Advertisement

Trauma Indicators in Spinal Cord Injury Rehabilitation Outcomes: A Retrospective Cohort Analysis of the National Trauma Data Bank and National Spinal Cord Injury Database

Published:December 19, 2021DOI:https://doi.org/10.1016/j.apmr.2021.12.001

      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 access
      One-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 Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kennedy P
        • Lude P
        • Taylor N.
        Quality of life, social participation, appraisals and coping post spinal cord injury: a review of four community samples.
        Spinal Cord. 2006; 44: 95-105
        • Burns AS
        • Ditunno JF.
        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
        • Richard-Denis A
        • Beauséjour M
        • Thompson C
        • Nguyen BH
        • Mac-Thiong JM.
        Early predictors of global functional outcome after traumatic spinal cord injury: a systematic review.
        J Neurotrauma. 2018; 35: 1705-1725
      1. 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.

        • Eastridge BJ
        • Salinas J
        • McManus JG
        • et al.
        Hypotension begins at 110 mm Hg: redefining “hypotension” with data.
        J Trauma. 2007; 63 (discussion 297-9): 291-297
        • Spaite DW
        • Hu C
        • Bobrow BJ
        • et al.
        The effect of combined out-of-hospital hypotension and hypoxia on mortality in major traumatic brain injury.
        Ann Emerg Med. 2017; 69: 62-72
        • Cretikos MA
        • Bellomo R
        • Hillman K
        • Chen J
        • Finfer S
        • Flabouris A.
        Respiratory rate: the neglected vital sign.
        Med J Aust. 2008; 188: 657-659
        • Ljunggren M
        • Castrén M
        • Nordberg M
        • Kurland L.
        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
        • Orr MB
        • Gensel JC.
        Interactions of primary insult biomechanics and secondary cascades in spinal cord injury: implications for therapy.
        Neural Regen Res. 2017; 12: 1618-1619
        • Anwar MA
        • Al Shehabi TS
        • Eid AH
        Inflammogenesis of secondary spinal cord injury.
        Front Cell Neurosci. 2016; 10: 98
      2. National Trauma Data Bank. About NTDB. Available at:https://www.facs.org/quality-programs/trauma/tqp/center-programs/ntdb/about. Accessed November 1, 2020.

      3. 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.

        • Mena JH
        • Sanchez AI
        • Rubiano AM
        • et al.
        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
        • Long WB
        • Bachulis BL
        • Hynes GD.
        Accuracy and relationship of mechanisms of injury, trauma score, and injury severity score in identifying major trauma.
        Am J Surg. 1986; 151: 581-584
        • Saunders LL
        • Murday D
        • Corley B
        • Cao Y
        • Krause JS.
        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
        • Stineman MG
        • Shea JA
        • Jette A
        • et al.
        The Functional Independence Measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories.
        Arch Phys Med Rehabil. 1996; 77: 1101-1108
        • Liao JM
        • Stack CB.
        Annals understanding clinical research: implications of missing data due to dropout.
        Ann Intern Med. 2017; 166: 596-598
        • Menacho ST
        • Floyd C.
        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
        • Hawryluk G
        • Whetstone W
        • Saigal R
        • et al.
        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
        • Squair JW
        • Bélanger LM
        • Tsang A
        • et al.
        Spinal cord perfusion pressure predicts neurologic recovery in acute spinal cord injury.
        Neurology. 2017; 89: 1660-1667
        • Martin ND
        • Kepler C
        • Zubair M
        • Sayadipour A
        • Cohen M
        • Weinstein M.
        Increased mean arterial pressure goals after spinal cord injury and functional outcome.
        J Emerg Trauma Shock. 2015; 8: 94-98
        • Khorasanizadeh M
        • Yousefifard M
        • Eskian M
        • et al.
        Neurologic recovery following traumatic spinal cord injury: a systematic review and meta-analysis.
        J Neurosurg Spine. 2019; 30: 683-699
        • Beninato M
        • Gill-Body KM
        • Salles S
        • Stark PC
        • Black-Schaffer RM
        • Stein J.
        Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.
        Arch Phys Med Rehabil. 2006; 87: 32-39
        • Fyffe D
        • Kalpakjian CZ
        • Slavin M
        • et al.
        Clinical interpretation of the Spinal Cord Injury Functional Index (SCI-FI).
        J Spinal Cord Med. 2016; 39: 527-534