Clinical features of coronavirus disease 2019 (COVID-19) in a cohort of patients with disability due to spinal cord injury

Abstract

Study design: Cohort study of patients with spinal cord injury (SCI)Objectives: To describe the clinical and analytical features of a Covid-19 infected cohort with SCI to contribute new knowledge for a more accurate diagnosis and to outline prevention measures.Setting: This study was conducted at the National Hospital for Paraplegics (Toledo, Spain).Methods: A cohort analysis of seven patients with SCI infected by Covid-19 was carried out. Diagnosis was confirmed with reverse transcriptase polymerase chain reaction (RT-PCR) of nasal exudate or sputum samples. Clinical, analytical and radiographic findings were registered.Results: RT-PCR detected COVID-19 infection in all patients, affecting males and people with a cervical level of injury more often (5 out 7). The average delay for diagnostic confirmation was 4 days (interquartile range, 1-10). Fever was the most frequent symptom (6 out of 7). The second most common symptom was asthenia (4 out of 7), followed by dyspnea, cough and expectoration (3 out of 7 for each symptom). The MEWS score for Covid-19 severity rating was classified as severe in 5 out of 7. All but one patient showed radiological alterations evident in chest X-Rays at the time of diagnosis. All patients recovered gradually.

A case for inspiratory muscle training in SCI: potential role as a preventative tool in infectious respiratory diseases like COVID-19

“…Even though pneumonia was a prevalent clinical feature of their illness, clinical symptoms such as dyspnea and cough were not as predominant as fever [14,[16][17][18][19]. Fever appears to be the most prevalent, and often the first symptom of COVID-19 for individuals with SCI, followed by lymphocytopenia [14,[16][17][18][19]. In addition, all individuals who were tracheostomy-reliant prior to COVID-19 required aspiration and hyperinflation techniques for secretion removal, when only half of them required these maneuvers prior to COVID-19 diagnosis [14].…”

“…Pneumonia, a prevalent cause of death for individuals with SCI, appears to be a common, and serious manifestation of COVID-19 [8][9][10][11]. As such, individuals with SCI are at a high risk of developing complications secondary to COVID-19 due to compromised immune function and underlying respiratory weakness [12][13][14]. There have been case reports of 16 individuals with SCI and concomitant COVID-19 reported thus far.…”

“…There have been case reports of 16 individuals with SCI and concomitant COVID-19 reported thus far. While one study reported an asymptomatic case of an individual with acute SCI due to the increased screening efforts found at many hospitals [15], nine of these individuals had some form of imaging evidence indicating pneumonia [14,[16][17][18][19]. Even though pneumonia was a prevalent clinical feature of their illness, clinical symptoms such as dyspnea and cough were not as predominant as fever [14,[16][17][18][19].…”

“…While one study reported an asymptomatic case of an individual with acute SCI due to the increased screening efforts found at many hospitals [15], nine of these individuals had some form of imaging evidence indicating pneumonia [14,[16][17][18][19]. Even though pneumonia was a prevalent clinical feature of their illness, clinical symptoms such as dyspnea and cough were not as predominant as fever [14,[16][17][18][19]. Fever appears to be the most prevalent, and often the first symptom of COVID-19 for individuals with SCI, followed by lymphocytopenia [14,[16][17][18][19].…”

“…Fever appears to be the most prevalent, and often the first symptom of COVID-19 for individuals with SCI, followed by lymphocytopenia [14,[16][17][18][19]. In addition, all individuals who were tracheostomy-reliant prior to COVID-19 required aspiration and hyperinflation techniques for secretion removal, when only half of them required these maneuvers prior to COVID-19 diagnosis [14]. Interestingly, six of the 16 patients required some form of non-invasive oxygen therapy during the course of the virus [14,[16][17][18], and only one patient required intubation with successful extubation [19].…”