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Pelletier-Roy R, Dionne A, Richard-Denis A, Briand MM, Bourassa-Moreau É, Mac-Thiong JM. Validation of a New Tool to Detect and Characterize Spinal Cord Injury in the Acute Trauma Patient: The Montreal Acute Classification of Spinal Cord Injury. Global Spine J 2023:21925682231202447. [PMID: 37732564 DOI: 10.1177/21925682231202447] [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 Retrospective validation protocol. OBJECTIVE The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the most comprehensive tool for classifying spinal cord injuries (SCI), but it is not adapted for the evaluation of trauma patients. The objective is to develop and validate a streamlined tool, the Montreal Acute Classification of Spinal Cord Injury (MAC-SCI) that can be integrated in the evaluation of trauma patients to detect and characterize traumatic SCI (tSCI). METHODS The completion rate of the ISCNSCI during initial evaluation after tSCI was estimated at a Level-1 trauma center specialized in SCI care. Using a modified Delphi technique, we designed the MAC-SCI, a new tool to detect and characterize the severity grade and level of SCI in the polytrauma patient. A cohort consisting of 35 consecutive tSCI patients with complete ISNCSCI documentation was used to validate the MAC-SCI. The severity grade and neurological level of injury (NLI) were assessed using the MAC-SCI, and compared to those obtained with the ISNCSCI. RESULTS Only 33% of 148 patients admitted after a tSCI had a complete ISNCSCI performed at initial presentation. The MAC-SCI retains 53 of the 134 elements from the ISNCSCI. There was a 100% concordance in severity grade between the MAC-SCI and ISNCSCI. The NLI were within 2 levels between the MAC-SCI and ISNCSI for 100% of patients. CONCLUSION The MAC-SCI is a streamlined tool that accurately detects and characterizes tSCI in the acute trauma setting. It could be implemented in trauma protocols to guide the management of SCI patients. LEVEL OF EVIDENCE Level III Diagnostic criteria.
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Affiliation(s)
- Rémi Pelletier-Roy
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Antoine Dionne
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Andréane Richard-Denis
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Marie-Michèle Briand
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Étienne Bourassa-Moreau
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Jean-Marc Mac-Thiong
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
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Batchelor P, Bernard S, Gantner D, Udy A, Board J, Fitzgerald M, Skeers P, Battistuzzo C, Stephenson M, Smith K, Nunn A. Immediate Cooling and Early Decompression for the Treatment of Cervical Spinal Cord Injury: A Safety and Feasibility Study. Ther Hypothermia Temp Manag 2023. [PMID: 36779969 DOI: 10.1089/ther.2022.0046] [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: 02/14/2023] Open
Abstract
Cervical spinal cord injury (SCI) usually results in severe, long-term disability. Early therapeutic hypothermia (33-34°C) has been used to improve outcomes in preclinical studies, but previous clinical studies have commenced cooling after arrival at hospital. The objective of the study is to determine the feasibility and safety of early therapeutic hypothermia initiated by paramedics and maintained for up to 24 hours in hospital in patients with SCI. This is a pilot clinical study. The study was undertaken at Ambulance Victoria and The Alfred Hospital, Victoria, Australia. A total of 17 consecutive patients with suspected acute traumatic cervical SCI were enrolled. Patients with suspected cervical SCI were administered a bolus (up to 20 mL/kg) intravenous (IV) cold (4°C) normal saline in the prehospital phase of care. After hospital admission and spinal imaging, further cooling used IV catheter temperature control or surface cooling. Major complications and long-term outcomes were compared with historical controls admitted to the same center before the study. A decrease in core temperature of 1.1°C was achieved during prehospital care and the target temperature was achieved in 6 hours with mechanical temperature management devices in the hospital. There were no major safety concerns. Patients with motor complete SCI who underwent early decompressive surgery had a favorable rate of partial spinal cord recovery compared with historical controls. Therapeutic hypothermia induced using bolus, large-volume, ice-cold saline prehospital and maintained for 24 hours using mechanical devices appears to be feasible and safe in patients with SCI. Larger trials need to be undertaken to determine whether prehospital cooling combined with early decompressive surgery improves outcomes in patients with complete cervical SCI. Australian and New Zealand Clinical Trials Registry (ACTRN12616001086459).
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Affiliation(s)
- Peter Batchelor
- Department of Neurology, University Hospital Geelong, Geelong, Australia
| | - Stephen Bernard
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia.,Ambulance Victoria, Doncaster, Australia.,Prehospital, Emergency and Trauma Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dashiell Gantner
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia.,Australian and New Zealand Intensive Care-Research Center, Melbourne, Australia
| | - Andrew Udy
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia.,Australian and New Zealand Intensive Care-Research Center, Melbourne, Australia
| | - Jasmin Board
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia.,Australian and New Zealand Intensive Care-Research Center, Melbourne, Australia
| | - Mark Fitzgerald
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia.,Prehospital, Emergency and Trauma Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Peta Skeers
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia
| | - Camila Battistuzzo
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia.,Prehospital, Emergency and Trauma Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mick Stephenson
- Ambulance Victoria, Doncaster, Australia.,Prehospital, Emergency and Trauma Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,School of Primary and Allied Health Care, Monash University Peninsula Campus, Frankston, Australia
| | - Karen Smith
- Prehospital, Emergency and Trauma Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Hospital, Heidelberg, Australia
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Engel-Haber E, Radomislensky I, Peleg K, Bodas M, Bondi M, Noy S, Zeilig G. Early Trauma Predictors of Mobility in People with Spinal Cord Injury. Spine (Phila Pa 1976) 2021; 46:E1089-E1096. [PMID: 33813583 DOI: 10.1097/brs.0000000000004053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE This study aims to assess the potential value of very early trauma variables such as Abbreviated Injury Scale (AIS) and the Injury Severity Score for predicting independent ambulation following a traumatic spinal cord injury (TSCI). SUMMARY OF BACKGROUND DATA Several models for prediction of ambulation early after TSCI have been published and validated. The vast majority rely on the initial examination of American Spinal Injury Association (ASIA) impairment scale and level of injury; however, in many locations and clinical situations this examination is not feasible early after the injury. METHODS Patient characteristics, trauma data, and ASIA scores on admission to rehabilitation were collected for each of the 144 individuals in the study. Outcome measure was the indoor mobility item of the Spinal Cord Independence Measure taken upon discharge from rehabilitation. Univariate and multivariable models were created for each predictor, Odds ratios (ORs) were obtained by a multivariable logistic regression analysis, and area under the receiver operator curve was calculated for each model. RESULTS We observed a significant correlation between the trauma variables and independent ambulation upon discharge from rehabilitation. Of the early variables, the AIS for the spine region showed the strongest correlation. CONCLUSION These findings support using preliminary trauma variables for early prognostication of ambulation following a TSCI, allowing for tailored individual interventions.Level of Evidence: 3.
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Affiliation(s)
- Einat Engel-Haber
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Irina Radomislensky
- Israel National Centre for Trauma and Emergency Medicine Research, The Gertner institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Kobi Peleg
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Israel National Centre for Trauma and Emergency Medicine Research, The Gertner institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Moran Bodas
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Israel National Centre for Trauma and Emergency Medicine Research, The Gertner institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Moshe Bondi
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shlomo Noy
- The Chaim Sheba Medical Center, Tel Hashomer, Israel
- School of Health Professions, Ono Academic College, Kiryat Ono, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- School of Health Professions, Ono Academic College, Kiryat Ono, Israel
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Kirshblum S, Snider B, Eren F, Guest J. Characterizing Natural Recovery after Traumatic Spinal Cord Injury. J Neurotrauma 2021; 38:1267-1284. [PMID: 33339474 PMCID: PMC8080912 DOI: 10.1089/neu.2020.7473] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The predominant tool used to predict outcomes after traumatic spinal cord injury (SCI) is the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), in association with the American Spinal Injury Association (ASIA) Impairment Scale (AIS). These measures have evolved based on analyses of large amounts of longitudinal neurological recovery data published in numerous separate studies. This article reviews and synthesizes published data on neurological recovery from multiple sources, only utilizing data in which the sacral sparing definition was applied for determination of completeness. Conversion from a complete to incomplete injury is more common in tetraplegia than paraplegia. The majority of AIS conversion and motor recovery occurs within the first 6-9 months, with the most rapid rate of motor recovery occurring in the first three months after injury. Motor score changes, as well as recovery of motor levels, are described with the initial strength of muscles as well as the levels of the motor zone of partial preservation influencing the prognosis. Total motor recovery is greater for patients with initial AIS B than AIS A, and greater after initial AIS C than with motor complete injuries. Older age has a negative impact on neurological and functional recovery after SCI; however, the specific age (whether >50 or >65 years) and underlying reasons for this impact are unclear. Penetrating injury is more likely to lead to a classification of a neurological complete injury compared with blunt trauma and reduces the likelihood of AIS conversion at one year. There are insufficient data to support gender having a major effect on neurological recovery after SCI.
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Affiliation(s)
- Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersy, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - Brittany Snider
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Fatma Eren
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - James Guest
- Neurological Surgery, Miller School of Medicine, Miami, Florida, USA
- The Miami Project to Cure Paralysis, Miami, Florida, USA
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5
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Ding SQ, Chen J, Wang SN, Duan FX, Chen YQ, Shi YJ, Hu JG, Lü HZ. Identification of serum exosomal microRNAs in acute spinal cord injured rats. Exp Biol Med (Maywood) 2019; 244:1149-1161. [PMID: 31450959 DOI: 10.1177/1535370219872759] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
It is important to find specific and easily detectable diagnostic markers in acute stage of spinal cord injury for guiding treatment and estimating prognosis. Although, microRNAs are attractive biomarkers, there is still no uniform standard for clinical evaluation of spinal cord injury based on “free circulation” miRNA spectrum. The reason may be that miRNA analysis from biological fluids is influenced by many pre-analysis variables. Exosome miRNAs are widely distributed in body fluids and have many advantages comparing with free miRNAs. The specific miRNAs in the central nervous system can be transported to the peripheral circulation and concentrated in exosomes. Therefore, we hypothesized that there might be some physiological changes associated with spinal cord injury in serum exosomal miRNAs. Using next-generation sequencing, miRNA profiles in serum exosomes of sham and acute spinal cord injury rats were analyzed, and integrative bioinformatics were used to analyze the function and regulation of putative target genes. The results showed that acute spinal cord injury can lead to changes in miRNA expression in the circulating exosomes. The changed miRNAs and their associated pathways may explain the pathology of acute spinal cord injury. More importantly, we determined serum exosomal miR-125b-5p, miR-152-3p, and miR-130a-3p are specific and easily detectable diagnostic markers in acute spinal cord injury. More interestingly, we also found some valuable known and novel miRNAs. Further bioinformatics analysis and functional research will be of great help to make clear their role in the pathological process of spinal cord injury and judging whether they can be used as diagnostic markers. Impact statement This research hypothesized that there might be some physiological changes associated with SCI in serum exosomal miRNAs. Using next-generation sequencing, miRNA profiles in serum exosomes of sham and acute SCI rats were analyzed, and integrative bioinformatics were used to analyze the function and regulation of putative target genes. The results showed that acute SCI can lead to changes in miRNA expression in the circulating exosomes. The changed miRNAs and their associated pathways may explain the pathology of acute SCI. More importantly, we determined serum exosomal miR-125b-5p, miR-152-3p, and miR-130a-3p are specific and easily detectable diagnostic markers in acute SCI.
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Affiliation(s)
- Shu-Qin Ding
- Clinical Laboratory, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Anhui Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China
| | - Jing Chen
- Clinical Laboratory, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Anhui Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Department of Immunology, Bengbu Medical College, Anhui 233030, P.R. China
| | - Sai-Nan Wang
- Clinical Laboratory, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Anhui Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Department of Immunology, Bengbu Medical College, Anhui 233030, P.R. China
| | - Fei-Xiang Duan
- Clinical Laboratory, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Anhui Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China
| | - Yu-Qing Chen
- Clinical Laboratory, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Anhui Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Department of Immunology, Bengbu Medical College, Anhui 233030, P.R. China
| | - Yu-Jiao Shi
- Clinical Laboratory, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Anhui Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China
| | - Jian-Guo Hu
- Clinical Laboratory, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Anhui Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China
| | - He-Zuo Lü
- Clinical Laboratory, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Anhui Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Anhui 233004, P.R. China.,Department of Immunology, Bengbu Medical College, Anhui 233030, P.R. China
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6
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Batchelor P, Dietrich WD, Kochanek PM, Lundbye J. Secondary Changes After Injury and Temperature. Ther Hypothermia Temp Manag 2016; 6:58-62. [PMID: 27249580 DOI: 10.1089/ther.2016.29013.pjb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Peter Batchelor
- 1 Department of Medicine, University of Melbourne , Melbourne, Australia
| | - W Dalton Dietrich
- 2 Department of Neurological Surgery, University of Miami Miller School of Medicine , Miami, Florida
| | - Patrick M Kochanek
- 3 Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Justin Lundbye
- 4 Department of Cardiology, Hospital of Central Connecticut , New Britain, Connecticut
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