Retrospective cohort study of 82 patients with cervical traumatic spinal cord injury (TSCI).
Determine the relevance of preoperative MRI to predict neurological recovery following cervical TSCI.
...Level I trauma center specialized in TSCI.
The following three MRI parameters were assessed: presence of an intramedullary hemorrhage, intramedullary lesion length and maximal compression of the spinal cord compression (MSCC). Analyses were performed to assess the relationship between MRI parameters and three neurological outcomes: ASIA motor score (AMS), improvement by at least one ASIA impairment scale (AIS) grade (conversion of AIS grade), and reaching AIS grade D or E.
Predicting AMS based on initial AIS grade and intramedullary hemorrhage resulted in a validation R-squared of 0.662, and of 0.636 when using only the initial AIS grade. Predicting conversion of AIS grade based on initial AIS grade, intramedullary hemorrhage and lesion length resulted in a validation c-index of 0.704, and of 0.727 when using only the initial AIS grade. Predicting the likelihood of a follow-up AIS grade D or E based on initial AIS grade and intramedullary hemorrhage in a validation c-index of 0.903, and of 0.873 when using only the initial AIS grade.
Intramedullary hemorrhage and lesion length assessed from preoperative MRI were predictors of the neurological recovery following cervical TSCI. However, the clinical benefit of these MRI parameters to predict the neurological recovery remains limited when the initial AIS grade is available, confirming that the initial neurological status remains the most important predictor of the neurological outcome.
We report the design and testing of a sensor pad based on optical and flexible materials for the development of pressure monitoring devices. This project aims to create a flexible and low-cost ...pressure sensor based on a two-dimensional grid of plastic optical fibers embedded in a pad of flexible and stretchable polydimethylsiloxane (PDMS). The opposite ends of each fiber are connected to an LED and a photodiode, respectively, to excite and measure light intensity changes due to the local bending of the pressure points on the PDMS pad. Tests were performed in order to study the sensitivity and repeatability of the designed flexible pressure sensor.
Retrospective comparative study.
Clinical prediction rules (CPRs) are an effervescent topic in the medical literature. Recovering ambulation after a traumatic spinal cord injury (tSCI) is a priority ...for patients and multiple CPRs have been proposed for predicting ambulation outcomes. Our objective is to confront clinical judgment to an established CPR developed for patients with tSCI.
Level one trauma center specialized in tSCI and its affiliated rehabilitation center.
In this retrospective comparative study, six physicians had to predict the ambulation outcome of 68 patients after a tSCI based on information from the acute hospitalization. Ambulation was also predicted according to the CPR of van Middendorp (CPR-vM). The success rate of the CPR-vM and clinicians to predict ambulation was compared using criteria of 5% for defining clinical significance, and a level of statistical significance of 0.05 for bilateral McNemar tests.
There was no statistical difference between the overall performance of physicians (success rate of 79%) and of the CPR-vM (81%) for predicting ambulation. The differences between the CPR-vM and physicians varied clinically and significantly with the level of experience, clinical setting, and field of expertise.
Confronting CPRs with the judgment of a group of clinicians should be an integral part of the design and validation of CPRs. Head-to-head comparison of CPRs with clinicians is also a cornerstone for defining the optimal strategy for translation into the clinical practice, and for defining which clinician and specific clinical context would benefit from using the CPR.
Population-based cohort study for the western part of Quebec.
To determine the impact of declining to participate in a national spinal cord injury (SCI) registry on patient outcomes and continuum of ...care.
Level-1 trauma center specialized in SCI care in Montreal, Canada.
This cohort study compared the outcomes of 444 patients who were enrolled in the Rick Hansen SCI registry and 140 patients who refused. Logistic regression analyses were performed to assess the association between voluntary participation and the outcomes, while adjusting for confounding factors. The main outcomes were: attendance to follow-up 6- to 12-month post injury, 1-year mortality, and the occurrence of pressure injury during acute care.
Declining to be enrolled in the registry was a significant predictor of lower attendance to specialized follow-up (adjusted odds ratio OR 0.04, 95% confidence interval CI 0.02-0.08). It was also associated with a higher 1-year mortality rate (OR 12.50, CI 4.50-33.30) and higher occurrence of pressure injury (OR 2.56, CI 1.56-4.17).
This study sheds invaluable insight on individuals that researchers and clinicians are usually blind to in SCI cohort studies. This study suggests that decline to participate in a registry during the care hospitalization may be associated with worsened health, poorer outcomes, and reduced follow-up to specialized care. Declining the enrollment to voluntary registry could represent a potential prognostic factor for future research.
We present the fabrication and characterization of elastomeric optical waveguides, to be used for the manufacture of a conformable, water-resistant, and cost-effective pressure sensor that is ...amenable to the development of smart wearable health monitoring devices. To achieve this goal, high-sensitivity polydimethylsiloxane waveguides with a rectangular cross-section were fabricated. A new up-doping procedure, to tailor the refractive index of the ensuing waveguides, was experimentally developed using benzophenone additives. With this method we demonstrated a high refractive index change (up to +0.05) as a linear function of the benzophenone doping concentration. Propagation losses of about 0.37 dB/cm in the visible range and a high sensitivity to transverse compression of 0.10%/dB optical power loss were measured. It was also shown that one can further control the refractive index of the waveguide core and cladding regions through proper selection of the polydimethylsiloxane base to curing agent mixing ratio.
Objectives: To determine factors associated with functional status six months following a traumatic cervical and thoracic spinal cord injury (SCI), with a particular interest in factors related to ...the acute care hospitalization stay.
Design: This is a prospective cohort study. Sixteen potential predictive variables were studied. Univariate regression analyses were first performed to determine the strength of association of each variable independently with the total Spinal Cord Independence Measure (SCIM) score. Significant ones were then included in a General linear model in order to determine the most relevant predictive factors among them. Analyses were carried out separately for tetraplegia and paraplegia.
Setting: A single specialized Level I trauma center.
Participants: One hundred fifty-nine patients hospitalized for an acute traumatic SCI between January 2010 and February 2015.
Interventions: Not applicable.
Main outcome measure: The SCIM (version 3) functional score.
Results: Motor-complete SCI (AIS-A,B) was the main predictive factor associated with decreased total SCIM score in tetraplegia and paraplegia. Longer acute care length of stay and the occurrence of acute medical complications (either pneumonia, urinary tract infections or pressure ulcers) were predictors of decreased functional outcome following tetraplegia, while increased body mass index and higher trauma severity were predictive of decreased functional outcome following paraplegia.
Conclusions: This study supports previous work while adding information regarding the importance of optimizing acute care hospitalization as it may influence chronic functional status following traumatic SCI.
Purpose
To evaluate how Canadian clinicians involved in trauma patient care and prescribing opioids perceive the use and effectiveness of strategies to prevent long-term opioid therapy following ...trauma. Barriers and facilitators to the implementation of these strategies were also assessed.
Methods
We conducted a web-based cross-sectional survey. Potential participants were identified by trauma program managers and directors of the targeted departments in three Canadian provinces. We designed our questionnaire using standard health survey research methods. The questionnaire was administered between April 2021 and November 2021.
Results
Our response rate was 47% (350/744), and 52% (181/350) of participants completed the entire survey. Most respondents (71%, 129/181) worked in teaching hospitals. Multimodal analgesia (93%, 240/257), nonsteroidal anti-inflammatory agents (77%, 198/257), and physical stimulation (75%, 193/257) were the strategies perceived to be the most frequently used. Several preventive strategies were perceived to be very effective by over 80% of respondents. Of these, some that were reported as not being frequently used were perceived to be among the most effective ones, including guidelines or protocols, assessing risk factors for opioid misuse, physical health follow-up by a professional, training for clinicians, patient education, and prescription monitoring systems. Staff shortages, time constraints, and organizational practices were identified as the main barriers to the implementation of the highest ranked preventive strategies.
Conclusions
Several strategies to prevent long-term opioid therapy following trauma are perceived as being effective by those prescribing opioids in this population. Some of these strategies appear to be commonly used in everyday practice and others less so. Future research should focus on which preventive strategies should be given higher priority for implementation before assessing their effectiveness.
Study designRetrospective study of a prospective cohort of patients with traumatic spinal cord injury (SCI).ObjectivesDetermine the relationship between the occurrence of early spasticity, defined as ...the development of signs and/or symptoms of spasticity during the hospitalization in traumatology, and the functional outcome 6–12 months following a SCI. Secondly, to determine the specific impact of early clonus, velocity-dependent hypertonia and/or muscle spasms on the functional outcome at the same timepoint.SettingSingle trauma center specialized in SCI care.MethodsOne hundred sixty-two patients sustaining an acute traumatic SCI were included in the analyses. Comparative analysis was performed to describe the characteristics of patients with early spasticity. Correlations were performed to determine the relationship between the clinical signs of spasticity and the Spinal Cord Independence Measure (SCIM) scores collected 6–12 months after SCI.Results51.9% of the cohort developed clinical signs of spasticity during the hospitalization in traumatology (29.7 days) following SCI. These showed a significantly lower total SCIM score and subscores compared to individuals without early spasticity at follow-up (p < 0.05). After adjusting for confounding factors, the occurrence of early spasms was only clinical sign of spasticity significantly associated with a decreased mobility at follow-up (r = −0.17, p = 0.04).ConclusionsThe development of signs and symptoms of spasticity, in particular the occurrence of spasms in the first month following the injury may be associated with decreased functional outcome and mobility. Early assessment of spasticity following SCI is thus recommended.
Study designRetrospective review of data from a prospective database of a Level 1 trauma center.ObjectivesThis project aims to identify factors collected during the acute and rehabilitative care ...following a traumatic spinal cord injury (TSCI) associated with success and failure to return home after inpatient intensive functional rehabilitation (IFR).SettingLevel 1 trauma center specialized in TSCI care in Montreal, Canada.MethodsAll eligible patients from our prospective database were separated into two groups according to discharge destination following IFR. Clinical variables collected during the acute and rehabilitative care as well as demographic variables were compared between patients who managed to return home (Group 1) and those who were discharged elsewhere (Group 2). Multivariable regression analyses were conducted with variables that were significant at the univariate level.ResultsOut of the 193 patients included, 22 (11%) failed to return home following IFR. Six variables were associated with failure to return home at the univariate level: longer acute length of stay (LOS), longer rehabilitation LOS, living alone, higher neurological level of injury, having comorbidities, and having a pressure injury (PI) during acute care. Three variables remained significant at the multivariate level: living alone, increasing acute LOS and presenting a high cervical (C1-C4) neurological level of injury.ConclusionsIt is important that acute care clinicians recognize the aforementioned factors early after TSCI in order to optimize patients for community reintegration.
Prospective cohort study.
To determine the extent of functional recovery between 6 and 12 months following a traumatic spinal cord injury (TSCI) and to identify individuals achieving a small clinical ...functional improvement during this period.
A single level-1 trauma center specialized in SCI care.
A cohort of 125 patients sustaining TSCI was studied. The Spinal Cord Independence Measure (SCIM) version III at 6 and 12 months post injury was used as the main outcome measure.
The observed functional improvement for the final cohort did not reach a clinically significant level between 6 and 12 months post injury. However, 30.4% of individuals achieved this level (≥4 points in the SCIM-III total score). This group showed a higher proportion of motor-complete TSCI (AIS grade A or B) and showed a tendency toward older age and higher trauma severity. Longer duration of intensive functional rehabilitation was the single factor associated with reaching a small clinically important improvement in the SCIM-III total score.
Functional status between 6 and 12 months following a TSCI may be considered clinically similar, regardless of the level of injury. However, 30% may reach a small clinical functional improvement in the subacute to chronic phase following TSCI, particularly individuals sustaining severe deficits and older age, which may highlight the importance of functional compensation during this period for these patients.
PDF
