients across 255 centers were eligible; of these, 1523 (38.8%) were treated nonoperatively. Older age, noncommercial insurance (odds ratio [OR] 1.26, 95% CI 1.08-1.48, P = .004), absence of fracture (OR 0.58, 95% CI 0.49-0.68, P < .001), severe head injury (OR 1.41, 95% CI 1.09-1.82, P = .008), and comatose presentation (1.82, 95% CI 1.15-2.89, P = .011) were associated with nonoperative treatment. Twenty-eight hospitals were outliers, and the median odds ratio was 2.02. Patients receiving nonoperative treatment had shorter LOS (mean difference -4.65 days). Nonoperative treatment was associated with lesser in-hospital morbidity (OR 0.49, 95% CI 0.37-0.63, P < .001) at the patient level. There was no difference in mortality. CONCLUSION Operative decision-making for CCS is influenced by patient factors. There remains substantial variability between trauma centers not explained by case-mix differences. Nonoperative treatment was associated with shorter hospital LOS and lesser inpatient morbidity.
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Affiliation(s)
- Jetan H Badhiwala
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto , Ontario , Canada
| | - Christopher D Witiw
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto , Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto , Ontario , Canada
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto , Ontario , Canada
| | - Jefferson R Wilson
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto , Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto , Ontario , Canada
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto , Ontario , Canada
| | - Leodante B da Costa
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto , Ontario , Canada
- Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto , Ontario , Canada
| | - Avery B Nathens
- Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto , Ontario , Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto , Ontario , Canada
- Clinical Epidemiology Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto , Ontario , Canada
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto , Ontario , Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto , Ontario , Canada
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Långsjö J, Jordan S, Laurila S, Paaso M, Thesleff T, Huhtala H, Ronkainen A, Karlsson S, Koskinen E, Luoto T. Traumatic cervical spinal cord injury: Comparison of two different blood pressure targets on neurological recovery. Acta Anaesthesiol Scand 2024; 68:493-501. [PMID: 38228292 DOI: 10.1111/aas.14372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/28/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Controversy exists whether blood pressure augmentation therapy benefits patients suffering from spinal cord injury (SCI). This retrospective comparative study was designed to assess the impact of two different mean arterial pressure (MAP) targets (85-90 mmHg vs. 65-85 mmHg) on neurological recovery after traumatic cervical SCI. METHODS Fifty-one adult patients with traumatic cervical SCI were retrospectively divided into two groups according to their intensive care unit (ICU) MAP targets: 85-90 mmHg (higher MAP group, n = 32) and 65-85 mmHg (lower MAP group, n = 19). Invasive MAP measurements were stored as 2-min median values for 3-7 days. The severity of SCI (AIS grade and neurological level) was evaluated upon ICU stay and during rehabilitation. Neurological recovery was correlated with individual mean MAP values and with the proportion of MAP values ≥85 mmHg upon the first 3 days (3d-MAP%≥85 ). RESULTS The initial AIS grades were A 29.4%, B 17.6%, C 31.4%, and D 21.6%. AIS grade improved in 24 patients (47.1%). During ICU care, 82.0% and 36.8% of the measured MAP values reached ≥85 mmHg in the higher and the lower MAP groups, respectively (p < .001). The medians of individual mean MAP values were different between the groups (90.2 mmHg vs. 81.4 mmHg, p < .001). Similarly, 3d-MAP%≥85 was higher in the higher MAP group (85.6% vs. 50.0%, p < .001). However, neurological recovery was not different between the groups, nor did it correlate with individual mean MAP values or 3d-MAP%≥85 . CONCLUSION The currently recommended MAP target of 85-90 mmHg was not associated with improved outcomes compared to a lower target in patients with traumatic cervical SCI in this cohort.
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Affiliation(s)
- Jaakko Långsjö
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Sofia Jordan
- Department of Anesthesiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Salla Laurila
- Department of Anesthesiology, Tampere University Hospital, Tampere, Finland
| | - Markku Paaso
- Department of Anesthesiology, Tampere University Hospital, Tampere, Finland
| | - Tuomo Thesleff
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Antti Ronkainen
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Sari Karlsson
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Eerika Koskinen
- Department of Neurology, Tampere University Hospital, Tampere, Finland
| | - Teemu Luoto
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Pattanakuhar S, Kammuang-Lue P, Komaratat N, Chotiyarnwong C, Kovindha A, Gemperli A. Do individuals from an SCI-specialized rehabilitation facility have fewer secondary health conditions than those from a non-SCI-specialized rehabilitation facility? Analysis of the InSCI database from a middle-income country. J Spinal Cord Med 2024:1-10. [PMID: 38251980 DOI: 10.1080/10790268.2023.2289690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES To determine whether attending an SCI-specialized rehabilitation facility (SSRF) is independently associated with having fewer secondary health conditions (SHCs) in middle-income country contexts. STUDY DESIGN Cross-sectional observational study. SETTING Four rehabilitation facilities in Thailand (one SSRF and three non-SSRF). METHODS Data from a Thai arm of the International Spinal Cord Injury Community Survey (InSCI) were analyzed. SHCs occurring within the last three months were evaluated using the Spinal Cord Injury Secondary Condition Scale. A causal diagram was applied to create a multivariable regression model to determine the independent effect of attending in the SSRF on having SHC as a single condition and as a sum score. RESULTS Three hundred and thirteen individuals with chronic SCI were included in this study. Two hundred and nineteen participants (70%) were recruited from the SSRF. Being recruited from the SSRF was an independent negative correlating factor of the SHC sum score with an unstandardized coefficient of -1.12 (95% CI: -2.00-0.24). Being recruited from the SSRF was also an independent negative correlating factor of having bladder dysfunction, sexual dysfunction, and pressure ulcer SHC with an odds ratio of 0.32 (95% CI: 0.16-0.59), 0.43 (95% CI: 0.22-0.84), and 0.46 (95% CI: 0.24-0.89), respectively. CONCLUSION Attending an SSRF was significantly associated with having fewer SHCs, specifically, bladder dysfunctions, sexual dysfunctions, and pressure ulcers. These results suggest the importance of having SSRF in middle-income countries for delivering effective care to people with SCI and standardized education to health care providers.
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Affiliation(s)
- Sintip Pattanakuhar
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Health Services and Clinical Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Pratchayapon Kammuang-Lue
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Napasakorn Komaratat
- Department of Medical Services, Ministry of Health, Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand
| | - Chayaporn Chotiyarnwong
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apichana Kovindha
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Armin Gemperli
- Health Services and Clinical Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center of Primary and Community Care, University of Lucerne, Lucerne, Switzerland
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Dvorak MF, Evaniew N, Chen M, Waheed Z, Rotem-Kohavi N, Fallah N, Noonan VK, Fisher C, Charest-Morin R, Dea N, Ailon T, Street J, Kwon BK. Impact of Specialized Versus Non-Specialized Acute Hospital Care on Survival Among Patients With Acute Incomplete Traumatic Spinal Cord Injuries: A Population-Based Observational Study from British Columbia, Canada. J Neurotrauma 2023; 40:2638-2647. [PMID: 37294210 PMCID: PMC10698776 DOI: 10.1089/neu.2022.0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Given the complexity of care necessitated after an acute traumatic spinal cord injury (SCI), it seems intuitively beneficial for such care to be delivered at hospitals with specialized SCI expertise. Demonstrating these benefits is not straightforward, however. We sought to determine whether specialized acute hospital care influenced the most fundamental outcomes after SCI: mortality within the first year of injury. We compared survival among patients with incomplete tSCI admitted to a single quaternary-level trauma hospital with a specialized acute SCI program versus those admitted to trauma hospitals without specialized acute SCI care. We performed a population-based retrospective observational cohort study using administrative and clinical data linked from multiple sources in British Columbia (BC) from 2001 to 2017. Among a cohort of 1920 patients, there were 193 deaths within one year. We failed to identify a significant overall benefit for survival after adjusting for potential confounders, and the confidence intervals (CIs) were compatible with both benefit and harm (odds ratio [OR] 1.01, 95% CI 0.17 to 6.11, p = 0.99). Significant associations were observed with age greater than 65 (OR 4.92, 95% CI 1.66 to 14.57, p < 0.01), Charlson Comorbidity Index (OR 1.61, 95% CI 1.42 to 1.83, p < 0.01), Injury Severity Score (OR 1.08, 95% CI 1.06 to 1.11, p < 0.01), and traumatic brain injury (OR 2.12, 95% CI 1.32 to 3.41, p < 0.01). Among patients with acute tSCI, admission to a hospital with specialized acute SCI care was not associated with improved overall one-year survival. Subgroup analyses, however, suggested heterogeneity of effects, with little benefit for older patients with less polytrauma and substantial benefit for younger patients with greater polytrauma.
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Affiliation(s)
- Marcel F. Dvorak
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
| | - Nathan Evaniew
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Melody Chen
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Zeina Waheed
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | | | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | | | - Charles Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raphaële Charest-Morin
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Dea
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tamir Ailon
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Street
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K. Kwon
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
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Basiratzadeh S, Hakimjavadi R, Baddour N, Michalowski W, Viktor H, Wai E, Stratton A, Kingwell S, Mac-Thiong JM, Tsai EC, Wang Z, Phan P. A data-driven approach to categorize patients with traumatic spinal cord injury: cluster analysis of a multicentre database. Front Neurol 2023; 14:1263291. [PMID: 37900603 PMCID: PMC10602788 DOI: 10.3389/fneur.2023.1263291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/05/2023] [Indexed: 10/31/2023] Open
Abstract
Background Conducting clinical trials for traumatic spinal cord injury (tSCI) presents challenges due to patient heterogeneity. Identifying clinically similar subgroups using patient demographics and baseline injury characteristics could lead to better patient-centered care and integrated care delivery. Purpose We sought to (1) apply an unsupervised machine learning approach of cluster analysis to identify subgroups of tSCI patients using patient demographics and injury characteristics at baseline, (2) to find clinical similarity within subgroups using etiological variables and outcome variables, and (3) to create multi-dimensional labels for categorizing patients. Study design Retrospective analysis using prospectively collected data from a large national multicenter SCI registry. Methods A method of spectral clustering was used to identify patient subgroups based on the following baseline variables collected since admission until rehabilitation: location of the injury, severity of the injury, Functional Independence Measure (FIM) motor, and demographic data (age, and body mass index). The FIM motor score, the FIM motor score change, and the total length of stay were assessed on the subgroups as outcome variables at discharge to establish the clinical similarity of the patients within derived subgroups. Furthermore, we discussed the relevance of the identified subgroups based on the etiological variables (energy and mechanism of injury) and compared them with the literature. Our study also employed a qualitative approach to systematically describe the identified subgroups, crafting multi-dimensional labels to highlight distinguishing factors and patient-focused insights. Results Data on 334 tSCI patients from the Rick Hansen Spinal Cord Injury Registry was analyzed. Five significantly different subgroups were identified (p-value ≤0.05) based on baseline variables. Outcome variables at discharge superimposed on these subgroups had statistically different values between them (p-value ≤0.05) and supported the notion of clinical similarity of patients within each subgroup. Conclusion Utilizing cluster analysis, we identified five clinically similar subgroups of tSCI patients at baseline, yielding statistically significant inter-group differences in clinical outcomes. These subgroups offer a novel, data-driven categorization of tSCI patients which aligns with their demographics and injury characteristics. As it also correlates with traditional tSCI classifications, this categorization could lead to improved personalized patient-centered care.
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Affiliation(s)
| | | | - Natalie Baddour
- Department of Mechanical Engineering, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | | | - Herna Viktor
- School of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Eugene Wai
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexandra Stratton
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Stephen Kingwell
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Eve C. Tsai
- Division of Neurosurgery, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Zhi Wang
- Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, QC, Canada
| | - Philippe Phan
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Zeinaddini-Meymand A, Baigi V, Mousavi-Nasab MM, Shool S, Sadeghi-Naini M, Azadmanjir Z, Jazayeri SB, Berchi Kankam S, Dashtkoohi M, Shakeri A, Fakharian E, Kouchakinejad-Eramsadati L, Pirnejad H, Sadeghi-Bazargani H, Bagheri L, Pourandish Y, Amiri M, Pour-Rashidi A, Harrop J, Rahimi-Movaghar V. Pre-Hospital and Post-Hospital Quality of Care in Traumatic Spinal Column and Cord Injuries in Iran. Global Spine J 2023:21925682231202425. [PMID: 37732722 DOI: 10.1177/21925682231202425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES The quality of care (QoC) for spinal column/cord injury patients is a major health care concern. This study aimed to implement the QoC assessment tool (QoCAT) in the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to define the current state of pre- and post-hospital QoC of individuals with Traumatic Spinal Column and Spinal Cord Injuries (TSC/SCIs). METHODS The QoCAT, previously developed by our team to measure the QoC in patients with TSC/SCIs, was implemented in the NSCIR-IR. The pre-hospital QoC was evaluated through a retrospective analysis of NSCIR-IR registry data. Telephone interviews and follow-ups of patients with SCI evaluated the QoC in the post-hospital phase. RESULTS In the pre-hospital phase, cervical collars and immobilization were implemented in 46.4% and 48.5% of the cases, respectively. Transport time from the scene to the hospital was documented as <1 hour and <8 hours in 33.4% and 93.9% of the patients, respectively. Post-hospital indicators in patients with SCI revealed a first-year mortality rate of 12.5% (20/160), a high incidence of secondary complications, reduced access to electrical wheelchairs (4.2%) and modified cars (7.7%), and low employment rate (21.4%). CONCLUSION These findings revealed a significant delay in transport time to the first care facilities, low use of immobilization equipment indicating low pre-hospital QoC. Further, the high incidence of secondary complications, low employment rate, and low access to electrical wheelchairs and modified cars indicate lower post-hospital QoC in patients with SCI. These findings imply the need for further planning to improve the QoC for patients with TSC/SCIs.
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Affiliation(s)
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sina Shool
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Department of Neurosurgery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Zahra Azadmanjir
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behnam Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samuel Berchi Kankam
- International Neurosurgery Group (ING), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mohammad Dashtkoohi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Aidin Shakeri
- Department of Neurosurgery, Arak University of Medical Sciences, Arak, Iran
| | - Esmail Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Habibollah Pirnejad
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Homayoun Sadeghi-Bazargani
- Research Center for Evidence Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Laleh Bagheri
- Shahid Rahnemoun Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Yasaman Pourandish
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Malihe Amiri
- Department of Neurosurgery, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - James Harrop
- Department of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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Kelly-Hedrick M, Ugiliweneza B, Toups EG, Jimsheleishvili G, Kurpad SN, Aarabi B, Harrop JS, Foster N, Goodwin RC, Shaffrey CI, Fehlings MG, Tator CH, Guest JD, Neal CJ, Abd-El-Barr MM, Williamson T. Interhospital Transfer Delays Care for Spinal Cord Injury Patients: A Report from the North American Clinical Trials Network for Spinal Cord Injury. J Neurotrauma 2023; 40:1928-1937. [PMID: 37014079 DOI: 10.1089/neu.2022.0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract The North America Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of tertiary medical centers that has maintained a prospective SCI registry since 2004, and it has espoused that early surgical intervention is associated with improved outcome. It has previously been shown that initial presentation to a lower acuity center and necessity of transfer to a higher acuity center reduce rates of early surgery. The NACTN database was evaluated to examine the association between interhospital transfer (IHT), early surgery, and outcome, taking into account distance traveled and site of origin for the patient. Data from a 15-year period of the NACTN SCI Registry were analyzed (years 2005-2019). Patients were stratified into transfers directly from the scene to a Level 1 trauma center (NACTN site) versus IHT from a Level 2 or 3 trauma facility. The main outcome was surgery within 24 hours of injury (yes/no), whereas secondary outcomes were length of stay, death, discharge disposition, and 6-month American Spinal Injury Association Impairment Scale (AIS) grade conversion. For the IHT patients, distance traveled for transfer was calculated by measuring the shortest distance between origin and NACTN hospital. Analysis was performed with Brown-Mood test and chi-square tests. Of 724 patients with transfer data, 295 (40%) underwent IHT and 429 (60%) were admitted directly from the scene of injury. Patients who underwent IHT were more likely to have a less severe SCI (AIS D; p = 0.002), have a central cord injury (p = 0.004), and have a fall as their mechanism of injury (p < 0.0001) than those directly admitted to an NACTN center. Of the 634 patients who had surgery, direct admission to an NACTN site was more likely to result in surgery within 24 hours compared with IHT patients (52% vs. 38%) (p < 0.0003). Median IHT distance was 28 miles (interquartile range [IQR] = 13-62 miles). There was no significant difference in death, length of stay, discharge to a rehab facility versus home, or 6-month AIS grade conversion rates between the two groups. Patients who underwent IHT to an NACTN site were less likely to have surgery within 24 hours of injury, compared with those directly admitted to the Level 1 trauma facility. Although there was no difference in mortality rates, length of stay, or 6-month AIS conversion between groups, patients with IHT were more likely be older with a less severe level of injury (AIS D). This study suggests there are barriers to timely recognition of SCI in the field, appropriate admission to a higher level of care after recognition, and challenges related to the management of individuals with less severe SCI.
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Affiliation(s)
- Margot Kelly-Hedrick
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Elizabeth G Toups
- Department of Neurosurgery, Houston Methodist Hospital, Houston TX, USA
| | | | - Shekar N Kurpad
- Department of Neurosurgery, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bizhan Aarabi
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Norah Foster
- Department of Orthopedics, Miami Valley Hospital, Centerville, Ohio, USA
| | - Rory C Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles H Tator
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James D Guest
- The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Chris J Neal
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Hu X, Xu W, Ren Y, Wang Z, He X, Huang R, Ma B, Zhao J, Zhu R, Cheng L. Spinal cord injury: molecular mechanisms and therapeutic interventions. Signal Transduct Target Ther 2023; 8:245. [PMID: 37357239 DOI: 10.1038/s41392-023-01477-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/22/2023] [Accepted: 05/07/2023] [Indexed: 06/27/2023] Open
Abstract
Spinal cord injury (SCI) remains a severe condition with an extremely high disability rate. The challenges of SCI repair include its complex pathological mechanisms and the difficulties of neural regeneration in the central nervous system. In the past few decades, researchers have attempted to completely elucidate the pathological mechanism of SCI and identify effective strategies to promote axon regeneration and neural circuit remodeling, but the results have not been ideal. Recently, new pathological mechanisms of SCI, especially the interactions between immune and neural cell responses, have been revealed by single-cell sequencing and spatial transcriptome analysis. With the development of bioactive materials and stem cells, more attention has been focused on forming intermediate neural networks to promote neural regeneration and neural circuit reconstruction than on promoting axonal regeneration in the corticospinal tract. Furthermore, technologies to control physical parameters such as electricity, magnetism and ultrasound have been constantly innovated and applied in neural cell fate regulation. Among these advanced novel strategies and technologies, stem cell therapy, biomaterial transplantation, and electromagnetic stimulation have entered into the stage of clinical trials, and some of them have already been applied in clinical treatment. In this review, we outline the overall epidemiology and pathophysiology of SCI, expound on the latest research progress related to neural regeneration and circuit reconstruction in detail, and propose future directions for SCI repair and clinical applications.
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Affiliation(s)
- Xiao Hu
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Wei Xu
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Yilong Ren
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Zhaojie Wang
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Xiaolie He
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Runzhi Huang
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Bei Ma
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Jingwei Zhao
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Rongrong Zhu
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China.
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China.
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China.
| | - Liming Cheng
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China.
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China.
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China.
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González-Viejo MA, Avellanet M, Boada-Pladellorens A, Montesinos-Magraner L, Jaúregui-Abrisqueta ML, Bárbara-Bataller E, Méndez-Ferrer B, Sánchez-Raya J, Cívicos N, Méndez-Suarez JL, Barrera-Chacón JM. International Spinal Cord Injury Community Survey: Socioeconomic and Healthcare Satisfaction in Spain. Global Spine J 2023:21925682231183972. [PMID: 37326207 DOI: 10.1177/21925682231183972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
STUDY DESIGN Survey study. OBJECTIVES People living with spinal cord injury (SCI) are major healthcare and rehabilitation services consumers and have unmet healthcare needs. This study aimed to describe the socioeconomic characteristics of people living with SCI in Spain and to determine the level of use and satisfaction with the public healthcare system. METHODS We conducted a survey (the Spanish version of the International Spinal Cord Injury Community Survey) consisting of 134 questions. We analyzed the age, sex, neurological classification of the injury on the American Spinal Injury Association Impairment Scale, time of injury, socio-occupational and socioeconomic status, and level of use and satisfaction with the public health system. RESULTS 472 people responded to the survey [68.9% male; mean age 51.2 years (standard deviation: 13.9 years); 61.7% with paraplegia and 38.3% with tetraplegia]. 89.2% of those surveyed were unemployed and 77.1% received a disability pension. The number of medical visits was 2.3/year, and 19.8% of the patients required at least 1 hospital admission during the previous year. 94.7% of the people with SCI considered the health care received as good or very good. CONCLUSIONS Respondents with SCI in Spain considered they had good access to primary and specialized care and were satisfied with the healthcare system. Notably, we observed a high average of annual visits to medical professionals but a low rate of hospitalizations. Technical aids and state services related to disability should be the most important elements to be improved.
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Affiliation(s)
| | - Merce Avellanet
- Rehabilitation Department, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | - Anna Boada-Pladellorens
- Rehabilitation Department, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | | | | | - Enrique Bárbara-Bataller
- SCI Unit, Hospital Universitario Insular Materno-infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Nora Cívicos
- SCI Unit, Hospital Universitario Cruces, Barakaldo, Spain
| | - José Luis Méndez-Suarez
- SCI Unit, Hospital Universitario Insular Materno-infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Ushirozako H, Suda K, Harmon SM, Komatsu M, Ota M, Shimizu T, Minami A, Takahata M, Iwasaki N, Matsuyama Y. Complications Associated with Preventive Management to Reduce the Risk of COVID-19 Spread After Surgery for Spinal Cord Injury. J Bone Joint Surg Am 2023; Publish Ahead of Print:00004623-990000000-00811. [PMID: 37216434 DOI: 10.2106/jbjs.22.00785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Preventive management to reduce the risk of coronavirus disease-2019 (COVID-19) spread led to delays in active rehabilitation, which may have negatively impacted the outcomes of patients with traumatic spinal cord injury (SCI). Therefore, the aim of this study was to clarify the influence of preventive management on the rate of perioperative complications after surgical treatment for SCI. METHODS This single-center retrospective study examined the cases of 175 patients who had SCI surgery between 2017 and 2021. We could not continue early rehabilitation interventions starting on April 30, 2020, because of our preventive management to reduce the risk of COVID-19 spread. Using a propensity score-matched model, we adjusted for age, sex, American Spinal Injury Association impairment scale score at admission, and risk factors for perioperative complications described in previous studies. Perioperative complication rates were compared between the COVID-19 pandemic and prepandemic groups. RESULTS Of the 175 patients, 48 (the pandemic group) received preventive management. The preliminary analysis revealed significant differences between the unmatched pandemic and prepandemic groups with respect to age (75.0 versus 71.2 years, respectively; p = 0.024) and intraoperative estimated blood loss (152 versus 227 mL; p = 0.013). The pandemic group showed significant delays in visiting the rehabilitation room compared with the prepandemic group (10 versus 4 days from hospital admission; p < 0.001). There were significant differences between the pandemic and prepandemic groups with respect to the rates of pneumonia (31% versus 16%; p = 0.022), cardiopulmonary dysfunction (38% versus 18%; p = 0.007), and delirium (33% versus 13%; p = 0.003). With a propensity score-matched analysis (C-statistic = 0.90), 30 patients in the pandemic group and 60 patients in the prepandemic group were automatically selected. There were significant differences between the matched pandemic and prepandemic groups with respect to the rates of cardiopulmonary dysfunction (47% versus 23%; p = 0.024) and deep venous thrombosis (60% versus 35%; p = 0.028). CONCLUSIONS Even with early surgical intervention, late mobilization and delays in active rehabilitation during the COVID-19 pandemic increased perioperative complications after SCI surgery. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hiroki Ushirozako
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kota Suda
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Satoko Matsumoto Harmon
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Miki Komatsu
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Masahiro Ota
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Tomoaki Shimizu
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Akio Minami
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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13
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Richard-Denis A, Dionne A, Mputu PM, Mac-Thiong JM. Do all patients with functional motor-incomplete (AIS-D) traumatic spinal cord injury need specialized inpatient functional rehabilitation? A prospective observational cohort study proposing clinical criteria for home-based rehabilitation after acute care. J Spinal Cord Med 2023:1-12. [PMID: 37083554 DOI: 10.1080/10790268.2023.2200354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
CONTEXT/OBJECTIVE Functional motor-incomplete AIS-D traumatic spinal cord injury (tSCI) represents an important growing population in neuro-traumatology. There is thus an important need for establishing strategies to optimize SCI rehabilitation resources. This study aims at proposing eligibility criteria to select individuals who could be discharged home (home-based rehabilitation) after acute care following an AIS-D tSCI and investigate its impact on the long-term functional status and quality of life (QOL), as compared to transfer to inpatient functional rehabilitation (IFR) resources. DESIGN An observational prospective cohort study. SETTING A single Level-1 specialized trauma center. PARTICIPANTS 213 individuals sustaining an AIS-D tSCI. INTERVENTIONS Home-based rehabilitation based on clinical specific criteria to be assessed by the acute care team. OUTCOME MEASURES Functional status and QOL as assessed by the Spinal Cord Independence Measure version 3 and WHOQOL-BREF questionnaire one year following the injury, respectively. RESULTS A total 37.9% of individuals fulfilled proposed criteria for home-based rehabilitation after acute care. As expected, this group was significantly younger, experienced lesser comorbidities and acute complications, and showed higher motor and sensory function compared to the IFR group. Home-rehabilitation was associated with a higher long-term functional status, physical and psychological QOL, when accounting for relevant confounding factors after an acute AIS-D tSCI. There was no readmission due to failure of home-based rehabilitation. CONCLUSION Home-based rehabilitation in selected individuals sustaining an acute AIS-D tSCI is a safe and interesting strategy to optimize the long-term outcome in terms of functional recovery, physical and psychological QOL, as well as to optimize inpatient rehabilitation resources. The proposed eligibility criteria can be used by the acute care team to select the optimal discharge orientation in this important subpopulation.
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Affiliation(s)
- Andréane Richard-Denis
- Department of medicine, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montreal, Montreal, Québec, Canada
| | - Antoine Dionne
- Department of medicine, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Pascal Mputu Mputu
- Department of medicine, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Jean-Marc Mac-Thiong
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Department of orthopaedic surgery, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada
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Alves MA, Pilusa S, Mashola MK. The prevalence and profile of spinal cord injury in public healthcare rehabilitation units in Gauteng, South Africa. Spinal Cord Ser Cases 2023; 9:15. [PMID: 37055403 PMCID: PMC10102299 DOI: 10.1038/s41394-023-00571-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/01/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023] Open
Abstract
STUDY DESIGN Retrospective medical record review. OBJECTIVE To determine the prevalence and describe the profile of person with SCI (PWSCI) admitted in the public healthcare sector in Gauteng, South Africa. SETTING Specialized public healthcare rehabilitation units in Gauteng, South Africa. METHODS Medical records of PWSCI admitted to public healthcare rehabilitation units between 01 January 2018 and 31 December 2019 were perused. Data were collected anonymously and then summarised using descriptive and inferential statistics. Significance was set at p < 0.05. RESULTS 386 of 998 participants (38.7%) were admitted following SCI and the mean age was 36.9 years. Most participants were male (69.9%), with females significantly more likely to sustain a NTSCI (p < 0.001), which was the least common cause of SCI (34.9%). Those sustaining a TSCI were found to be significantly younger than their NTSCI counterparts (p < 0.001). Assault was the leading cause of injury (35.2%), and a positive HIV status with the presence of comorbidities were found to be significant risk factors for developing a NTSCI (p < 0.001). Most injuries were between T7-T12 (39.9%) and were complete (56.9%). The rehabilitation length of stay 85.6 days, with a mortality rate of 6.48%. CONCLUSIONS Gauteng has among the highest global proportion of TSCI due to assault. Of interest, more females sustained a NTSCI than their male counterparts. There is a need to strengthen SCI prevention strategies, particularly targeting assault in young males and infectious causes in females and older populations. Further epidemiological and outcomes-based research is required for PWSCI.
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Affiliation(s)
- Michael Alexandre Alves
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonti Pilusa
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mokgadi Kholofelo Mashola
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Alfin JD, Shilong DJ, Bot GM, Nwibo OE, Kyesmen NI, Olalere SA, Bakwa ND. Clinical Profile and Predictors of Early Outcome in Patients with Traumatic Spinal Cord Injury in Jos, North-Central Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:49-58. [PMID: 37228886 PMCID: PMC10204922 DOI: 10.4103/jwas.jwas_200_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/19/2022] [Indexed: 05/27/2023]
Abstract
Background/Objectives Spinal cord injury is a devastating condition and has been recognised so since antiquity with evolving pattern of presentation and outcome. This study aimed to review the clinical profile and determinants of early outcome in patients with traumatic spinal cord injury (TSCI) in Jos, Nigeria. Materials and Methods This retrospective cohort study, reviewed the health records of all patients with TSCI that were managed, based on the neurosurgical unit protocol for the management of TSCI in our institution from 2011 to 2021. Relevant data were retrieved into a preformed pro forma, analysis was done for determinants of outcome using SPSS and presented in tables and figure. Results A total of 296 patients, aged 20-39 years, with male to female ratio of 5.2:1 were studied. The median time from injury to presentation was 96 h, and the cervical spine was the most (139, 47.0%) affected region. Most of the patients (183, 61.8%) had complete injury (ASIA A) at presentation, the average, first week mean arterial blood pressure (MAP) of 89.98 ± 8.86. Mortality was 73 (24.7%) at 6 weeks post injury and complete TSCI, cervical spinal cord segment and the average "first week" MAP were, independent predictors of mortality. The admission ASIA impairment scale (AIS) and injury to presentation interval were predictive of AIS improvement at 6 weeks and length of hospital stay (LOHs). Conclusions We also found that AIS at admission, level of spinal cord affected and the average first week MAP were early predictors of mortality, while the injury to presentation interval and admission AIS, predicted improvement of AIS at 6 weeks. The LOHs was seen more in patients with severe AIS at admission and those who had delayed presentation.
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Affiliation(s)
- Jeneral Dumura Alfin
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Danaan Joseph Shilong
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Gyang Markus Bot
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Onyemaechi Ereke Nwibo
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Nanpan Isa Kyesmen
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Shina Abidemi Olalere
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Nenkimun Dirting Bakwa
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
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16
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Flury I, Mueller G, Perret C. The risk of malnutrition in patients with spinal cord injury during inpatient rehabilitation-A longitudinal cohort study. Front Nutr 2023; 10:1085638. [PMID: 36755991 PMCID: PMC9899810 DOI: 10.3389/fnut.2023.1085638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Background and aim Patients with spinal cord injury (SCI) show an increased risk of malnutrition. Studies found that about 50% of patients with a recent SCI are affected by malnutrition when they enter a rehabilitation institution. However, there is a lack of data during the course and at discharge of initial rehabilitation as well as missing knowledge about the factors promoting such a risk. The aim of this study was to assess the risk of malnutrition in individuals with SCI 3 months post injury and at the end of inpatient rehabilitation and to identify factors associated with a high risk of malnutrition. Methods Retrospective, monocentric, longitudinal cohort study, using the data set of the Swiss Spinal Cord Injury Cohort Study and additional data from the patients' medical records. Individuals with SCI were assessed for the risk of malnutrition using the Spinal Nutrition Screening Tool 3 months post injury and at discharge from initial inpatient rehabilitation. Odds ratios (OR) for potential risk parameters were calculated. Results Of the 252 participants included, 62% were at risk for malnutrition 3 months post injury and 40% at discharge (p = 0.000). Moderate to high risk of malnutrition was found regardless of age and BMI. The highest odds for an increased risk at 3 months post injury was identified in ventilator-dependent persons (OR 10.2). At discharge from inpatient rehabilitation, pressure injury (OR 16.3) was the most prominent risk factor. Conclusion In the population with SCI the risk of malnutrition is widespread during inpatient rehabilitation, but also at discharge. Ventilated persons and persons with pressure injuries are clear risk groups and need special attention. Based on these findings and the known negative impact of malnutrition on clinical outcomes, the awareness of malnutrition should be increased in the population with SCI. Therefore, a regular and standardized screening of the malnutrition risk is highly recommended.
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Affiliation(s)
- Irene Flury
- Nutritional Therapy Department, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Gabi Mueller
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Claudio Perret
- Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland,*Correspondence: Claudio Perret,
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17
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Abedi A, Biering-Sørensen F, Chhabra HS, D’Andréa Greve JM, Khan NM, Koskinen E, Kwan KYH, Liu N, Middleton JW, Moslavac S, Rahimi-Movaghar V, O’Connell C, Previnaire JG, Patel A, Scivoletto G, Sharwood LN, Townson A, Urquhart S, Vainionpää A, Zaman AU, Noonan VK, Cheng CL. An international survey of the structure and process of care for traumatic spinal cord injury in acute and rehabilitation facilities: lessons learned from a pilot study. BMC Health Serv Res 2022; 22:1565. [PMID: 36544168 PMCID: PMC9768992 DOI: 10.1186/s12913-022-08847-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To describe the key findings and lessons learned from an international pilot study that surveyed spinal cord injury programs in acute and rehabilitation facilities to understand the status of spinal cord injury care. METHODS An online survey with two questionnaires, a 74-item for acute care and a 51-item for rehabilitation, was used. A subset of survey items relevant to the themes of specialized care, timeliness, patient-centeredness, and evidence-based care were operationalized as structure or process indicators. Percentages of facilities reporting the structure or process to be present, and percentages of indicators met by each facility were calculated and reported separately for facilities from high-income countries (HIC) and from low and middle-income countries (LMIC) to identify "hard to meet" indicators defined as those met by less than two-thirds of facilities and to describe performance level. RESULTS A total of 26 acute and 26 rehabilitation facilities from 25 countries participated in the study. The comparison of the facilities based on the country income level revealed three general observations: 1) some indicators were met equally well by both HIC and LMIC, such as 24-hour access to CT scanners in acute care and out-patient services at rehabilitation facilities; 2) some indicators were hard to meet for LMIC but not for HIC, such as having a multidisciplinary team for both acute and rehabilitation settings; and 3) some indicators were hard to meet by both HIC and LMIC, including having peer counselling programs. Variability was also observed for the same indicator between acute and rehabilitation facilities, and a wide range in the total number of indicators met among HIC facilities (acute 59-100%; rehabilitation 36-100%) and among LMIC facilities (acute: 41-82%; rehabilitation: 36-93%) was reported. CONCLUSIONS Results from this international pilot study found that the participating acute and rehabilitation facilities on average adhered to 74% of the selected indicators, suggesting that the structure and processes to provide ideal traumatic spinal cord injury care were broadly available. Recruiting a representative sample of SCI facilities and incorporating regional attributes in future surveys will be helpful to examine factors affecting adherence to indicators.
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Affiliation(s)
- Aidin Abedi
- grid.42505.360000 0001 2156 6853Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Fin Biering-Sørensen
- grid.5254.60000 0001 0674 042XDepartment for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Nasser M. Khan
- grid.413542.50000 0004 0637 437XOrthopedic Surgery Department, Hamad General Hospital, Doha, Qatar
| | - Eerika Koskinen
- grid.412330.70000 0004 0628 2985Department of Neurology and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Kenny Yat Hong Kwan
- grid.194645.b0000000121742757Department of Orthopaedics & Traumatology, Faculty of Medicine, University of Hong Kong, Hong Kong, SAR China
| | - Nan Liu
- grid.411642.40000 0004 0605 3760Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - James W. Middleton
- grid.1013.30000 0004 1936 834XJohn Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Sasa Moslavac
- Post-acute and Palliative Care Department Novi Marof, General Hospital Varaždin, Varaždin, Croatia
| | - Vafa Rahimi-Movaghar
- grid.411705.60000 0001 0166 0922Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Colleen O’Connell
- grid.55602.340000 0004 1936 8200Physical Medicine & Rehabilitation, Dalhousie University Faculty of Medicine, Fredericton, NB Canada
| | | | - Alpesh Patel
- grid.415534.20000 0004 0372 0644Middlemore Hospital, Auckland, New Zealand
| | - Giorgio Scivoletto
- grid.417778.a0000 0001 0692 3437Spinal Unit and Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Lisa N. Sharwood
- grid.1013.30000 0004 1936 834XUniversity of Sydney, Sydney, NSW Australia
| | - Andrea Townson
- grid.17091.3e0000 0001 2288 9830Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Susan Urquhart
- Spinal Injuries Unit, Queensland Spinal Cord Injuries Services, Brisbane, QLD Australia
| | - Aki Vainionpää
- grid.412326.00000 0004 4685 4917Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Atiq Uz Zaman
- Lahore Medical and Dental College, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Vanessa K. Noonan
- grid.429086.10000 0004 5907 4485Praxis Spinal Cord Institute, Vancouver, BC Canada
| | - Christiana L. Cheng
- grid.429086.10000 0004 5907 4485Praxis Spinal Cord Institute, Vancouver, BC Canada
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18
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Marchesini N, Rubiano AM, Sala F, Demetriades AK, Alves OL. Secondary damage management of acute traumatic spinal cord injury in low and middle-income countries: A survey on a global scale (Part III). BRAIN & SPINE 2022; 2:101694. [PMID: 36605387 PMCID: PMC9808472 DOI: 10.1016/j.bas.2022.101694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/16/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
•In LMICs, several factor may affect the applicability of guidelines for secondary damage control of spinal cord injury.•In LMICs, the use of steroids for spinal cord injury is heterogeneous and admissions to an intensive care units are limited.•The delays for surgical decompression of spinal cord injury can be significan and vary across income and geographic region.•Transfer times seem to be the most common reason for surgical delay in all income and geographic regions.•Costs for surgery for spinal trauma may be a significant barrier to guideline adherence, especially in low-resource settings.
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Affiliation(s)
- Nicolò Marchesini
- Department of Neurosurgery, University Hospital Borgo Trento, Verona, Italy,Corresponding author. Department of Neurosurgery, University Hospital Borgo Trento, Piazzale Stefani 1, 37126, Verona, Italy.
| | - Andrés M. Rubiano
- Neuroscience Institute, Universidad El Bosque, Bogotá, Colombia,Meditech Foundation, Cali, Colombia
| | - Francesco Sala
- Department of Neurosurgery, University Hospital Borgo Trento, Verona, Italy
| | - Andreas K. Demetriades
- Department of Neurosurgery, Royal Infirmary, Edinburgh, UK,Department of Neurosurgery, Leiden University, the Netherlands
| | - Oscar L. Alves
- Department of Neurosurgery, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal,Department of Neurosurgery, Hospital Lusiadas Porto, Porto, Portugal
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Does Wait Time During Acute Care for Transfer to Rehabilitation Admission Impact the Outcomes After a Traumatic Spinal Cord Injury?: A Retrospective Cohort Study. Am J Phys Med Rehabil 2022; 101:1122-1128. [PMID: 35213398 DOI: 10.1097/phm.0000000000001992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this study was to determine the impact of wait time in acute care for inpatient functional rehabilitation admission on the inpatient functional rehabilitation length of stay and functional outcome after a traumatic spinal cord injury. METHODS A retrospective cohort including 277 patients admitted to a single level 1 spinal cord injury acute care center was completed. Partial correlations were used between wait time (in days) for transfer to inpatient functional rehabilitation, the inpatient functional rehabilitation length of stay, and the Spinal Cord Independence Measure total score in the chronic period, adjusting for confounding variables. Stratified analyses were carried out based on the age group and severity of the injury. RESULTS Patients had to wait a mean of 7.3 ± 6.4 days (median = 6 days, interquartile range = 2-10 days, max = 29 days) for inpatient functional rehabilitation admission after rehabilitation readiness, which was not associated with the outcomes when adjusted ( P > 0.05). However, individuals 65 yrs or older with a motor-complete injury showed a lower functional status when exposed to wait time for transfer ( r = -0.87, P = 0.02). CONCLUSIONS Wait time up to 29 days may have no impact on the inpatient functional rehabilitation length of stay nor functional outcome after traumatic spinal cord injury. However, additional resources and/or prioritization should be considered for vulnerable subgroups.
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McRae J, Smith C, Beeke S, Emmanuel A. Development of a swallowing risk screening tool and best practice recommendations for the management of oropharyngeal dysphagia following acute cervical spinal cord injury: an international multi-professional Delphi consensus. Disabil Rehabil 2022; 44:8311-8324. [PMID: 34904488 DOI: 10.1080/09638288.2021.2012607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE International multi-professional expert consensus was sought to develop best practice recommendations for clinical management of patients following cervical spinal cord injury with oropharyngeal dysphagia and associated complications. Additionally, risk factors for dysphagia were identified to support the development of a screening tool. MATERIALS AND METHODS A two-round Delphi study was undertaken with a 27-member panel of expert professionals in cervical spinal cord injury and complex dysphagia. They rated 85 statements across seven topic areas in round one, using a five-point Likert scale with a consensus set at 70%. Statements not achieving consensus were revised for the second round. Comparative group and individual feedback were provided at the end of each round. RESULTS Consensus was achieved for 50 (59%) statements in round one and a further 12 (48%) statements in round two. Recommendations for best practice were agreed for management of swallowing, respiratory function, communication, nutrition and oral care. Twelve risk factors for dysphagia were identified for components of a screening tool. CONCLUSIONS Best practice recommendations support wider clinical management to prevent complications and direct specialist care. Screening for risk factors allows early dysphagia identification with the potential to improve clinical outcomes. Further evaluation of the impact of these recommendations is needed.Implications for RehabilitationDysphagia is an added complication following cervical spinal cord injury (cSCI) affecting morbidity, mortality and quality of life.Early identification of dysphagia risk allows focused interventions that reduce associated nutritional and respiratory impairments.Best practice recommendations based on expert consensus provide a baseline of appropriate interventions, in the absence of empirical evidence.A multi-professional approach to rehabilitation encourages a consistent and coordinated approach to care across acute and rehabilitation settings.
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Affiliation(s)
- Jackie McRae
- Centre for Allied Health, St George's University of London, London, UK
| | - Christina Smith
- Division of Psychology and Language Science, University College London, London, UK
| | - Suzanne Beeke
- Division of Psychology and Language Science, University College London, London, UK
| | - Anton Emmanuel
- Division of Medicine, University College London, London, UK
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21
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Consequences of neglected traumatic spinal cord injuries. J Taibah Univ Med Sci 2022; 18:265-270. [PMID: 36817223 PMCID: PMC9926210 DOI: 10.1016/j.jtumed.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/11/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023] Open
Abstract
Objectives Spinal cord injuries cause major disabilities and are devastating events for both patients and healthcare providers. Most traumatic spinal cord injuries (TSCIs) are due to motor vehicle accidents (MVAs). Neglected injuries result in complications and poor outcomes. Here, we investigated the causes, consequences, and outcomes of neglected TSCIs. Methods This case series study was performed at King Abdulaziz Medical City, Riyadh, KSA. Of the 750 patients treated between February 2016 and February 2021, 18 patients met our inclusion criterion of neglected high-energy TSCI with neurological deficit, necessitating surgical intervention more than 14 days after the index trauma. Results Of the 18 patients with neglected TSCIs, 72.2% were men. The patients' mean age at the time of injury was 36.8 years, 77.8% were from outside Riyadh, and all patients had MVA-induced TSCIs, 88.9% of which were attributable to delayed referral to a tertiary center. The mean duration of neglect was 43 days, and the longest duration was 125 days. The most common site of injury was the thoracolumbar region (55.5%). The American Spinal Injury Association impairment scale score improved in two patients. Bed sores occurred in 55.5%, and deep vein thrombosis occurred in 27.8% of patients. Postoperatively, 77% of patients required intensive care unit admission. Most patients (12) did not receive specialized spinal cord injury rehabilitation postoperatively. Conclusion Early referral of patients with TSCIs is crucial to prevent short- and long-term complications.
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22
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Standard set of network outcomes for traumatic spinal cord injury: a consensus-based approach using the Delphi method. Spinal Cord 2022; 60:789-798. [PMID: 35332273 DOI: 10.1038/s41393-022-00792-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN Consensus study. OBJECTIVES The purpose of this study is to define a standardized (network) outcomes set for traumatic spinal cord injury (t-SCI), covering the patient journey from acute to chronic rehabilitation phase, including patient-relevant outcomes, adequate measurement instruments, as well as case-mix and risk factors. SETTING Acute Spinal Cord Injury (ASCI) Unit Nijmegen, the Netherlands. METHODS A modified Delphi method was performed, including a multidisciplinary panel of 19 health-care professionals with experience in t-SCI management. Formal consensus was reached after two web-based surveys, a face-to-face meeting, and a final confirmation round (threshold consensus: 70%). RESULTS In the first two Delphi rounds, 18/19 invited panelists (94.7%) responded and 10 panelists participated in the final meeting. The prefinal set was confirmed by all panelists. The standard set encompasses the three-tiered outcome hierarchy and consists of patient-reported and clinician-reported outcome domains and measurement instruments. Consensus was reached to include survival, degree of health or recovery, time to recovery, and return to normal activities, disutility of care or treatment process, sustainability of health and nature of recurrences, and long-term consequences of therapy. A measurement schedule was defined as well as for proposed casemix and risk factors, including demographics, clinical status, and treatment process. CONCLUSION A standard set of network outcomes is developed that could be implemented in hospitals and rehabilitation centers involved in the treatment of t-SCI. Using this standard set, comparison of the quality of care is possible and prognostic prediction of outcomes of treatment is feasible, so that each patient receives the right care at the right time in the right place.
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23
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Huang Z, Gong J, Lin W, Feng Z, Ma Y, Tu Y, Cai X, Liu J, Lv C, Lv X, Wu Q, Lu W, Zhao J, Ying Y, Li S, Ni W, Chen H. Catalpol as a Component of Rehmannia glutinosa Protects Spinal Cord Injury by Inhibiting Endoplasmic Reticulum Stress-Mediated Neuronal Apoptosis. Front Pharmacol 2022; 13:860757. [PMID: 35873542 PMCID: PMC9305481 DOI: 10.3389/fphar.2022.860757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Disturbance of the internal environment in the spinal cord after spinal cord injury (SCI) is an important cause of the massive death of neurons in the injury area and one of the major problems that lead to the difficult recovery of motor function in patients. Rehmannia glutinosa, a famous traditional Chinese medicine, is commonly used in neurodegenerative diseases, whereas an iridoid glycoside extract of catalpol (CAT), with antioxidant, antiapoptotic, and neuroprotective pharmacological effects. However, the neuroprotective and anti-apoptosis mechanism of CAT in SCI remains unclear. In our study, we found that CAT has a restorative effect on the lower limb motor function of rats with SCI by establishing a rat model of SCI and treating CAT gavage for 30 days. Our study further found that CAT has the effect of inhibiting apoptosis and protecting neurons, and the action pathway may reduce endoplasmic reticulum (ER) stress by inhibiting CHOP and GRP78 expression and then reduce apoptosis and protect neurons through the Caspase3/Bax/Bcl-2 pathway. In conclusion, we demonstrated that CAT can treat SCI by inhibiting ER stress-mediated neuronal apoptosis and has the potential to be a clinical drug for the treatment of SCI.
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Affiliation(s)
- Zhiyang Huang
- Rehabilitation Medicine Center, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiahong Gong
- Rehabilitation Medicine Center, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wen Lin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhiyi Feng
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Yirou Ma
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yurong Tu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiong Cai
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianhua Liu
- Department of Physical Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Chang Lv
- Rehabilitation Medicine Center, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinru Lv
- Rehabilitation Medicine Center, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiuji Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenjie Lu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Juan Zhao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yibo Ying
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shengcun Li
- Rehabilitation Medicine Center, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Shengcun Li, ; Wenfei Ni, ; Haili Chen,
| | - Wenfei Ni
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Shengcun Li, ; Wenfei Ni, ; Haili Chen,
| | - Haili Chen
- Rehabilitation Medicine Center, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Shengcun Li, ; Wenfei Ni, ; Haili Chen,
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24
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Shenot PJ, Teplitsky S, Margules A, Miller A, Das AK. Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients. J Spinal Cord Med 2022; 45:614-621. [PMID: 33054669 PMCID: PMC9246097 DOI: 10.1080/10790268.2020.1829420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Context: Spinal cord injury (SCI) patients with neurogenic bladder and the inability to self-catheterize may require incontinent diversion to provide low-pressure drainage while avoiding the use of indwelling catheters. We demonstrate that in patients with significant functional improvement, the ileovesicostomy can be a reversible form of diversion, with simultaneous bladder augmentation using the same segment of ileum utilized for the ileovesicostomy. Multidisciplinary management should be utilized to assure mastery of intermittent catheterization before urinary undiversion. This technique allows for transition to a regimen of intermittent self-catheterization with excellent functional and urodynamic outcomes.Design: Case Series.Setting: Tertiary care hospital, Philadelphia, Pennsylvania.Participants: Three individuals with an SCI.Interventions: Conversion of bladder management from an incontinent ileovesicostomy to an augmentation ileocystoplasty, with intermittent catheterization.Outcome Measures: Ability to regain urinary continence with preservation of renal function as determined by serum creatinine and renal ultrasound.Results: Three SCI patients who had an incontinent ileovesicostomy developed sufficient functional improvement to intermittently self-catheterize reliably and underwent conversion of ileovesicostomy to ileocystoplasty. For each, the ileovesicostomy channel was taken down and detubularized, then used to create an ileal patch for augmentation ileocystoplasty. Intermittent catheterization was then used for periodic bladder drainage. All achieved large capacity, low-pressure bladders with complete continence and stable creatinine.Conclusion: In motivated SCI patients, it is possible to regain continence by converting the ileovesicostomy into augmentation ileocystoplasty, avoiding the disadvantages of a urostomy. A multidisciplinary collaborative approach facilitates the optimal rehabilitation of SCI individuals.
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Affiliation(s)
- Patrick J. Shenot
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA,Correspondence to: Patrick J. Shenot, Department of Urology, Thomas Jefferson University, 1025 Walnut St, Ste 1112, Philadelphia, PA19107, USA.
| | - Seth Teplitsky
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Margules
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aaron Miller
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Akhil K. Das
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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25
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Le Fort M, Lefèvre C, Kieny P, Perrouin-Verbe B, Ravaud JF. Adherence to long-term medical follow-up: A qualitative, experience-focused study of people with spinal cord injury. Ann Phys Rehabil Med 2022; 65:101629. [PMID: 35031498 DOI: 10.1016/j.rehab.2022.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 11/07/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Scientific evidence indicates the presence of secondary conditions (such as pressure injuries) after spinal cord injury (SCI). Treatment methods focusing on the management of paraplegia and tetraplegia include systematic preventive follow-up. These advances have significantly improved the functional and vital prognosis of people with SCI, but some people may not have access to these specialized organizations or may not adhere closely to this medicalized vision. We used a narrative approach to explore the perceptions of people with SCI to better understand their adherence to follow-up. OBJECTIVES We aimed to determine the "common denominators" that lead to adherence or non-adherence to long-term follow-up after SCI. METHODS People with SCI who had completed their first rehabilitation period for > 1 year were included with regard to 2 variables: 1) an actual medical follow-up or not and 2) a history of pressure injury or not. A review of the literature was used as preparation for semi-directive interviews, which were prospectively analysed by using qualitative analysis software. Thematic saturation was reached at 28 interviews, and 32 interviews were ultimately completed. RESULT Three main areas concerning participants' perceptions emerged: people's readiness, appropriation and modulation of the systematic follow-up. We developed a broad conceptual framework representing follow-up and the promotion of the long-term health of people with SCI from their perspectives. CONCLUSIONS The medical environment should ensure that people with SCI are ready to actively consider the implementation of prevention strategies and should take into account their ability to establish their own truth, to integrate various life stages after SCI and to negotiate systematic follow-up. The implementation of data about functioning should be conducted using the concept of the Learning Health System.
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Affiliation(s)
- Marc Le Fort
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France; Neurological PMR department, University Hospital, 85, rue Saint-Jacques, 44093, Nantes cedex, France.
| | - Chloé Lefèvre
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Pierre Kieny
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Brigitte Perrouin-Verbe
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Jean-François Ravaud
- Neurological PMR department, University Hospital, 85, rue Saint-Jacques, 44093, Nantes cedex, France; National Institute for Health and Medical research (INSERM), 101, rue de Tolbiac, 75654, cedex 13, France
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26
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Tracy BM, Hoover E, Jones N, Hinrichs MJ, Gelbard RB. The Effect of Physiatry Involvement for Patients With Acute Traumatic Spinal Cord Injury at a Level 1 Trauma Center. Top Spinal Cord Inj Rehabil 2022; 28:76-83. [PMID: 36457359 PMCID: PMC9678214 DOI: 10.46292/sci21-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective To explore the impact of physiatry on acute traumatic spinal cord injury (ATSCI) outcomes using a propensity score matching (PSM) analysis. Methods We retrospectively reviewed all patients with ATSCI at a level 1 trauma center from 2018 to 2019. In a 1:1 fashion, we matched patients who were evaluated by physiatry to those who were not. Our PSM analysis controlled for patient demographics, Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), comorbidities, mechanism, and presence of a traumatic brain injury (TBI). Outcomes included complications, discharge disposition, and 30-day mortality. Survival analysis was performed using Kaplan-Meier plots. Results A total of 102 patients (physiatry 51; no physiatry 51) were matched. Median age was 38 (28-55) years, and median ISS was 25.5 (17-35); 82.4% (n = 84) were male, and 77.5% (n = 79) were bluntly injured. Rates of in-hospital complications were similar between groups. Physiatry involvement was associated with increased odds of discharge to inpatient rehabilitation (odds ratio, 4.6; 95% CI, 2-11.6; p < .001). There was a significant survival benefit seen with physiatry involvement at 30 days (92.6% vs. 78.6%, p = .004) that correlated with a decreased risk of mortality (hazard ratio, 0.2; 95% CI, 0.03-0.7; p = .01). Conclusion Incorporating physiatry into the management of patients with ATSCI is associated with improved survival and greater odds of discharge to rehabilitation. In this population, physiatry should be incorporated into the trauma care team to optimize patient outcomes.
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Affiliation(s)
- Brett M Tracy
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Erin Hoover
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nikki Jones
- Department of Surgery, Morehouse School of Medicine at Grady Memorial Hospital, Atlanta, Georgia
| | - Mark J Hinrichs
- Department of Rehabilitation Medicine, Emory University School of Medicine at Grady Memorial Hospital, Atlanta, Georgia
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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27
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Progression in translational research on spinal cord injury based on microenvironment imbalance. Bone Res 2022; 10:35. [PMID: 35396505 PMCID: PMC8993811 DOI: 10.1038/s41413-022-00199-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 11/14/2021] [Accepted: 12/22/2021] [Indexed: 02/07/2023] Open
Abstract
Spinal cord injury (SCI) leads to loss of motor and sensory function below the injury level and imposes a considerable burden on patients, families, and society. Repair of the injured spinal cord has been recognized as a global medical challenge for many years. Significant progress has been made in research on the pathological mechanism of spinal cord injury. In particular, with the development of gene regulation, cell sequencing, and cell tracing technologies, in-depth explorations of the SCI microenvironment have become more feasible. However, translational studies related to repair of the injured spinal cord have not yielded significant results. This review summarizes the latest research progress on two aspects of SCI pathology: intraneuronal microenvironment imbalance and regenerative microenvironment imbalance. We also review repair strategies for the injured spinal cord based on microenvironment imbalance, including medications, cell transplantation, exosomes, tissue engineering, cell reprogramming, and rehabilitation. The current state of translational research on SCI and future directions are also discussed. The development of a combined, precise, and multitemporal strategy for repairing the injured spinal cord is a potential future direction.
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Barnett HM, Patel HR, Fuentes MM, Bunnell AE. Trends and Disparities in Inpatient Rehabilitation of Adolescents: The Effect of Demographics, Injury Characteristics, and Facility Type. Top Spinal Cord Inj Rehabil 2022; 28:13-20. [PMID: 35145331 PMCID: PMC8791415 DOI: 10.46292/sci21-00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Intensive rehabilitation of adolescents occurs in general and pediatric inpatient rehabilitation facilities (IRFs), but differences in admission and outcomes by facility type have not been thoroughly investigated, particularly among persons with spinal cord injury (SCI). OBJECTIVES To investigate factors related to admission to pediatric or adult IRFs among adolescents and compare the rehabilitation outcomes between facility types. METHODS Using a single-center retrospective cohort study design, demographic information, medical data, and rehabilitation outcomes were obtained by chart review of patients aged 15 to 18 years who received a rehabilitation medicine consultation at an urban level 1 trauma center between 2017 and 2019 (N = 96). Analysis was performed using R statistical software. RESULTS SCI was the second most common diagnosis (21% of patients) and accounted for 36% of inpatient rehabilitation admissions. SCI patients were more likely to undergo rehabilitation at the level 1 trauma versus pediatric facility (relative risk [RR] = 2.43; 95% confidence interval [CI] = 1.08-5.44) compared to traumatic brain injury patients. Admission to trauma versus pediatric IRF was also associated with Black compared to White race (RR = 2.5; CI = 1.12-5.56), violence compared to other etiologies of injury (RR = 2.0; CI = 1.10-3.77), and Medicaid compared to private insurance (RR = 2.15; CI = 1.01-4.59). Admission to pediatric IRF was associated with longer length of stay than admission to adult IRF when adjusted for diagnosis (30.86 ± 21.82 vs. 24.33 ± 18.17 days; p = .046), but Functional Independence Measures did not differ. CONCLUSION Adolescents with SCI and those experiencing systemic disadvantages, including racism and poverty, were more likely to be admitted to trauma compared to pediatric IRF.
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Affiliation(s)
- Heather M. Barnett
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Hetal R. Patel
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Molly M. Fuentes
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
- Seattle Children’s Hospital, Seattle, Washington
| | - Aaron E. Bunnell
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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Bárbara-Bataller E, Méndez-Suárez J, Alemán-Sánchez C, Peñaloza-Polo P, Sánchez-Enríquez J, Saavedra-Santana P. Factores predictivos de destino al alta tras una lesión medular. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chronic physical health conditions following injury: a comparison of prevalence and risk in people with orthopaedic major trauma and other types of injury. Arch Phys Med Rehabil 2022; 103:1738-1748. [DOI: 10.1016/j.apmr.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022]
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Current Approaches in Telehealth and Telerehabilitation for Spinal Cord Injury (TeleSCI). CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022; 10:77-88. [PMID: 35493027 PMCID: PMC9039273 DOI: 10.1007/s40141-022-00348-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review Telehealth and telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and improve health outcomes in the spinal cord injury population. This review provides an overview of the recent literature on the topic of teleSCI and provides insights on current evidence, future directions, and considerations when using teleSCI for clinical care. Recent Findings TeleSCI is used most often for preventive health; management of chronic pain, anxiety, and depression; and rehabilitation-related interventions. As video telehealth becomes mainstream, growth in wearable monitors, bio and neurofeedback mechanisms, and app-based care is expected. Summary TeleSCI is growing in prevalence, demonstrates positive impact on health outcomes, and requires ongoing study to identify, refine, and implement best practices.
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A survey on the early management of spinal trauma in low and middle-income countries: From the scene of injury to the diagnostic phase (part II). BRAIN AND SPINE 2022; 2:101185. [PMID: 36248114 PMCID: PMC9560661 DOI: 10.1016/j.bas.2022.101185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/17/2022] [Accepted: 09/02/2022] [Indexed: 11/20/2022]
Abstract
Most spinal trauma worldwide occurs in low-and middle-income countries (LMICs). Several factors may limit the applicability of current guidelines as regards the early management of spinal injury. The pre-hospital management per se of spinal trauma in LMICs is subject to partial adherence to recommendations, with possible impact on patient outcomes. The use of clinical (eg ASIA) and morphological (eg SLIC, TLICS, AO Spine) grading scales is not homogeneous. The availability and cost of diagnostic equipment, and the timing of emergency imaging can vary significantly from one region to another, probably affecting the timely management of spinal injury patients. The introduction of resource-targeted guidelines for spinal trauma may be a valuable option to overcome the limitations of real-life application of current guidelines.
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Mu J, Wu J, Cao J, Ma T, Li L, Feng S, Gao J. Rapid and effective treatment of traumatic spinal cord injury using stem cell derived exosomes. Asian J Pharm Sci 2021; 16:806-815. [PMID: 35027955 PMCID: PMC8739259 DOI: 10.1016/j.ajps.2021.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 02/08/2023] Open
Abstract
Traumatic spinal cord injury is a fatal acute event without effective clinical therapies. Following the trauma, immediate neural protection and microenvironment mitigation are vitally important for nerve tissue repair, where stem cell-based therapies could be eclipsed by the deficiency of cells due to the hostile microenvironment as well as the transport and preservation processes. Effective emergency strategies are required to be convenient, biocompatible, and stable. Herein, we assess an emergency cell-free treatment using mesenchymal stem cell-derived exosomes, which have proven capable of comprehensive mitigation of the inhibitory lesion microenvironment. The clinically validated fibrin glue is utilized to encapsulate the exosomes and in-situ gelates in transected rat spinal cords to provide a substrate for exosome delivery as well as nerve tissue growth. The emergency treatment alleviates the inflammatory and oxidative microenvironment, inducing effective nerve tissue repair and functional recovery. The therapy presents a promising strategy for effective emergency treatment of central nervous system trauma.
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Gour-Provencal G, Mac-Thiong JM, Feldman DE, Bégin J, Richard-Denis A. Decreasing pressure injuries and acute care length of stay in patients with acute traumatic spinal cord injury. J Spinal Cord Med 2021; 44:949-957. [PMID: 32045340 PMCID: PMC8725680 DOI: 10.1080/10790268.2020.1718265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Identifying factors associated with the occurrence of pressure injuries (PI) during acute care and with longer length of stay (LOS), focusing on modifiable factors that can be addressed and optimized by the acute rehabilitation team. DESIGN Prospective cohort study. SETTING A single Level-1 trauma center specialized in SCI care. PARTICIPANTS A cohort of 301 patients with acute TSCI was studied. OUTCOME MEASURES The primary outcome was the occurrence of PI during acute care stay. The secondary outcome was acute care LOS. Bivariate and multivariate logistic or linear regression analyses were performed to determine the association between non-modifiable factors and outcomes (PI of any stage and acute LOS), whereas bivariate and hierarchical multivariate logistic or linear regression analyses were used for modifiable factors. RESULTS When controlling for the level and severity of the TSCI, the occurrence of pneumonia (OR = 2.1, CI = 1.1-4.1) was significantly associated with the occurrence of PI. When controlling for the level and severity of the TSCI, the occurrence of medical complications (PI, urinary tract infection and pneumonia) and lesser daily therapy resulted in significantly longer acute care LOS (P < .001). CONCLUSIONS Prevention of PI occurrence and the optimization of the acute care LOS represent crucial challenges of the acute rehabilitation team, as they are significantly associated with higher functional outcomes. Patients who develop pneumonia may benefit from more aggressive prevention strategies to reduce PI occurrence. Systematic protocols for the prevention of complications as well as greater volume of therapy interventions should be considered to optimize the acute care LOS.
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Affiliation(s)
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
- Sainte-Justine University Hospital Research Center, Montréal, Quebec, Canada
| | - Debbie E. Feldman
- École de réadaptation, Pavillon du Parc, Université de Montréal, Québec, Canada
| | - Jean Bégin
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Andréane Richard-Denis
- Faculty of Medicine, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
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Levasseur A, Mac-Thiong JM, Richard-Denis A. Are early clinical manifestations of spasticity associated with long-term functional outcome following spinal cord injury? A retrospective study. Spinal Cord 2021; 59:910-916. [PMID: 34230603 DOI: 10.1038/s41393-021-00661-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective study of a prospective cohort of patients with traumatic spinal cord injury (SCI). OBJECTIVES Determine the relationship between the occurrence of early spasticity, defined as the development of signs and/or symptoms of spasticity during the hospitalization in traumatology, and the functional outcome 6-12 months following a SCI. Secondly, to determine the specific impact of early clonus, velocity-dependent hypertonia and/or muscle spasms on the functional outcome at the same timepoint. SETTING Single trauma center specialized in SCI care. METHODS One hundred sixty-two patients sustaining an acute traumatic SCI were included in the analyses. Comparative analysis was performed to describe the characteristics of patients with early spasticity. Correlations were performed to determine the relationship between the clinical signs of spasticity and the Spinal Cord Independence Measure (SCIM) scores collected 6-12 months after SCI. RESULTS 51.9% of the cohort developed clinical signs of spasticity during the hospitalization in traumatology (29.7 days) following SCI. These showed a significantly lower total SCIM score and subscores compared to individuals without early spasticity at follow-up (p < 0.05). After adjusting for confounding factors, the occurrence of early spasms was only clinical sign of spasticity significantly associated with a decreased mobility at follow-up (r = -0.17, p = 0.04). CONCLUSIONS The development of signs and symptoms of spasticity, in particular the occurrence of spasms in the first month following the injury may be associated with decreased functional outcome and mobility. Early assessment of spasticity following SCI is thus recommended.
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Affiliation(s)
- Annie Levasseur
- Research Center, Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal (Hopital du Sacré-Coeur de Montréal), Montreal, QC, H4J 1C5, Canada.,Department of Biomedical Sciences, University of Montreal, Montreal, QC, Canada
| | - Jean-Marc Mac-Thiong
- Research Center, Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal (Hopital du Sacré-Coeur de Montréal), Montreal, QC, H4J 1C5, Canada.,Department of Surgery, Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal (Hopital du Sacré-Coeur de Montréal), Montreal, QC, Canada.,Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Andréane Richard-Denis
- Research Center, Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal (Hopital du Sacré-Coeur de Montréal), Montreal, QC, H4J 1C5, Canada. .,Department of Physical Medicine and Rehabilitation, Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal (Hopital du Sacré-Coeur de Montréal), Montreal, QC, Canada. .,Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
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Sengupta D, Bindra A, Kumar N, Goyal K, Singh PK, Chaturvedi A, Malhotra R, Mishra AK. Respiratory morbidity and mortality of traumatic cervical spinal cord injury at a level I trauma center in India. Spinal Cord Ser Cases 2021; 7:36. [PMID: 33986249 PMCID: PMC8117130 DOI: 10.1038/s41394-020-00371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/09/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022] Open
Abstract
STUDY DESIGN Descriptive retrospective. OBJECTIVES To evaluate the burden of respiratory morbidity in terms of ventilator dependence (VD) days and length of stay in neurotrauma ICU (NICU) and hospital, and to determine mortality in patients with traumatic cervical spinal cord injury (CSCI) in a low middle-income country (LMIC). SETTING Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. METHODS A total of 135 patients admitted with CSCI in the NICU between January 2017 to December 2018 were screened. Information regarding age, gender, American Spinal Injury Association (ASIA) impairment scale (AIS), level of injury, duration of VD, length of NICU, hospital stay, and outcome in terms of mortality or discharge from the hospital were obtained from the medical records. RESULTS A total of 106 CSCI patients were analyzed. The mean (SD) age of patients was 40 (±16) years and male: female ratio was 5:1. The duration of VD, duration of NICU, and hospital stay was a median of 8 days (IQR 1127), 6 days (IQR 1118), and 15 days (IQR 3127) respectively. Mortality was 19% (20/106). The mortality was significantly associated with poorer AIS score, VD, and duration of ICU and hospital stay. All patients were discharged to home only after they became ventilator-free. CONCLUSIONS The ventilator burden, hospital stay, and mortality are high in patients with CSCI in LMICs. Poor AIS scores, prolonged VD, ICU and hospital stay are associated with mortality. There is a need for comprehensive CSCI rehabilitation programs in LMICs to improve outcome.
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Affiliation(s)
- Deep Sengupta
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Bindra
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Niraj Kumar
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Keshav Goyal
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Neurosurgey, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Chaturvedi
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwani Kumar Mishra
- Biostatistics, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India
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Perrouin-Verbe B, Lefevre C, Kieny P, Gross R, Reiss B, Le Fort M. Spinal cord injury: A multisystem physiological impairment/dysfunction. Rev Neurol (Paris) 2021; 177:594-605. [PMID: 33931244 DOI: 10.1016/j.neurol.2021.02.385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/24/2022]
Abstract
Spinal cord injury (SCI) is a complex disease that affects not only sensory and motor pathways below the neurological level of injury (NLI) but also all the organs and systems situated below this NLI. This multisystem impairment implies comprehensive management in dedicated SCI specialized centers, by interdisciplinary and multidisciplinary teams, able to treat not only the neurological impairment, but also all the systems and organs affected. After a brief history of the Spinal Cord Medicine, the author describes how to determine the level and severity of a SCI based on the International Standards for Neurological Classification of Spinal Cord Injury and the prognosis factors of recovery. This article provides also a review of the numerous SCI-related impairments (except for urinary, sexual problems and pain treated separately in this issue), their principles of management and related complications.
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Affiliation(s)
- B Perrouin-Verbe
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France.
| | - C Lefevre
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France
| | - P Kieny
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France
| | - R Gross
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France
| | - B Reiss
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France
| | - M Le Fort
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France
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Sharwood LN, Whyatt D, Vaikuntam BP, Cheng CL, Noonan VK, Joseph AP, Ball J, Stanford RE, Kok MR, Withers SR, Middleton JW. A geospatial examination of specialist care accessibility and impact on health outcomes for patients with acute traumatic spinal cord injury in New South Wales, Australia: a population record linkage study. BMC Health Serv Res 2021; 21:292. [PMID: 33794879 PMCID: PMC8015029 DOI: 10.1186/s12913-021-06235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Timely treatment is essential for achieving optimal outcomes after traumatic spinal cord injury (TSCI), and expeditious transfer to a specialist spinal cord injury unit (SCIU) is recommended within 24 h from injury. Previous research in New South Wales (NSW) found only 57% of TSCI patients were admitted to SCIU for acute post-injury care; 73% transferred within 24 h from injury. We evaluated pre-hospital and inter-hospital transfer practices to better understand the post-injury care pathways impact on patient outcomes and highlight areas in the health service pathway that may benefit from improvement. METHODS This record linkage study included administrative pre-hospital (Ambulance), admissions (Admitted Patients) and costs data obtained from the Centre for Health Record Linkage, NSW. All patients aged ≥16 years with incident TSCI in NSW (2013-2016) were included. We investigated impacts of geographical disparities on pre-hospital and inter-hospital transport decisions from injury location using geospatial methods. Outcomes assessed included time to SCIU, surgery and the impact of these variables on the experience of inpatient complications. RESULTS Inclusion criteria identified 316 patients, geospatial analysis showed that over half (53%, n = 168) of all patients were injured within 60 min road travel of a SCIU, yet only 28.6% (n = 48) were directly transferred to a SCIU. Patients were more likely to experience direct transfer to a SCIU without comorbid trauma (p < 0.01) but higher ICISS (p < 0.001), cervical injury (p < 0.01), and transferred by air-ambulance (p < 0.01). Indirect transfer to SCIU was more likely with two or more additional traumatic injuries (p < 0.01) or incomplete injury (p < 0.01). Patients not admitted to SCIU at all were older (p = 0.05) with lower levels of injury (p < 0.01). Direct transfers received earlier operative intervention (median (IQR) 12.9(7.9) hours), compared with patients transferred indirectly to SCIU (median (IQR) 19.5(18.9) hours), and had lower risk of complications (OR 3.2 v 1.4, p < 0.001). Complications included pressure injury, deep vein thrombosis, urinary infection, among others. CONCLUSIONS Getting patients with acute TSCI patients to the right place at the right time is dependent on numerous factors; some are still being triaged directly to non-trauma services which delays specialist and surgical care and increases complication risks. The higher rates of complication following delayed transfer to a SCIU should motivate health service policy makers to investigate reasons for this practice and consent to improvement strategies. More stringent adherence to recommended guidelines would prioritise direct SCIU transfer for patients injured within 60 min radius, enabling the benefits of specialised care.
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Affiliation(s)
- Lisa N Sharwood
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia.
- University of New South Wales, Faculty of Medicine and Health, NSW Black Dog Institute, Sydney, Australia.
- University of Technology Sydney, Faculty of Engineering, Sydney, NSW, Australia.
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, VIC, Australia.
| | - David Whyatt
- University of Western Australia, (M706), 35 Stirling Highway, Perth, 6009, Australia
| | - Bharat P Vaikuntam
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Christiana L Cheng
- Praxis Spinal Cord Institute, 6400-818 W 10th Ave, Vancouver, BC, V5Z 1M9, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, 6400-818 W 10th Ave, Vancouver, BC, V5Z 1M9, Canada
| | - Anthony P Joseph
- Royal North Shore Hospital, Trauma Department, Reserve Road, St Leonards, NSW, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jonathon Ball
- Royal North Shore Hospital, Neurosurgery, St Leonards, NSW, 2065, Australia
| | - Ralph E Stanford
- Prince of Wales Hospital, Spinal Cord Injury Unit, Randwick, NSW, 2033, Australia
| | - Mei-Ruu Kok
- University of Western Australia, (M706), 35 Stirling Highway, Perth, 6009, Australia
| | - Samuel R Withers
- Australian Institute of Robotic Orthopaedics, Perth, Western Australia, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Reserve Road, St Leonards, NSW, 2065, Australia
- Agency for Clinical Innovation, NSW Health, Reserve Road, St Leonards, NSW, 2065, Australia
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Weber L, Voldsgaard NH, Holm NJ, Schou LH, Biering-Sørensen F, Møller T. Exploring the contextual transition from spinal cord injury rehabilitation to the home environment: a qualitative study. Spinal Cord 2021; 59:336-346. [PMID: 33564119 PMCID: PMC7943422 DOI: 10.1038/s41393-020-00608-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
Study design Explorative qualitative study based on an interpretative phenomenological approach. Objectives This study explored the possibility of transferring knowledge and skills from a spinal cord injury (SCI) unit to the home environment; the individual and structural factors that potentially influenced this transfer; and its compatibility with a meaningful everyday life. Setting Hospital-based rehabilitation unit and community in Denmark. Methods Fourteen individuals with SCI were selected with maximum variation according to age, sex, marital status, and level of injury. In-depth, semi-structured interviews were conducted in the participants’ homes, 2–10 months after discharge from an SCI unit. Data analysis involved taking an interpretative phenomenological approach combined with a template analysis and applying the transfer of training theory to the discussion. Results Transitioning from the SCI unit to the home environment involved a multidimensional change of context in which most of the participants’ previous life roles had changed. This overarching theme had a decisive influence on: balancing loss and acceptance, facing external structural barriers, and the strength of social relationships when the knowledge and skills acquired at the unit were applied in a meaningful everyday life. Conclusions Transition from the SCI unit to the home environment is influenced by a multidimensional change of context that may restrict the use of acquired skills post-discharge, provide distant prospects for tertiary health promotion, and aggravate the experience of loss in people with SCI. Maintaining relationships is a strong mediator for transferring skills and re-establishing a meaningful everyday life.
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Affiliation(s)
- Lene Weber
- The University Hospitals Centre for Health Research (UCSF), Rigshospitalet, Copenhagen University Hospital, Department, 9701, Copenhagen, Denmark. .,Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), Department of Neurorehabilitation, Traumatic Brain Injury Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Nanna Hoffgaard Voldsgaard
- The University Hospitals Centre for Health Research (UCSF), Rigshospitalet, Copenhagen University Hospital, Department, 9701, Copenhagen, Denmark
| | - Nicolaj Jersild Holm
- Department of Spinal Cord Injuries, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lone Helle Schou
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Fin Biering-Sørensen
- Department of Spinal Cord Injuries, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tom Møller
- The University Hospitals Centre for Health Research (UCSF), Rigshospitalet, Copenhagen University Hospital, Department, 9701, Copenhagen, Denmark
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Noonan VK, Jaglal SB, Humphreys S, Cronin S, Waheed Z, Fallah N, Kwon BK, Dvorak MF. Linking Spinal Cord Injury Data Sets to Describe the Patient Journey Following Injury: A Protocol. Top Spinal Cord Inj Rehabil 2021; 26:232-242. [PMID: 33536728 DOI: 10.46292/sci20-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background To optimize traumatic spinal cord injury (tSCI) care, administrative and clinical linked data are required to describe the patient's journey. Objectives To describe the methods and progress to deterministically link SCI data from multiple databases across the SCI continuum in British Columbia (BC) and Ontario (ON) to answer epidemiological and health service research questions. Methods Patients with tSCI will be identified from the administrative Hospital Discharge Abstract Database using International Classification of Diseases (ICD) codes from Population Data BC and ICES data repositories in BC and ON, respectively. Admissions for tSCI will range between 1995-2017 for BC and 2009-2017 for ON. Linkage will occur with multiple administrative data holdings from Population Data BC and ICES to create the "Admin SCI Cohorts." Clinical data from the Rick Hansen SCI Registry (and VerteBase in BC) will be transferred to Population Data BC and ICES. Linkage of the clinical data with the incident cases and administrative data at Population Data BC and ICES will create subsets of patients referred to as the "Clinical SCI Cohorts" for BC and ON. Deidentified patient-level linked data sets will be uploaded to a secure research environment for analysis. Data validation will include several steps, and data analysis plans will be created for each research question. Discussion The creation of provincially linked tSCI data sets is unique; both clinical and administrative data are included to inform the optimization of care across the SCI continuum. Methods and lessons learned will inform future data-linking projects and care initiatives.
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Affiliation(s)
- Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan B Jaglal
- ICES, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Shawna Cronin
- ICES, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Zeina Waheed
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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41
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Ronca E, Scheel-Sailer A, Eriks-Hoogland I, Brach M, Debecker I, Gemperli A. Factors influencing specialized health care utilization by individuals with spinal cord injury: a cross-sectional survey. Spinal Cord 2020; 59:381-388. [PMID: 33188260 DOI: 10.1038/s41393-020-00581-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Cross-sectional observational study using data from the second community survey of the Swiss Spinal Cord Injury Cohort Study (Survey 2017) conducted between 03/2017 and 03/2018. OBJECTIVES To identify facilitators of and barriers to utilizing SCI-specialized outpatient clinic and inpatient care by individuals with spinal cord injury (SCI). SETTING Community. METHODS Multivariable logistic regression was used to identify factors influencing (1) the attendance at annual check-ups at SCI-specialized treatment facilities, (2) the utilization of SCI-specialized outpatient clinic care by those who utilized any outpatient clinic care, and (3) the utilization of SCI-specialized inpatient care by those who were hospitalized. Multiple imputation was used to account for missing data. RESULTS Out of 3959 eligible individuals, 1294 completed the questionnaire (response rate 33%). In the last 12 months, 51% of study participants attended the annual check-up, 33% of outpatient clinic care users utilized SCI-specialized outpatient clinic care, and 44% of those who were hospitalized were hospitalized at a SCI center. Annual check-ups were attended less by women, the elderly, and those with nontraumatic SCI. SCI-specialized outpatient clinic care was less likely to be utilized when individuals with SCI were living with cancer, lived farther away from SCI-specialized treatment facilities or in a minority language region. Specialized inpatient care was less likely to be utilized by women and those with incomplete lesions. CONCLUSIONS SCI-specialized outpatient clinic care must be provided near the residence of individuals with SCI, otherwise non-specialized care is utilized. The reasons why women utilize SCI-specialized care less frequently than men merits further investigation.
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Affiliation(s)
- Elias Ronca
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Anke Scheel-Sailer
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Swiss Paraplegic Centre, Nottwil, Switzerland
| | | | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Armin Gemperli
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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42
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Peñaloza-Polo P, Bárbara-Bataller E, Méndez-Suárez JL, Alemán-Sánchez C, Saavedra-Santana P, Delgado-Duque I. [Factors associated with functional improvement in patients with cervical spinal cord injuries]. Rehabilitacion (Madr) 2020; 55:118-124. [PMID: 33168183 DOI: 10.1016/j.rh.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission. MATERIAL AND METHODS We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge. RESULTS Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge. CONCLUSIONS Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays.
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Affiliation(s)
- P Peñaloza-Polo
- Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas, España.
| | - E Bárbara-Bataller
- Unidad de Lesionados Medulares Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, España
| | - J L Méndez-Suárez
- Unidad de Lesionados Medulares Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, España
| | - C Alemán-Sánchez
- Unidad de Lesionados Medulares Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, España
| | - P Saavedra-Santana
- Área de Estadística e Investigación Operativa del Departamento de Matemáticas, Universidad de Las Palmas de Gran Canaria, Las Palmas, España
| | - I Delgado-Duque
- Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas, España
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Madasa V, Boggenpoel B, Phillips J, Joseph C. Mortality and secondary complications four years after traumatic spinal cord injury in Cape Town, South Africa. Spinal Cord Ser Cases 2020; 6:84. [PMID: 32887870 DOI: 10.1038/s41394-020-00334-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN A prospective, regional, population-based study. OBJECTIVES (1) Determine the mortality rate and factors associated with it 4 years after a TSCI and (2) The point prevalence of secondary medical complications of survivors at 4 years. SETTING Communities of the Cape metropolitan area, South Africa. METHODS All persons (n = 145) sustaining a TSCI from 15 September 2013 to 14 September 2014 were eligible for follow-up at 4 years. Participants were contacted after 4 years. The next of kin, via verbal autopsy, was used to establish cause of death. Those who were alive at 4 years were asked to indicate any secondary medical complications. Logistic regression techniques were used to identify independently associated risk indicators for death and development of secondary complications, respectively. RESULTS Of the initial 145 persons, 87 were included and accounted for. Of these, 21 (24%) had died, 55 (63%) were alive and completed the survey, and 11 (13%) were classified as alive but did not submit the survey. The main cause of death reported was septicaemia (n = 7; 33%), followed by unknown natural causes (n = 7; 33%), then pressure injuries (n = 5; 24%). Out of the 55 persons alive, 89% had at least one medical complication at the time of enquiry, while more than 50% experienced 6 or more complications. The most common complications were pain (80%), muscle spasms (76%), sleeping problems (56%), and bladder dysfunction (44%). CONCLUSIONS Almost one-quarter of persons with TSCI have died 4 years after injury. Also, secondary complications were found to be highly prevalent at 4 years. This information could be used to develop secondary complications prevention programmes to reduce premature deaths. SPONSORSHIP This study was funded by the Medical Research Council of South Africa within the Research Capacity Development Initiative.
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Affiliation(s)
- V Madasa
- Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - B Boggenpoel
- Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - J Phillips
- Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - C Joseph
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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McRae J, Smith C, Emmanuel A, Beeke S. The experiences of individuals with cervical spinal cord injury and their family during post-injury care in non-specialised and specialised units in UK. BMC Health Serv Res 2020; 20:783. [PMID: 32831066 PMCID: PMC7443811 DOI: 10.1186/s12913-020-05659-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with acute cervical spinal cord injury require specialised interventions to ensure optimal clinical outcomes especially for respiratory, swallowing and communication impairments. This study explores the experiences of post-injury care for individuals with cervical spinal cord injury and their family members during admissions in specialised and non-specialised units in the United Kingdom. METHODS Semi-structured interviews were undertaken with individuals with a cervical spinal cord injury and their family member, focussing on the experience of care across units. Eight people with spinal cord injury levels from C2 to C6, were interviewed in their current care settings. Six participants had family members present to support them. Interviews were audio-recorded and transcribed with data inputted into NVivo for thematic analysis. RESULTS The study identified six themes from the participant interviews that highlighted different experiences of care in non-specialised and specialised settings. A number of these were related to challenges with the system, whilst others were about the personal journey of recovery. The themes were titled as: adjustment, transitions, "the golden opportunity", "when you can't eat", communication, and "in the hands of the nurses and doctors". CONCLUSIONS Whilst participants reported being well cared for in non-specialised units, they felt that they did not receive specialist care and this delayed their rehabilitation. Participants were dependent on healthcare professionals for information and care and at times lost hope for recovery. Staff in non-specialised units require training and guidance to help provide support for those with dysphagia and communication difficulties, as well as reassurance to patients and families whilst they wait for transfer to specialised units.
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Affiliation(s)
- Jackie McRae
- Faculty of Health, Social Care and Education, Kingston and St Georges University of London, London, UK
| | - Christina Smith
- Division of Psychology and Language Science, University College London, London, WC1N 1PF UK
| | - Anton Emmanuel
- Division of Medicine, University College London, London, WC1E 6JF UK
| | - Suzanne Beeke
- Division of Psychology and Language Science, University College London, London, WC1N 1PF UK
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Chamberlain JD, Eriks-Hoogland IE, Hug K, Jordan X, Schubert M, Brinkhof MWG. Attrition from specialised rehabilitation associated with an elevated mortality risk: results from a vital status tracing study in Swiss spinal cord injured patients. BMJ Open 2020; 10:e035752. [PMID: 32647022 PMCID: PMC7351285 DOI: 10.1136/bmjopen-2019-035752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Study drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation. METHODS This retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality. RESULTS 1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI. CONCLUSION The differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care.
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Affiliation(s)
- Jonviea D Chamberlain
- Swiss Paraplegic Research, Nottwil, Switzerland
- Centre INSERM U1219, CIC 1401-EC, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France
| | | | | | | | | | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
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Kelly ML, He J, Roach MJ, Moore TA, Steinmetz MP, Claridge JA. Regionalization of Spine Trauma Care in an Urban Trauma System in the United States: Decreased Time to Surgery and Hospital Length of Stay. Neurosurgery 2020; 85:773-778. [PMID: 30329091 DOI: 10.1093/neuros/nyy452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/13/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effect of regionalized trauma care (RT) on hospital-based outcomes for traumatic spine injury (TSI) in the United States is unknown. OBJECTIVE To test the hypothesis that RT would be associated with earlier time to surgery and decreased length of stay (LOS). METHODS TSI patients >14 yr were identified using International Classification of Diseases Ninth Revision Clinical Modification diagnostic codes. Data from 2008 through 2012 were analyzed before and after RT in 2010. RESULTS A total of 4072 patients were identified; 1904 (47%) pre-RT and 2168 (53%) post-RT. Injury severity scores, Spine Abbreviated Injury Scale scores, and the percentage of TSIs with spinal cord injury (tSCI) were similar between time periods. Post-RT TSIs demonstrated a lower median intensive care unit (ICU) LOS (0 vs 1 d; P < 0.0001), underwent spine surgery more frequently (13% vs 11%; P = 0.01), and had a higher rate of spine surgery performed within 24 h of admission (65% vs 55%; P = 0.02). In patients with tSCI post-RT, ICU LOS was decreased (1 vs 2 d; P < 0.0001) and ventilator days were reduced (average days: 2 vs 3; P = 0.006). The post-RT time period was an independent predictor for spine surgery performed in less than 24 h for all TSIs (odds ratio [OR] 1.52, 95% confidence interval [CI]: 1.04-2.22, C-stat = 0.65). Multivariate linear regression analysis demonstrated an independent effect on reduced ICU LOS post-RT for TSIs (OR -1.68; 95% CI: -2.98 to 0.39; R2 = 0.74) and tSCIs (OR -2.42, 95% CI: -3.99-0.85; R2 = 0.72). CONCLUSION RT is associated with increased surgical rates, earlier time to surgery, and decreased ICU LOS for patients with TSI.
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Affiliation(s)
- Michael L Kelly
- Department of Neurosurgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Jack He
- Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Mary Jo Roach
- Center for Healthcare Research and Policy, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Timothy A Moore
- Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | | | - Jeffrey A Claridge
- Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio.,Division of Trauma, Critical Care, Burns, and Acute Care Surgery, MetroHealth Medical Center, Cleveland, Ohio.,Northern Ohio Trauma System, Case Western Reserve University School of Medicine, Cleveland, Ohio
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47
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Roquilly A, Vigué B, Boutonnet M, Bouzat P, Buffenoir K, Cesareo E, Chauvin A, Court C, Cook F, de Crouy AC, Denys P, Duranteau J, Fuentes S, Gauss T, Geeraerts T, Laplace C, Martinez V, Payen JF, Perrouin-Verbe B, Rodrigues A, Tazarourte K, Prunet B, Tropiano P, Vermeersch V, Velly L, Quintard H. French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury. Anaesth Crit Care Pain Med 2020; 39:279-289. [PMID: 32229270 DOI: 10.1016/j.accpm.2020.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To update the French guidelines on the management of trauma patients with spinal cord injury or suspected spinal cord injury. DESIGN A consensus committee of 27 experts was formed. A formal conflict-of-interest (COI) policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS The committee studied twelve questions: (1) What are the indications and arrangements for spinal immobilisation? (2) What are the arrangements for pre-hospital orotracheal intubation? (3) What are the objectives of haemodynamic resuscitation during the lesion assessment, and during the first few days in hospital? (4) What is the best way to manage these patients to improve their long-term prognosis? (5) What is the place of corticosteroid therapy in the initial phase? (6) What are the indications for magnetic resonance imaging in the lesion assessment phase? (7) What is the optimal time for surgical management? (8) What are the best arrangements for orotracheal intubation in the hospital environment? (9) What are the specific conditions for weaning these patients from mechanical ventilation for? (10) What are the procedures for analgesic treatment of these patients? (11) What are the specific arrangements for installing and mobilising these patients? (12) What is the place of early intermittent bladder sampling in these patients? Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® Methodology. RESULTS The experts' work synthesis and the application of the GRADE method resulted in 19 recommendations. Among the recommendations formalised, 2 have a high level of evidence (GRADE 1+/-) and 12 have a low level of evidence (GRADE 2+/-). For 5 recommendations, the GRADE method could not be applied, resulting in expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. CONCLUSIONS There was significant agreement among experts on strong recommendations to improve practices for the management of patients with spinal cord injury.
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Affiliation(s)
- A Roquilly
- Anaesthesiology and Intensive Care Unit, Hôtel-Dieu, Nantes University Hospital, Nantes, France.
| | - B Vigué
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - M Boutonnet
- Hôpital d'instruction des armées Percy, Clamart, France
| | - P Bouzat
- Grenoble Alps Trauma Centre, Department of Anaesthesia and Critical Care, Grenoble University Hospital, Grenoble, France
| | - K Buffenoir
- Neurosurgery department, Nantes University Hospital, Nantes, France
| | - E Cesareo
- Edouard-Herriot University Hospital, Lyon, France
| | - A Chauvin
- Anaesthesiology and Intensive Care Unit, Lariboisière Hospital, AP-HP, Paris, France
| | - C Court
- Orthopaedic Surgery Department, Spine and Bone Tumor Unit, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - F Cook
- Unité de réanimation chirurgicale polyvalente et de polytraumatologie, Albert-Chenevier-Henri-Mondor University Hospital, Créteil, France
| | - A C de Crouy
- Unité SRPR/Réanimation chirurgicale, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - P Denys
- Orthopaedic department, Spine and Bone Tumor Unit. Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - J Duranteau
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - S Fuentes
- Aix-Marseille University, AP-HM, Department of Neurosurgery, University Hospital Timone, Marseille, France
| | - T Gauss
- Post-Intensive Care Rehabilitation Unit, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - T Geeraerts
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, University of Toulouse 3-Paul Sabatier, Toulouse, France
| | - C Laplace
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - V Martinez
- Neuro Urology Unit, Department of Physical Medicine and Rehabilitation. Raymond Poincaré University Hospital, Garches, France
| | - J F Payen
- Department of Anaesthesia and Critical Care, Grenoble Alps University Hospital, 38000 Grenoble, France
| | - B Perrouin-Verbe
- Department of Neurological Physical Medicine and Rehabilitation, Nantes University Hospital, Nantes, France
| | - A Rodrigues
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - K Tazarourte
- Emergency department, Edouard-Herriot University Hospital, 69003 Lyon, France
| | - B Prunet
- Department of Anaesthesia and Critical Care, Val-de-Grâce Hospital, Paris, France
| | - P Tropiano
- Aix-Marseille University, AP-HM, Orthopaedic and traumatic surgery, University Hospital Timone, Marseille, France
| | - V Vermeersch
- Anaesthesiology and Intensive Care Unit, Brest University Hospital, Brest, France
| | - L Velly
- Aix Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France
| | - H Quintard
- Intensive Care Unit, Nice University Hospital, Pasteur 2 Hospital, Nice, France
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Rowan CP, Chan BCF, Jaglal SB, Catharine Craven B. Describing the current state of post-rehabilitation health system surveillance in Ontario - an invited review. J Spinal Cord Med 2019; 42:21-33. [PMID: 31573448 PMCID: PMC6781471 DOI: 10.1080/10790268.2019.1605724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Context: Spinal cord injury (SCI) presents numerous physiological, psychosocial, and environmental complexities resulting in significant healthcare system resource demands. Objective: To describe the current health system surveillance mechanisms in Ontario, Canada and highlight gaps in health surveillance among adults with SCI across their lifespan. Methods: A review of administrative data sources capturing SCI-specific information took place via internet searching and networking among SCI rehabilitation and health services experts with emphasis on functionality, health service utilization, and quality of life data. Results: The review identified a distinct paucity of data elements specific to the health surveillance needs of individuals with SCI living in the community. The gaps identified are: (1) a lack of data usability; (2) inadequate linkage between available datasets; (3) inadequate/infrequent reporting of outcomes; (4) a lack of relevant content/patient-reported outcomes; and, (5) failure to incorporate additional data sources (e.g. Insurance datasets). Conclusion: Currently, SCI-specific health data is disproportionately weighted towards the first 3-6 months post injury with detailed data regarding pre-hospital care, acute management and rehabilitation, but little existing infrastructure supporting community-based health surveillance. Given this reality, the bolstering of meaningful community health surveillance of this population across the lifespan is needed. Addressing the identified gaps in health surveillance must inform the creation of a comprehensive community health dataset incorporating patient-reported outcome measures and enabling linkage with existing administrative and/or clinical databases. A future harmonized data surveillance strategy would, in turn, positively impact function, health services, resource utilization and health-related quality of life surveillance.
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Affiliation(s)
- Chip P. Rowan
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Correspondence to: Chip P. Rowan, Research Department, KITE, Toronto Rehab — University Health Network, Lyndhurst Centre, 520 Sutherland Dr, Toronto, Ontario, Canada M4G 3V9; Ph: 416-597-3422 x6217.
| | - Brian C. F. Chan
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Susan B. Jaglal
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Shabany M, Nikbakht Nasrabadi A, Mohammadi N, Davatgaran K, Yekaninejad M. Health Professionals' Experience of Barriers in Empowering People with Spinal Cord Injury: a Qualitative Inquiry. J Caring Sci 2019; 8:143-148. [PMID: 31598507 PMCID: PMC6778312 DOI: 10.15171/jcs.2019.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/27/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: Empowering an individual with spinal cord injury as far as possible is an experience with various social and cultural aspects. This study investigated health professionals' experiences of barriers in empowering individuals with spinal cord injuries. Methods: This was a qualitative inquiry with a conventional content analysis approach. A number of 11 healthcare professionals who were members of Iran Spinal Cord Injuries Research National Network or had been working in a related research center for at least three years participated in the study. A purposive sampling method was applied until reaching data saturation. The data were collected by semi-structured interviews. The collected data were managed with MAXQDA software version 13. Results: Three main themes as barriers in empowering people with spinal cord injury emerged: 1) Lack of patient-and-family-centered education, 2) Failure in providing sufficient healthcare services and 3) Inappropriate setting for using rehabilitation services. Conclusion: These finding can help policymakers to provide better social facilities and more support services for people with spinal cord injuries and their families. Further research is needed to investigate barriers to empowerment from the perspective of individuals with SCI and their families.
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Affiliation(s)
- Maryam Shabany
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Nikbakht Nasrabadi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Surgical Nursing and Deputy Dean for International Affairs, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooredin Mohammadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Keyvan Davatgaran
- Department of Iranian Research Center on Ageing, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - MirSaeed Yekaninejad
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Patterns and predictors of functional recovery from the subacute to the chronic phase following a traumatic spinal cord injury: a prospective study. Spinal Cord 2019; 58:43-52. [DOI: 10.1038/s41393-019-0341-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022]
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