Previously Identified Common Post-Injury Adverse Events in Traumatic Spinal Cord Injury—Validation of Existing Literature and Relation to Selected Potentially Modifiable Comorbidities: A Prospective Canadian Cohort Study

Abstract

Adverse events (AEs) are common during care in patients with traumatic spinal cord injury (tSCI). Increased risk of AEs is linked to patient factors including pre-existing comorbidities. Our aim was to examine the relationships between patient factors and common post-injury AEs, and identify potentially modifiable comorbidities. Adults with tSCI admitted to a Level I acute specialized spine center between 2006 and 2014 who were enrolled in the Rick Hansen SCI Registry (RHSCIR) and had AE data collected using the Spine Adverse Events Severity system were included. Patient demographic, neurological injury, and comorbidities data were obtained from RHSCIR. Potentially modifiable comorbidities were grouped into health-related conditions, substance use/withdrawal, and psychiatric conditions. Negative binomial regression and multiple logistic regression were used to model the impact of patient factors on the number of AEs experienced and the occurrence of the five previously identified common AEs, respectively. Of the 444 patients included in the study, 24.8% reported a health-related condition, 15.3% had a substance use/withdrawal condition, 8% reported having a psychiatric condition; and 79.3% experienced one or more AEs. Older age (p = 0.004) and more severe injuries (p < 0.001) were nonmodifiable independent variables significantly associated with increased AEs. The AEs experienced by patients were urinary tract infections (42.8%), pneumonia (39.2%), neuropathic pain (31.5%), delirium (18.2%), and pressure ulcers (11.0%). Risk of delirium increased in those with substance use/withdrawal; and pneumonia risk increased with psychiatric comorbidities. Opportunity exists to develop clinical algorithms that include these types of risk factors to reduce the incidence and impact of AEs.

Factores de riesgo para la aparición y/o recurrencia de úlceras por presión en sujetos con lesión medular: revisión sistemática

“…(13) De todas formas, Marion y cols. en el 2017 (37) y Verscueren y cols. en el 2010, (47) incluidos en nuestra revisión, evaluaron pacientes en etapa aguda y subaguda y reportaron que el nivel de lesión es un FR para la aparición de UPP.…”

“…Debido a la heterogeneidad presentada por los artículos incluidos en la presente revisión no fue posible meta analizar la información obtenida. (26) Casocontrol Garber (2000) (27) Cohorte prospec tivo Gould (2014) (28) Observ acional retrosp ectivo Guihan (2008) (29) Observ acional retrosp ectivo Haisma (2007) (30) Observ acional prospec tivo Joseph (2015) (31) Cohorte prospec tivo Krause (2001) (32) Observ acional retrosp ectivo Krause (2004) (33) Observ acional retrosp ectivo Kroll (2007) (34) Observ acional prospec tivo Le Fort (2017) (35) Cohorte prospec tivo Li (2016) (36) Observ acional retrosp ectivo Marion (2017) (37) Cohorte Morita (2015) (38) Casocontrol New (2004) (39) Serie de casos retrosp ectivo Rochon (1993) (40) Observ acional retrosp ectivo Sadeghi Fazel (2017) (41) Observ acional retrosp ectivo Saunders (2010) (42) Cohorte Saunders (2012) (43) Observ acional retrosp ectivo Scheel-Sailer (2013) (44) Cohorte prospec tivo Smith (2008) (45) Observ acional retrosp ectivo Van der Wielen (2016) (46) Cohorte prospec tivo Verschu eren (2011) (47) Cohorte prospec tivo Waters (1998) (48) Observ acional retrosp ectivo Wilczwe ski (2012) (49) Cohorte retrosp ectivo Verde: Riesgo bajo, Amarillo: Riesgo moderado, Rojo: Riesgo alto.…”

Regeneration of Spinal Cord Connectivity Through Stem Cell Transplantation and Biomaterial Scaffolds

“…Spinal cord injury (SCI) is a severely debilitating condition leading to neurological dysfunction, loss of independence, respiratory failure, psychological morbidities, and an increased lifelong mortality rate (Marion et al, 2017; Satkunendrarajah et al, 2018; Shibahashi et al, 2018; Wang et al, 2018b). In the United States, approximately 288,000 individuals are estimated to suffer from symptoms caused by SCI, and a recent survey showed the annual incidence of SCI is approximately 54 cases per one million people (Fehlings et al, 2018).…”

The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study

“…[20][21][22][23][24][25][26] Two of the more common secondary complications in acute SCI admissions are UTI and PU. In a population of acute traumatic SCI admissions to a Level I specialized spine facility in British Columbia, Canada, up to 43% of individuals experienced UTI 27 and 15% experienced PU. 18 These reported incidences may suggest a demand for innovation in the prevention and management of hospitalacquired UTI and PU in the acute SCI population in Canada, but there is limited evidence to determine the extent of the demand.…”