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Walter T, Schwabe P, Schaser KD, Maurer M. Positive Outcome After a Small-Caliber Gunshot Fracture of the Upper Cervical Spine without Neurovascular Damage. Pol J Radiol 2016; 81:134-7. [PMID: 27081417 PMCID: PMC4811303 DOI: 10.12659/pjr.895529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/02/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Gunshot wounds to the cervical spine most frequently concur with serious injuries to the spinal cord and cervical vessels and often have a fatal outcome. CASE REPORT We describe the case of a 35-year-old male with a complex fracture of the C2 vertebra body and a mandibular fracture after a penetration gunshot to the cervical spine. Computed tomography (CT) at admission revealed the exact extent of the fractures and the small caliber bullet lodged next to the C2 vertebra. In this rare and extremely lucky case no collateral vascular or neurological damage was detected. Eighteen months after surgical bullet removal and posterior C1-C3 fusion complete bone healing of the C2 vertebra was achieved and there were no secondary neurovascular deficits. CONCLUSIONS Immediate surgical C1-C3 fixation resulted in an excellent outcome without secondary neurovascular deficits in this rare case of traumatic complex C2 vertebral fracture caused by a gunshot injury.
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Affiliation(s)
- Thula Walter
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - Philipp Schwabe
- Department of Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Klaus-Dieter Schaser
- Department of Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Martin Maurer
- Department of Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
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Spinal cord injury resulting from gunshot wounds: a comparative study with non-gunshot causes. Spinal Cord 2016; 54:737-41. [DOI: 10.1038/sc.2016.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/17/2016] [Accepted: 02/02/2016] [Indexed: 11/08/2022]
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Chopra T, Marchaim D, Awali RA, Levine M, Sathyaprakash S, Chalana IK, Ahmed F, Martin ET, Sieggreen M, Sobel JD, Kaye KS. Risk factors and acute in-hospital costs for infected pressure ulcers among gunshot-spinal cord injury victims in southeastern Michigan. Am J Infect Control 2016; 44:315-9. [PMID: 26619947 DOI: 10.1016/j.ajic.2015.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Management of pressure ulcers (PrUs) in patients with gunshot-spinal cord injuries (SCIs) presents unique medical and economic challenges for practitioners. METHODS A retrospective chart review was conducted at 3 acute care hospitals in metropolitan Detroit for patients admitted with PrUs due to gunshot-SCIs between January 2004 and December 2008. Multivariate analysis using logistic regression was conducted to choose for the independent predictors of infected PrUs. Mean adjusted in-hospital costs per patient and per hospitalization were calculated and compared between infected and noninfected PrUs. RESULTS The study cohort included 201 gunshot-SCI patients with PrUs contributing to 395 admissions, including readmissions, between 2004 and 2008. Seventy-six patients (38%) had infected PrUs at time of the index admission. Independent predictors of infected PrUs on index admission included Charlson Comorbidity Index ≥2 (odds ratio, 2.18, P = .026) and stage III/IV PrU (odds ratio, 4.82; P <.0001). During the study period, the cumulative median duration of hospitalization per patient was 12 days (interquartile range, 6-24 days), resulting in a mean adjusted cost of $19,969 ± $6639 per patient. The mean adjusted cost per hospitalization for patients with infected PrUs was significantly higher than that for patients with noninfected PrUs ($16,735 ± $8310 vs $12,356 ± $7007; P <.001). CONCLUSIONS A multidisciplinary approach including home-based rehabilitation programs and SCI wound clinics might help prevent PrUs and their complications and reduce associated costs.
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Abstract
STUDY DESIGN Retrospective analysis of inpatient and outpatient data from a single academic trauma center. OBJECTIVE To test the effectiveness of a conservative treatment algorithm for civilian spinal gunshot wounds (CSGSWs) by comprehensively evaluating neurological status and recovery, fracture type, concomitant injuries, indications for surgery, and complications. SUMMARY OF BACKGROUND DATA Few large studies exist to guide treatment of CSGSWs, and none have been published in nearly 20 years. METHODS A search of International Classification of Diseases, Ninth Revision (ICD-9) codes was performed for all hospital patients treated from 2003 to 2011 by either neurosurgery or orthopedic surgery to identify 159 consecutive patients who sustained CSGSWs. Mean follow-up was 13.6 months. American Spinal Injury Association grading was used to assess neurological injury. RESULTS Fifty percent of patients had neurological deficits from CSGSW. Complete spinal injury was the most common injury grade; thoracic injuries had the most risk of complete injury (P < 0.001). Nearly 80% of patients had concomitant injuries to other organs. Operative treatment was more likely in patients with severe neurological injuries (P = 0.008) but was not associated with improved neurological outcomes (P = 1.00). Nonoperative treatment did not lead to any cases of late spinal instability or neurological deterioration. Overall, 31% of patients had an improvement of at least 1 American Spinal Injury Association grade by final follow-up. Nearly half of patients experienced at least 1 GSW-related complication; risk of complications was associated with neurological injury grade (P < 0.001) and operative treatment (P = 0.04). CONCLUSION The vast majority of CSGSWs should be managed nonoperatively, regardless of neurological grade or number of spinal columns injured. Indications for surgery include spinal infection and persistent cerebrospinal fluid leaks. LEVEL OF EVIDENCE 3.
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Zhang JL, Chen J, Wu M, Wang C, Fan WX, Mu JS, Wang L, Ni CM. Several time indicators and Barthel index relationships at different spinal cord injury levels. Spinal Cord 2015; 53:679-81. [PMID: 25622731 DOI: 10.1038/sc.2014.206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/05/2014] [Accepted: 10/12/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVES To compare different injury levels in spinal cord injury (SCI) patients with respect to operation intervention time (OIT), rehabilitation intervention time (RIT), average length of hospital stay (ALOS) and Barthel Index (BI) on admission and discharge. SETTING China. METHODS We retrospectively analyzed data from 95 SCI cases who received treatment in our rehabilitation center from 2010-2013. RESULTS SCI resulted from high falls (55.79%), traffic accidents (28.42%), diseases (8.42%) and low falls (7.37%). We found no correlations between OIT, RIT, ALOS and discharge BI for all spinal segments (P>0.05). The OIT of thoracic SCI and lumbar SCI correlated negatively with RIT (P<0.01). The OIT of lumbar SCI correlated negatively with ALOS (P<0.05). CONCLUSION BI had no correlation with OIT, RIT or ALOS for all spinal segments; the OIT of thoracic and lumbar SCI correlated negatively with RIT; and the OIT of lumbar SCI correlated negatively with ALOS.
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Affiliation(s)
- J L Zhang
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - J Chen
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - M Wu
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - C Wang
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - W X Fan
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - J S Mu
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - L Wang
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - C M Ni
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
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Kalani MYS, Filippidis A, Martirosyan NL, Theodore N. Cerebral herniation as a complication of chest tube drainage of cerebrospinal fluid after injury to the spine. World Neurosurg 2011; 79:798.E17-9. [PMID: 22120389 DOI: 10.1016/j.wneu.2011.04.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/07/2011] [Accepted: 04/26/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Patients with concomitant injuries to the thorax and thecal sac requiring chest tube drainage are at risk for cerebral herniation caused by overdrainage of cerebrospinal fluid (CSF). CASE DESCRIPTION A 40-year-old man presented to the trauma service awake, alert, and oriented with an isolated gunshot wound to the midaxillary line through the tenth intercostal space and a complete spinal cord injury at T12. The patient was stabilized and intubated. A chest tube was placed, and he was transferred to the neurologic intensive care unit. The patient was found to be comatose with complete absence of brainstem reflexes 3 hours after admission. RESULTS Magnetic resonance imaging (MRI) and autopsy revealed diffuse cerebral edema, occlusion of the bilateral posterior cerebral arteries, and tonsillar herniation extending several centimeters below the foramen magnum, with petechial hemorrhages and absence of gliosis. CONCLUSIONS To the authors' knowledge, this case represents the first report of cerebral herniation secondary to chest tube drainage of a CSF leak caused by traumatic injury to the thecal sac.
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Affiliation(s)
- M Yashar S Kalani
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Gerhart KA, Mellick DC, Weintraub AH. Violence-Related Traumatic Brain Injury: A Population-Based Study. ACTA ACUST UNITED AC 2003; 55:1045-53. [PMID: 14676649 DOI: 10.1097/01.ta.0000044353.69681.96] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most studies of traumatic brain injury (TBI) and violence are small, focus on one violent mechanism only, and are nonrepresentative. This large, population-based effort examines characteristics, circumstances of injury, treatment pathways, and outcomes of persons with TBI as a result of all types of violence, compares them with other TBI survivors, identifies a risk profile, and examines how a violent cause impacts later outcomes. METHODS This study involved medical record abstraction and telephone survey at 1 year postinjury of a weighted sample of 2,771 Coloradans hospitalized with TBI between January 1, 1996, and June 30, 1999. RESULTS People with violently incurred TBI are more likely to be young, male, members of minority groups, single, and premorbid alcohol abusers than other TBI survivors. At 1 year postinjury, they report less community integration and more headaches, confusion, and sensory and attentional disturbances. Predictors of these outcomes included age, gender, injury severity, and employment status. CONCLUSION It appears that essentially the same factors that increase risk of sustaining a violent TBI negatively impact later outcomes as well.
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Affiliation(s)
- Kenneth A Gerhart
- Craig Hospital, Rocky Mountain Regional Brain Injury Syste, Englewood, Colorado 80110, USA.
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Abstract
The current authors did a retrospective review of the medical records of 47 patients with spinal cord injury secondary to gunshot wounds who were admitted to National Rehabilitation Hospital between 1993 and 1999. There were 44 male patients and three female patients; the mean age of the patients was 24.7 years (range, 15-56 years). Thirty-seven patients had paraplegia (27 had complete paraplegia, 10 had incomplete paraplegia) as a result of their gunshot wounds, and 10 had quadriplegia (eight had complete quadriplegia, two had incomplete quadriplegia). None of the weapons were identified. The most common firearm types were low-velocity weapons. The length of acute hospitalization increased with the number of associated injuries. Rehabilitation total length of stay was proportional to the injury classification (paraplegia, quadriplegia). The daily occupancy fee in the National Rehabilitation Hospital was approximately 1900 US dollars. Patients were admitted to the hospital when acute medical and surgical problems had been cleared and when they were ready to participate in rehabilitation and therapy.
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Affiliation(s)
- Winston Smith
- Division of Orthopaedic Surgery, Howard University Hospital, Washington, DC, USA
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Greenspan AI, Kellermann AL. Physical and psychological outcomes 8 months after serious gunshot injury. THE JOURNAL OF TRAUMA 2002; 53:709-16. [PMID: 12394871 DOI: 10.1097/00005373-200210000-00015] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to determine the health status and psychological distress of gunshot injury victims 8 months after hospital discharge. METHODS Sixty patients admitted to a Level I trauma center for firearm-related injuries were interviewed during their hospitalization and again 8 months postdischarge. Health status was measured using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Symptoms of posttraumatic stress (avoidance and intrusion) were assessed using the Impact of Event Scale. RESULTS Subjects were predominantly young (mean age, 30 years), male (92%), and African-American (95%). Mean SF-36 scores at follow-up were significantly worse than preinjury scores for all subscales (p < 0.05). Symptoms of posttraumatic stress were common; 39% of respondents reported severe intrusive thoughts and 42% reported severe avoidance behaviors. Admission Injury Severity Scores did not predict poor health status 8 months postdischarge, but intrusion symptoms were strongly associated with lower SF-36 scores. CONCLUSION Many hospitalized survivors of gunshot injuries report significant long-term declines in physical and/or mental health. Injury severity at hospital admission may not be predictive of long-term health status.
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Affiliation(s)
- Arlene I Greenspan
- Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia 30322, USA.
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Affiliation(s)
- T E Barros
- Spinal Injury, School of Medicine, University of São Paulo, São Paulo, Brazil
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Putzke JD, Richards JS, DeVivo MJ. Quality of life after spinal cord injury caused by gunshot. Arch Phys Med Rehabil 2001; 82:949-54. [PMID: 11441384 DOI: 10.1053/apmr.2001.23973] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine what effect gunshot-caused spinal cord injury (SCI) has on self-reported quality of life (QOL) and on the frequency of pain sufficient to interfere with day-to-day activities. DESIGN Follow-up, case-control design. SETTING Analysis of data obtained from the (US) National Spinal Cord Injury Statistical Center from 18 funded Spinal Cord Injury Model Systems. PARTICIPANTS Individuals with traumatic onset SCI (n = 1901). From these, 111 persons with gunshot-caused SCI were matched to persons with nongunshot SCI. MAIN OUTCOME MEASURES Satisfaction with Life Scale (SWLS), the Craig Handicap Assessment and Reporting Technique (CHART), Medical Outcomes Study Short-Form Health Survey (SF-12), and an individual pain item from the SF-12. RESULTS No between-group differences were found on any of the QOL outcome measures. In contrast, those with SCI caused by gunshot reported that pain more frequently interfered with day-to-day activities than the matched comparison group. CONCLUSIONS SCI caused by gunshot appears largely unrelated to QOL, after controlling for demographic and medical characteristics associated with this group. Gunshot as a mechanism of SCI may place individuals at an increased risk of subsequent development of pain that interferes with activities of daily living.
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Affiliation(s)
- J D Putzke
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
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Putzke JD, Richards JS, Devivo MJ. Gunshot versus nongunshot spinal cord injury: acute care and rehabilitation outcomes. Am J Phys Med Rehabil 2001; 80:366-70; quiz 371-3, 387. [PMID: 11327559 DOI: 10.1097/00002060-200105000-00008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the impact of gunshot-caused spinal cord injury on acute and rehabilitative care outcome using a case control design. DESIGN Two groups (i.e., gunshot- vs. nongunshot-caused spinal cord injury) of 212 individuals were matched case-for-case on age (i.e., within 10 yr), education, gender, race, marital status, primary occupation, impairment level, and Model System region. Outcome measures included length of hospital stay, functional status (FIM), treatment charges, and home discharge rates. RESULTS The two groups did not differ in the length of stay during acute and rehabilitative care, charges during rehabilitative care, or postrehabilitation discharge placement. Several significant between-group differences in treatment procedures were noted (e.g., prevalence of spinal surgery), which may, in part, account for the higher acute-care charges among those persons with nongunshot-caused spinal cord injury. CONCLUSION Once an individual is stabilized and admitted for rehabilitative care, gunshot etiology of spinal cord injury seems largely unrelated to the initial rehabilitation outcome.
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Affiliation(s)
- J D Putzke
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, USA
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Kirshblum SC, O’Connor KC. Levels of Spinal Cord Injury and Predictors of Neurologic Recovery. Phys Med Rehabil Clin N Am 2000. [DOI: 10.1016/s1047-9651(18)30144-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Flores LP, Nascimento Filho JDS, Pereira Neto A, Suzuki K. [Prognostic factors related to gunshot wounds to the spine in patients submitted to laminectomy]. ARQUIVOS DE NEURO-PSIQUIATRIA 1999; 57:836-42. [PMID: 10751920 DOI: 10.1590/s0004-282x1999000500016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The spinal trauma related to civilian gunshot missile still remains a serious neurological event that carries a dismal prognosis almost in all cases. Its surgical indication also is a matter of discussion. Our goal is to identify the aspects that could influence the prognosis after surgery to this kind of lesions. We conducted a retrospective study of 45 consecutive patients submitted to laminectomy at Hospital de Base do Distrito Federal (Brasília, Brazil), testing the following aspects: initial neurological status, level of the deficit, surgical timing, use of methilprednisolone and presence of dural tearing. Among those, the initial clinical presentation and the level of the lesion (60% of the patients with cauda equina syndrome and 53% of that with lesions in the lombar region improved their neurological status after laminectomy) were the most important factors affecting the outcome. Seventy percent of the patients experienced a pain relief after the surgical procedure.
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Affiliation(s)
- L P Flores
- Unidade de Neurocirurgia do Hospital de Base do Distrito Federal, Brasília, DF.
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McKinley WO, Johns JS, Musgrove JJ. Clinical presentations, medical complications, and functional outcomes of individuals with gunshot wound-induced spinal cord injury. Am J Phys Med Rehabil 1999; 78:102-7. [PMID: 10088582 DOI: 10.1097/00002060-199903000-00002] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Gunshot wounds are currently the second leading cause of spinal cord injury in the United States, and coexisting injuries or complications accompanying penetrating wounds often increase patient morbidity. A review of 217 traumatic spinal cord injury rehabilitation admissions to a tertiary care hospital during a 5-yr period revealed 49 individuals (23%) with gunshot wound-induced spinal cord injury. A single bullet entry site was seen in 54%, whereas 17% had greater than 3 sites of entry. Common (>25%) sites of bullet entry included the back, abdomen, neck, and chest. Common gunshot wound-related medical complications included pain (54%), infections (40%), pneumothorax (24%), nonspinal fractures (22%), colonic perforation (17%), cerebrospinal fluid leak (10%), and retroperitoneal hematoma (10%). When compared with nonviolence-related traumatic spinal cord injury (motor vehicle accidents and falls), patients with gunshot wound-induced spinal cord injury were significantly more frequently (P < 0.01) younger, non-Caucasian, unmarried, and unemployed. Injury characteristics revealed significantly (P < 0.01) more paraplegia and complete spinal cord injury within the gunshot wound-induced spinal cord injury group. Gunshot wound-induced spinal cord injury and nonviolent traumatic spinal cord injury groups had similar lengths of stay, Functional Independence Measure scores, and discharge to home rates. This article adds to the growing body of literature examining clinical, medical, and functional outcome characteristics of individuals with spinal cord injury secondary to violence-related cause.
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Affiliation(s)
- W O McKinley
- Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298, USA
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Waters RL, Adkins RH, Sie I, Cressy J. Postrehabilitation outcomes after spinal cord injury caused by firearms and motor vehicle crash among ethnically diverse groups. Arch Phys Med Rehabil 1998; 79:1237-43. [PMID: 9779677 DOI: 10.1016/s0003-9993(98)90268-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES To determine the differential effects of impairment, disability, etiology, and selected preinjury and social factors on medical complications, medical resources use, and handicap after rehabilitation for spinal cord injury (SCI). DESIGN Survey including interview and medical record review. SETTING Model SCI Care System centered at an urban, public medical center. PARTICIPANTS A volunteer convenience sample of 164 men, ages 18 to 35yrs at injury, with SCI caused by firearms or motor vehicle crash. MAIN OUTCOME MEASURES Mean numbers of documented complications, pressure sore episodes, nonroutine clinic visits, postrehabilitation hospitalization days per year, assessment by Functional Independence Measure (FIM), and total score on the Craig Handicap Assessment and Reporting Technique (CHART). RESULTS Significant factors for postrehabilitation complications were discharge FIM (p < .001) and injury duration (p = .046); for pressure ulcer episodes, they were injury completeness (p < .001), drug abuse following injury (p = .005), and ethnicity (p = .043); for average annual nonroutine clinic visits, they were complications (p < .001), pressure ulcer episodes (p < .001), duration of injury (p = .001), and pain (p = .052); for hospitalization, they were pressure ulcer episodes (p < .001) and complications (p = .043); for CHART scores, they were discharge FIM (p < .001), preinjury education (p < .001), hospitalization (p = .007), chronic pain (p = .01), longest time at one job (p = .02), completeness of injury (p = .042), and preinjury employment (p = .049). CONCLUSIONS Disability is the most important factor in postrehabilitation outcomes for SCI, followed by injury completeness, which is also associated with multiple outcomes. Postinjury but not preinjury drug abuse is adversely associated with outcomes. Etiology and ethnicity are not important determinates of outcome.
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Affiliation(s)
- R L Waters
- Regional Spinal Injury Care System of Southern California, Injury Prevention Research Center, University of California, Los Angeles, USA
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Heary RF, Vaccaro AR, Mesa JJ, Northrup BE, Albert TJ, Balderston RA, Cotler JM. Steroids and Gunshot Wounds to the Spine. Neurosurgery 1997. [DOI: 10.1227/00006123-199709000-00013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Heary RF, Vaccaro AR, Mesa JJ, Northrup BE, Albert TJ, Balderston RA, Cotler JM. Steroids and gunshot wounds to the spine. Neurosurgery 1997; 41:576-83; discussion 583-4. [PMID: 9310974 DOI: 10.1097/00006123-199709000-00013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The second National Acute Spinal Cord Injury Study demonstrated that there were neurological benefits from "spinal cord injury" doses of methylprednisolone for blunt spinal cord injuries. In this review, we examined the relative risk/benefit ratio of intravenously treating spinal gunshot wound victims with steroids. METHODS A retrospective review was conducted of 254 consecutive patients who were treated between 1979 and 1994 for gunshot wounds to the spine (C1-L1) and a spinal cord injury. Three subgroups were established based on the administration of the steroids methylprednisolone (National Acute Spinal Cord Injury Study 2 protocol), dexamethasone (initial dose, 10-100 mg), and no steroids. All patients who received steroids were initially treated at another hospital and then transferred. No patients received steroids at our institution. The data analyzed included neurological outcome and infectious and noninfectious complications. RESULTS No statistically significant neurological benefits were demonstrable from the use of steroids (methylprednisolone, dexamethasone). Infectious complications were increased in both groups receiving steroids (not statistically significant). Gastrointestinal complications were significantly increased in the dexamethasone group (P = 0.021), and pancreatitis was significantly increased in the methylprednisolone group (P = 0.040). The mean duration of follow-up was 56.3 months. CONCLUSION In this retrospective, nonrandomized review, no neurological benefits were detectable from intravenously administered steroids after a gunshot wound to the spine. Both infectious and noninfectious complication rates were higher in the groups receiving steroids. Patients who sustain a spinal cord injury secondary to a gunshot wound to the spine should not be treated with steroids until the efficacy of such treatment is proven in a controlled study.
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Affiliation(s)
- R F Heary
- Division of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, USA
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Waters RL, Adkins RH. Firearm versus motor vehicle related spinal cord injury: preinjury factors, injury characteristics, and initial outcome comparisons among ethnically diverse groups. Arch Phys Med Rehabil 1997; 78:150-5. [PMID: 9041895 DOI: 10.1016/s0003-9993(97)90256-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the extent to which individuals with spinal cord injuries caused by firearms differed from those caused by motor vehicle crash (MVC) in terms of selected preinjury factors, injury characteristics and related treatment, and outcomes at discharge from rehabilitation; and to determine the effect of ethnicity on preinjury factors and outcome. DESIGN Survey including interview of former rehabilitation inpatients and medical records review. SETTING Model Spinal Cord Injury Care System centered at an urban, public rehabilitation medical center. PARTICIPANTS Volunteer convenience sample of 164 men who were between the ages of 18 and 35 years at the time of injury and who were injured by firearm or MVC between January 1, 1980 and December 31, 1989. Subjects had completed rehabilitation at a rehabilitation center; they were non-Latino White, African-American, or Latino. Subjects were contacted by mail and telephone. The sample was comprised of 26% of the potential participants; however, differential follow-up rates were highly consistent with distribution of primary characteristics within the population of potential candidates. MAIN OUTCOME MEASURES The Functional Independence Measure (FIM) and total and rehabilitation lengths of stay were the outcome measures. Groups and outcomes were also compared in terms of preinjury education, employment, and indicators of antisocial behavior, as well as neurological deficit, associated injuries, and surgical treatment. RESULTS The firearm and MVC groups were different in terms of ethnic distribution. There were no non-Latino Whites in the firearm group and few African-Americans in the MVC group. With the exception of preinjury education, nonparametric and univariate tests showed differences between the firearm and MVC groups in terms of preinjury employment and indicators of antisocial behavior, associated injuries, surgical treatment, neurological deficit, and lengths of stay. Changes in FIM scores, however, were not different between etiologic or ethnic groups. Multiple regression indicated that injury severity accounted for the largest variance in outcomes and that preinjury factors, etiology, and ethnicity did not contribute significantly to the variance in outcome measures. CONCLUSIONS Although preinjury factors are associated with ethnicity and minorities have higher proportions of SCI caused by firearms, these factors do not significantly influence rehabilitation outcomes at discharge. The primary factors influencing rehabilitation outcomes are related to the deficits, associated physical injuries, and related treatments common to the causes of the injury.
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Affiliation(s)
- R L Waters
- Regional Spinal Cord Injury Care System of Southern California, Los Angeles, USA
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Aarabi B, Alibaii E, Taghipur M, Kamgarpur A. Comparative study of functional recovery for surgically explored and conservatively managed spinal cord missile injuries. Neurosurgery 1996; 39:1133-40. [PMID: 8938767 DOI: 10.1097/00006123-199612000-00013] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE In a retrospective study, the extent of functional recovery and the merits of surgical exploration versus conservative management for spinal cord injuries were evaluated for 145 casualties from the front lines of the Iran-Iraq conflict. METHODS Eighty-seven patients who underwent surgical exploration and 58 patients who were conservatively treated were monitored for 6 to 140 months (average, 57 +/- 31 mo) for any changes from their baseline neurological status, using the Frankel Scoring System. RESULTS Twenty-two of 90 patients (24.4%) with complete injuries (Frankel score A) and 53 of 55 (96.4%) with incomplete injuries (Frankel scores B, C, and D) experienced changes in their neurological status as they recovered. Improvement was noted for 42 of 87 surgically treated patients (13 of 55 with complete injuries and 29 of 32 with incomplete injuries). Among conservatively treated patients, improvement was noted for 32 of 58 (55%), including 25.7% of those with complete injuries and 100% of those with incomplete injuries. Independent walking (Frankel scores D and E) was achieved by 10 of 90 patients with complete injuries and by 52 of 55 patients with incomplete injuries. Surgery did not affect the final outcome. Thirteen of 17 (76%) cerebrospinal fluid fistulas, 13 of 15 (87%) meningitides, and 4 of 6 (67%) local septic complications were encountered in the surgically treated group. CONCLUSION Surgery did not enhance functional recovery from spinal cord missile injuries but did correlate with an increased prevalence of complications (fistulas, meningitis, and local sepsis). With or without surgical exploration, patients with seemingly complete cauda equina injuries demonstrated better functional outcome than did those with spinal cord injuries.
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Affiliation(s)
- B Aarabi
- Shiraz University of Medical Sciences, Division of Neurosurgery, Nemazee Hospital, Iran
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Levy ML, Gans W, Wijesinghe HS, SooHoo WE, Adkins RH, Stillerman CB. Use of methylprednisolone as an adjunct in the management of patients with penetrating spinal cord injury: outcome analysis. Neurosurgery 1996; 39:1141-8; discussion 1148-9. [PMID: 8938768 DOI: 10.1097/00006123-199612000-00014] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Since the results of the Second National Acute Spinal Cord Injury Study were published in 1990, methylprednisolone has become a mainstay in the treatment of nonpenetrating spinal cord injury. Although potential significant relationships between the prompt administration of high-dose methylprednisolone after blunt spinal cord injury and outcome have recently been addressed, the relationship between the prompt administration of high-dose methylprednisolone after penetrating spinal cord injury and outcome remain unanswered. METHODS To explore this relationship, we performed a retrospective nonrandomized study on a series of 252 patients with penetrating missile injuries to the spine who presented to our institution from March 1980 to July 1993. One hundred eighty-one patients (71%) were treated conventionally without adjunctive steroid therapy before 1990. Sixteen patients followed up during the 13-year study period received steroid protocols that were not consistent with the Second National Acute Spinal Cord Injury Study protocol and were excluded from the study. Since 1990, 55 patients (21%) were treated with intravenous methylprednisolone according to the Second National Acute Spinal Cord Injury Study protocol. All patients were subsequently transferred for rehabilitative care, and prospective evaluations of their neurological status were performed at admission and discharge. RESULTS The study included 236 men and 16 women (mean age, 25.6 yr). The mean duration of stay for initial hospitalization was 94.6 days, and the mean duration of stay in rehabilitation was 78.6 days. Frankel scores were used to assess outcome (P < 0.05) and were assessed at admission and at the time of definitive discharge from the Spinal Cord Injury Care System. The hypothesis that methylprednisolone therapy significantly improves functional outcomes in patients with gunshot wound injuries to the spine was rejected. Only the total number of days in rehabilitation and the degree of neurological injury at admission contributed significantly to explaining outcome at discharge. CONCLUSION The administration of methylprednisolone did not significantly improve functional outcomes in patients with gunshot wound injuries to the spine or increase the number of complications experienced by patients during their hospitalizations.
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Affiliation(s)
- M L Levy
- Department of Neurological Surgery, University of Southern California School of Medicine, Los Angeles, USA
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