Mortality, morbidity, health, functional, and psychosocial outcomes were exa mined in 834 individuals with long term spinal cord injuries. All were treated at one of two British spinal injury centres: the National Spinal Injuries Centre at Stoke Mandeville Hospital or the Regional Spinal Injuries Centre in Southport; all were 20 or more years post injury. Using life table techniques, median survival time was determined for the overall sample (32 years), and for various subgroups based on level and completeness of injury and age at injury. With the number of renal deaths decreasing over time, the cause of death patterns in the study group as it aged began to approximate those of the general population. Morbidity patterns were found to be associated with age, years post injury, or a combination of these factors, depending upon the particular medical compli cation examined. A current medical examination of 282 of the survivors revealed significant declines in functional abilities associated with the aging process. Declines with age also were found in measures of handicap and life satisfaction, but three quarters of those interviewed reported generally good health and rated their current quality of life as either good or excellent.
The aims of this study were to examine long-term survival in a population-based sample of spinal cord injury (SCI) survivors in Great Britain, identify risk factors contributing to deaths and explore trends in cause of death over the decades following SCI. Current survival status was successfully identi®ed in 92.3% of the study sample. Standardised mortality ratios (SMRs) were calculated and compared with a similar USA study. Relative risk ratio analysis showed that higher mortality risk was associated with higher neurologic level and completeness of spinal cord injury, older age at injury and earlier year of injury. For the entire ®fty year time period, the leading cause of death was related to the respiratory system; urinary deaths ranked second followed by heart disease related deaths, but patterns in causes of death changed over time. In the early decades of injury, urinary deaths ranked ®rst, heart disease deaths second and respiratory deaths third. In the last two decades of injury, respiratory deaths ranked ®rst, heart related deaths were second, injury related deaths ranked third and urinary deaths fourth. This study also raises the question of examining alternative neurological groupings for future mortality risk analysis.
The patient with spinal cord injury is at high risk of tissue breakdown at all times due to a number of adverse factors, such as reduced mobility and anaesthesia. It is therefore essential that each patient is prescribed appropriate support media during initial rehabilita tion. In this study, the effectiveness of prescribed wheelchair cushions has been assessed in terms of tissue response at the ischial tuberosities. A total of 42 subjects who had sustained traumatic spinal cord injury within 1 year were monitored on at least two occasions during initial rehabilitation. Changes in transcutaneous gas response (TcP02 and TcPC02) were monitored concurrently with regional interface pressures. A series of six transcutaneous gas variables were established, as markers of tissue viability, Non-parametric statistical analyses revealed some significant correlations between these variables. The results of this study also indicate that (1) spinal cord injury subjects with lesions below T6 show a progressive decrease in ability to maintain blood flow in sitting on prescribed support cushions and (2) SCI subjects with lesions above T6 show a progressive improvement in tissue viability status at the seating support interface. Therefore results imply that paraplegics are at a potentially higher risk of tissue breakdown than tetraplegics and thus require effective support cushions with strict adherence to a pressure relief regime.
Previous studies have estimated that between 25% and 45% of people with spinal cord injury report severe levels of chronic pain. Few studies have examined this longitudinally. This study examines the primary pain sites, intensity and variability of perceived pain in 76 patients, 6 weeks post injury and 45 patients from the same cohort, 8 year post discharge. Demographic information reveals a close similarity with the database (40 000) from Stover and Fine's cohort (1986). Data was assessed using visual analogue scales, measures were also taken of functional independence (FIM), emotional status and coping. At 6 weeks post injury, most pain is sited in the thoracic spine area, and in the upper and lower limbs. At 1 year post discharge, most pain is reported to be in the thoracic spine area, the lumbar region and the chest. Twenty-three per cent of the 6 week group reported that the intensity of their pain was severe, whilst at 1 year, 41% of the sample complained of severe pain. Factors associated with the pain at both time points were explored using correlational analyses. The emotional, functional and psychological factors that predict pain severity were explored using multiple regression analysis. Twenty-four per cent of those reporting moderate to severe pain at 6 weeks post injury were still reporting pain at 1 year post discharge. This study examines the relative contribution of psychological factors in reported pain.
Urinary catheters tend to block when bio®lm from urease-producing organisms build up on the catheter surface. This is a locally-occurring process that in¯uences and is in¯uenced by the composition of the urine. In this work we relate urine pH and calcium to catheter blockage and suggest how to reduce the rate of encrustation. Sixty patients with indwelling urinary catheters were studied, 26 of them being troubled by frequent blockage of their catheters, 34 of them not. A series of small urine samples were collected during a 24 h period. Urinary pH and calcium concentration were combined into discriminant functions designed to separate Blockers from Non-blockers and achieved a 95% correct classi®cation. The results indicate that a high and uniform rate of¯uid intake is mandatory for the patient with a tendency for catheter blockage. Excessive total¯uid intake may be avoided by attention to uniformity. Other avoidable risk factors include: excess dietary calcium from certain protein supplements and antacids; excess dietary magnesium from certain beverages and antacids; alkali from eervescent tablets; excess dietary citrate from some fruit juices and cordials; intermittent dehydration from alcohol ingestion. Less tractable risk factors include infection of the urinary tract with urease-positive organisms, hypercalciuria of immobilisation, hyperhydrosis and postural oliguria. The processes involved in catheter encrustation and blockage provide a model for the formation of calculi in spinal cord injured patients. Therefore the above considerations may also be relevant to the management of stone disease in paraplegic and tetraplegic patients.
The first few months following injury to the spinal cord requires constant care of the subject if tissue breakdown is to be avoided. The management of acute traumatic cases involves complete bedrest in a supine position with appropriately positioned pillows to minimize trauma to the bone prominences. This study assesses the effectiveness of the management procedure in terms of the tissue response at the sacrum of 15 acute spinal cord injured subjects. The measurement of mean interface pressures during a representative period of recumbency was performed and these were related to changes in transcutaneous gas tensions (TcPO2 and TcPCO2), which are reliable indices of tissue viability. A series of six variables was established which were compared to each other using non-parametric statistical analyses. It was shown that this group of subjects demonstrated a normal mechanism whereby the level of carbon dioxide was able to control the local vascular tone. The results also suggested that the practice of gapping at the sacrum should be revised to reduce mean sacral pressures and minimize the possibility of tissue breakdown, the risk of which is constant throughout the first three months following injury.
The aim of this work was to study factors related to the blockage of indwelling urinary catheters. There were 40 patients with indwelling catheters, 20 of whom had catheters that blocked frequently. The other 20 were trouble free at the time of our study. The type and gauge of catheter and frequency of events were recorded. Urine samples for biochemical analysis comprised 24-hour collections, morning specimens on up to 10 different days and 5-8 samples at different times during the same day.Chemical analysis of debris removed from blocked catheters showed it to consist of mixed phosphates of calcium and magnesium, thus being similar to urinary stones that may be seen in spinal cord injury patients.Patients with frequent catheter blockage had significantly elevated urinary pH and ammonium and calcium concentrations. Discriminant analysis gave 78-94% separation of catheter blocking patients from nonblockers depending on the type of sample.We conclude that bacterial urease activity and urinary calcium concentration are the most important factors in catheter blockage. Elevation of urinary pH following ingestion of effervescent preparations, drug-or diet-induced increases in urinary calcium or magnesium excretion and inadequate or erratic fluid intake may be avoidable contributing factors.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.