Post-discharge mortality in patients with traumatic spinal cord injury in a Brazilian hospital: a retrospective cohort

Leite, Victor Figueiredo; Souza, Daniel Rubio de; Imamura, Marta; Battistella, Linamara Rizzo

doi:10.1038/s41393-018-0183-y

Cited by 14 publications

(5 citation statements)

References 39 publications

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“…5,6,10 Fortunately, dysphagia is transient for most patients suggesting superficial post-operative injuries rather than permanent neural damage. 1 However, aspiration pneumonia is the highest cause of mortality in patients after SCI 14 and there is merit in advocating for early dysphagia screening for patients. 2 In recent years, attention has been placed on surgical and medical techniques to reduce the risk of dysphagia and its secondary complications.…”

Section: Introductionmentioning

confidence: 99%

Characterizing dysphagia after spinal surgery

Miles

Jamieson

Shasha

et al. 2019

The Journal of Spinal Cord Medicine

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Context/Objective: Dysphagia after spinal surgery is well recognised. Characteristics of post-operative dysphagia are not well defined. This study explored severity, longevity, and physiological characteristics of dysphagia. Design: Prospective, observational study. Setting: Tertiary urban hospital. Participants: Two-hundred fifty patients consecutively receiving spinal surgery.Interventions: Demographic and clinical information were collected. Flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopic study of swallowing (VFSS) recordings were analyzed. Outcomes Measures: FEES recordings were analyzed using three validated symptom scales. VFSS recordings were analyzed using 10 objective digital measures of timing, displacement and symptoms. Results: Of 250 patients, 75 were referred for swallowing assessment. Sixty-two received FEES and 11 VFSS. Patients with anterior approach surgery for cervical level injuries represented 85% of referrals (n = 64). Secretion accumulation, aspiration and residue scores decreased significantly within 2 months for most patients. For those with persisting dysphagia, objective VFSS measures demonstrated significant impairments in pharyngeal constriction, hyoid displacement and pharyngoesophageal segment opening with corresponding residue and aspiration scores. By 6 months, all patients had returned to a regular diet except three patients following anterior cervical discectomy and fusion (ACDF) who remained nil by mouth with severe physiological impairments. Conclusions: A quarter of patients following spinal surgery present with dysphagia. For most, symptoms decrease significantly by 2 months and patients return to normal diets. Early screening of dysphagia is critical to avoid secondary complications and prolonged hospitalizations. For some, significant pharyngeal impairments persist and high-quality case series exploring efficacy of rehabilitation programmes are needed.

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Section: Introductionmentioning

confidence: 99%

Characterizing dysphagia after spinal surgery

Miles

Jamieson

Shasha

et al. 2019

The Journal of Spinal Cord Medicine

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“…19 There is controversy about the impact of older age on in-hospital mortality in SCI patients with some studies showing that older age is a significant predictor for mortality while some do not. 20,21 Kumamaru et al in an animal study showed that older mice had worse functional recovery and higher pro-inflammatory cytokines during the early stage of complete SCI. They focused on age-related differences in inflammatory responses of microglia after spinal cord injury.…”

Section: Discussionmentioning

confidence: 99%

Acute traumatic quadriplegia: Predictors of in-hospital and six-month mortality

Alimohammadi

Ahadi

Rezaee

et al. 2020

Trauma

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Background Traumatic spinal cord injury is one of the most disastrous and devastating health burdens all over the world with a high mortality rate. The present study aimed to evaluate the predictors of in-hospital and six-month mortality in these patients. Methods The electronic medical records of 87 consecutive patients with acute complete traumatic quadriplegia were reviewed to extract clinical, radiological, and laboratory data. Simple and multiple logistic regression models were used to estimate crude and adjusted odds with 95% confidence interval (CI) ratios for the predictors of in-hospital mortality and six-month mortality. Results There were 48 males and the mean age was 38.67 ± 12.81; in-hospital and six-month mortality were 21.84% and 11.76%, respectively. Traffic road accidents (67.8%) and falls (12.6%) were the most common causes of injury. The univariate analysis demonstrated advanced age, level of injury, late surgery or no surgical intervention, the lack of methylprednisolone therapy, a higher Charlson comorbidity index, the Injury Severity Score, and the presence of respiratory failure or bradycardia on admission were predictors of in-hospital mortality ( p < 0.05). In the final multiple logistic regression model, the level of injury (OR = 0.02 (0.001,0.35), p = 0.008) and the presence of respiratory failure (OR = 2.37 (0.03,13.88), p = 0.024) were the only predictors of in-hospital mortality. The univariate model showed that the level of injury, respiratory failure on admission, and the Injury Severity Score were the predictors of six-month mortality; however, the level of injury was the only predictor of the six-month mortality (OR = 1.12 (0.99, 1.27), p = 0.028) according to the multiple logistic regression model. Conclusions Several factors could affect in-hospital and six-month mortality in patients with traumatic spinal cord injury. Our findings demonstrated the level of injury and respiratory failure on admission as independent predictors of in-hospital mortality in these patients. Furthermore, the level of injury was the only independent predictor of six-month mortality in the present study.

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“…Spinal cord injury (SCI) is one of the most important causes of permanent disability with a major social and economic impact on the affected population. Patients with SCI have a higher mortality risk, which can be 28.8 times greater than the reference population (Leite et al, 2019). The worldwide prevalence of SCI is estimated to be 440 to 526 per million people, with an incidence rate varying from 13.0 per million to 163.4 per million people and reaching 220.0 per million people in under-developed countries (Kang et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Electroencephalography as a Biomarker for Functional Recovery in Spinal Cord Injury Patients

Simis

Camsari

Imamura

et al. 2021

Front. Hum. Neurosci.

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BackgroundFunctional changes after spinal cord injury (SCI) are related to changes in cortical plasticity. These changes can be measured with electroencephalography (EEG) and has potential to be used as a clinical biomarker.MethodIn this longitudinal study participants underwent a total of 30 sessions of robotic-assisted gait training (RAGT) over a course of 6 weeks. The duration of each session was 30 min. Resting state EEG was recorded before and after 30-session rehabilitation therapy. To measure gait, we used the Walking Index for Spinal Cord Injury Scale, 10-Meter- Walking Test, Timed-Up-and-Go, and 6-Min-Walking Test. Balance was measured using Berg Balance Scale.ResultsFifteen participants with incomplete SCI who had AIS C or D injuries based on American Spinal Cord Injury Association Impairment Scale classification were included in this study. Mean age was 35.7 years (range 17–51) and the mean time since injury was 17.08 (range 4–37) months. All participants showed clinical improvement with the rehabilitation program. EEG data revealed that high beta EEG activity in the central area had a negative correlation with gait (p = 0.049; β coefficient: −0.351; and adj-R2: 0.23) and balance (p = 0.043; β coefficient: −0.158; and adj-R2:0.24) measured at baseline, in a way that greater high beta EEG power was related to worse clinical function at baseline. Moreover, improvement in gait and balance had negative correlations with the change in alpha/theta ratio in the parietal area (Gait: p = 0.049; β coefficient: −0.351; adj-R2: 0.23; Balance: p = 0.043; β coefficient: −0.158; and adj-R2: 0.24).ConclusionIn SCI, functional impairment and subsequent improvement following rehabilitation therapy with RAGT correlated with the change in cortical activity measured by EEG. Our results suggest that EEG alpha/theta ratio may be a potential surrogate marker of functional improvement during rehabilitation. Future studies are necessary to improve and validate these findings as a neurophysiological biomarker for SCI rehabilitation.

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Post-discharge mortality in patients with traumatic spinal cord injury in a Brazilian hospital: a retrospective cohort

Cited by 14 publications

References 39 publications

Characterizing dysphagia after spinal surgery

Characterizing dysphagia after spinal surgery

Acute traumatic quadriplegia: Predictors of in-hospital and six-month mortality

Electroencephalography as a Biomarker for Functional Recovery in Spinal Cord Injury Patients

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