Trauma Indicators in Spinal Cord Injury Rehabilitation Outcomes: A Retrospective Cohort Analysis of the National Trauma Data Bank and National Spinal Cord Injury Database |
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| Institution: | 1. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA;2. Spaulding Rehabilitation Hospital, Charlestown, MA;3. Case Western Reserve University School of Medicine, Cleveland, OH;4. MetroHealth Rehabilitation Institute, Cleveland, OH;5. Center for Health Research and Policy, Cleveland, OH;6. Trauma Care Delivery Research Unit, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL;7. University of Alabama at Birmingham School of Public Health, Birmingham, AL;8. Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham;1. Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA;2. Departments of Physical Medicine and Rehabilitation;3. Bioengineering;4. Physical Therapy;5. Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA;6. University of Pittsburgh Medical Center Centers for Rehab Services, Pittsburgh, PA;7. Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL;8. Department of Human Performance and Sport Studies, Idaho State University, Pocatello, ID;1. Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA;2. Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA;3. Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA;4. Department of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA;5. Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA;6. Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA;7. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA;1. College of Health Professions, Medical University of South Carolina, Charleston, SC;2. Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA;3. Department of Psychiatry, University of California, San Diego, La Jolla, CA;1. Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA;2. Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA;3. Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA;4. Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA;5. Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA;6. Crawford Research Institute, Shepherd Center, Atlanta, GA;7. Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA;8. Program in Applied Physiology, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA;9. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA;10. Physical Therapy, University of Pittsburgh, Pittsburgh, PA;1. Sociology Department, Vrije Universiteit Amsterdam, Netherlands;2. College of Health Sciences, Marquette University, Milwaukee, Wisconsin;3. Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois;4. Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois;5. Craig Hospital, Englewood, Colorado;6. University of Colorado, Denver, Colorado;7. UT Health Science Center at Houston, Houston, Texas;8. Neurorecovery Research Center, TIRR Memorial Hermann, Houston, Texas;9. Shepherd Center, Atlanta, Georgia;10. Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia;1. Departments of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL;2. Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL;3. Department of Pharmacology and Toxicology, University of Alabama at Birmingham, Birmingham, AL |
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| Abstract: | ObjectiveTo investigate whether initial emergency department physiological measures and metrics of trauma severity predict functional outcomes and neurologic recovery in traumatic spinal cord injury.DesignRetrospective analysis of a clinical database.SettingMerged 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.ParticipantsPatients (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 MeasuresPrimary 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.ResultsLinear 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.ConclusionsInitial emergency department physiological parameters did not prognosticate functional outcomes in this cohort. |
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| Keywords: | Outcome measures Trauma |
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