Abstract
Objective
To investigate whether initial emergency department physiological measures and metrics
of trauma severity predict functional outcomes and neurologic recovery in traumatic
spinal cord injury.
Design
Retrospective analysis of a clinical database.
Setting
Merged multicenter data from the Spinal Cord Injury Model Systems (SCIMS) database
and National Trauma Data Bank from 6 academic medical centers across the United States.
Participants
Patients (N=319) admitted to SCIMS rehabilitation centers within 1 year of injury.
The majority of patients were men (76.2%), with a mean age of 44 years (SD, 19y).
At rehabilitation admission, the most common neurologic level of injury was low cervical
(C5-C8, 39.5%) and ASIA impairment scale (AIS) was A (34.4%).
Main Outcome Measures
Primary outcomes were FIM motor score at discharge from inpatient rehabilitation and
change in FIM motor score between inpatient rehabilitation admission and discharge.
We hypothesized that derangements in emergency department physiological measures,
such as decreased blood pressure and oxygen saturation, as well as increased severity
of trauma burden, would predict poorer functional outcomes.
Results
Linear regression analysis showed that neurologic level of injury and AIS predicted
discharge FIM motor score. Systolic blood pressure, heart rate, oxygen saturation,
need for assisted respiration, and presence of penetrating injury did not predict
discharge motor FIM or FIM motor score improvement.
Conclusions
Initial emergency department physiological parameters did not prognosticate functional
outcomes in this cohort.
Keywords
List of abbreviations:
AIS (ASIA Impairment Scale), ASIA (American Spinal Injury Association), GCS (Glasgow Coma Scale), ISS (Injury Severity Score), NTDB (National Trauma Data Bank), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Quality of life, social participation, appraisals and coping post spinal cord injury: a review of four community samples.Spinal Cord. 2006; 44: 95-105
- Establishing prognosis and maximizing functional outcomes after spinal cord injury: a review of current and future directions in rehabilitation management.Spine (Phila Pa 1976). 2001; 26: S137-S145
- Early predictors of global functional outcome after traumatic spinal cord injury: a systematic review.J Neurotrauma. 2018; 35: 1705-1725
National Trauma Data Bank. National Trauma Data Bank 2016 Annual Report. Available at: https://www.facs.org/-/media/files/quality-programs/trauma/ntdb/ntdb-annual-report-2016.ashx. Accessed November 1, 2020.
- Hypotension begins at 110 mm Hg: redefining “hypotension” with data.J Trauma. 2007; 63 (discussion 297-9): 291-297
- The effect of combined out-of-hospital hypotension and hypoxia on mortality in major traumatic brain injury.Ann Emerg Med. 2017; 69: 62-72
- Respiratory rate: the neglected vital sign.Med J Aust. 2008; 188: 657-659
- The association between vital signs and mortality in a retrospective cohort study of an unselected emergency department population.Scand J Trauma Resusc Emerg Med. 2016; 24: 21
- Interactions of primary insult biomechanics and secondary cascades in spinal cord injury: implications for therapy.Neural Regen Res. 2017; 12: 1618-1619
- Inflammogenesis of secondary spinal cord injury.Front Cell Neurosci. 2016; 10: 98
National Trauma Data Bank. About NTDB. Available at:https://www.facs.org/quality-programs/trauma/tqp/center-programs/ntdb/about. Accessed November 1, 2020.
National Trauma Data Standard. Data dictionary. Available at:https://www.facs.org/-/media/files/quality-programs/trauma/ntdb/ntds/data-dictionaries/ntds_data_dictionary_2021.ashx. Accessed December 21, 2020.
- Effect of the modified Glasgow Coma Scale score criteria for mild traumatic brain injury on mortality prediction: comparing classic and modified Glasgow Coma Scale score model scores of 13.J Trauma. 2011; 71 (discussion 1193): 1185-1192
- Accuracy and relationship of mechanisms of injury, trauma score, and injury severity score in identifying major trauma.Am J Surg. 1986; 151: 581-584
- Comparison of rates of hospitalization and emergency department visits using self-report and South Carolina administrative billing data among a population-based cohort with spinal cord injury.Arch Phys Med Rehabil. 2016; 97: 1481-1486
- The Functional Independence Measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories.Arch Phys Med Rehabil. 1996; 77: 1101-1108
- Annals understanding clinical research: implications of missing data due to dropout.Ann Intern Med. 2017; 166: 596-598
- Current practices and goals for mean arterial pressure and spinal cord perfusion pressure in acute traumatic spinal cord injury: defining the gaps in knowledge.J Spinal Cord Med. 2021; 44: 350-356
- Mean arterial blood pressure correlates with neurologic recovery after human spinal cord injury: analysis of high frequency physiologic data.J Neurotrauma. 2015; 32: 1958-1967
- Spinal cord perfusion pressure predicts neurologic recovery in acute spinal cord injury.Neurology. 2017; 89: 1660-1667
- Increased mean arterial pressure goals after spinal cord injury and functional outcome.J Emerg Trauma Shock. 2015; 8: 94-98
- Neurologic recovery following traumatic spinal cord injury: a systematic review and meta-analysis.J Neurosurg Spine. 2019; 30: 683-699
- Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.Arch Phys Med Rehabil. 2006; 87: 32-39
- Clinical interpretation of the Spinal Cord Injury Functional Index (SCI-FI).J Spinal Cord Med. 2016; 39: 527-534
Article info
Publication history
Published online: December 19, 2021
Accepted:
December 8,
2021
Received in revised form:
December 5,
2021
Received:
September 28,
2021
Footnotes
Supported by funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Spinal Cord Injury Model Systems (Grant ID: 90SI5021).
Disclosures: Dr Zafonte received royalties from Springer/Demos publishing for serving as coeditor of Brain Injury Medicine. Dr Zafonte serves on the scientific advisory boards of Myomo, Oxeia Biopharma, ElMINDA, and Biodirection. He also evaluates patients in the MGH Brain and Body-TRUST Program, which is funded by the National Football League Players Association.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
