Discussion: Spinal Cord Injury Disability Fact Sheet

Discussion: Spinal Cord Injury Disability Fact Sheet ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Spinal Cord Injury Disability Fact Sheet I need help with a Health & Medical question. All explanations and answers will be used to help me learn. Discussion: Spinal Cord Injury Disability Fact Sheet 3-4 page minimum of factsheet – Use reliable web or library sources – Do not copy and paste (use an appropriate reference e.g., footnote or endnote) – Use your creative design and visual aids (graphs, tables, pictures) FactSheet Format 1. Definition 2. Incidence/Occurrence (statistics/demographics/epidemiology) 3. Etiology (or possible causes) 4. Characteristics/Symptoms -Physical/motor domain -Psychosocial/emotional domain -Cognitive domain 5. Classifications (types) 6. Current Interventions (Therapeutic, Medical & Surgical) 7. Medical diagnosis procedures 8. Additional Resources (web addresses of rehab, medical,institutions, organizations etc.) 9. References LINKS TO USE http://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury https://www.nscisc.uab.edu/Public/Facts%202016.pdf https://www.hopkinsmedicine.org/healthlibrary/conditions/physical_medicine_and_rehabilitation/spinal_cord_injury_85,P01180 https://www.dovepress.com/epidemiology-of-worldwide-spinal-cord-injury-a-literature-review-peer-reviewed-fulltext-article-JN TWO MORE ARTICLES UPLOADED AS ATTACHMENTS IF ADDITIONAL ARTICLES ARE USED THEY HAVE TO BE SCHOLARLY or PEER REVIEWED. I NEED LINKS/LOCATION OF ARTICLE AND ACCESS TO THEM! !! _2011_article_1866.pdf _s2.0_s1472029914001751_main.pdf Eur Spine J (2011) 20:2174–2180 DOI 10.1007/s00586-011-1866-7 ORIGINAL ARTICLE Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study Rebecca M. Hasler • Aristomenis K. Exadaktylos • Omar Bouamra • Lorin M. Benneker • Mike Clancy • Robert Sieber • Heinz Zimmermann Fiona Lecky • Received: 26 December 2010 / Revised: 14 April 2011 / Accepted: 22 May 2011 / Published online: 5 June 2011 Ó The Author(s) 2011. This article is published with open access at Springerlink.com Abstract This is a European cohort study on predictors of spinal injury in adult (C16 years) major trauma patients, using prospectively collected data of the Trauma Audit and Research Network from 1988 to 2009. Predictors for spinal fractures/dislocations or spinal cord injury were determined using univariate and multivariate logistic regression analysis. 250,584 patients were analysed. 24,000 patients (9.6%) sustained spinal fractures/dislocations alone and 4,489 (1.8%) sustained spinal cord injury with or without fractures/dislocations. Spinal injury patients had a median age of 44.5 years (IQR = 28.8–64.0) and Injury Severity Score of 9 (IQR = 4–17). 64.9% were male. 45% of Electronic supplementary material The online version of this article (doi:10.1007/s00586-011-1866-7) contains supplementary material, which is available to authorized users. R. M. Hasler (&) O. Bouamra F. Lecky Trauma Audit and Research Network (TARN), Health Sciences Research Group, School of Community Based Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal Hospital, Stott Lane, Salford M6 8HD, UK e-mail: [email protected] patients suffered associated injuries to other body regions. Age 45 years (C45 years OR 0.83–0.94), Glasgow Coma Score (GCS) 3–8 (OR 1.10, 95% CI 1.02–1.19), falls[2 m (OR 4.17, 95% CI 3.98–4.37), sports injuries (OR 2.79, 95% CI 2.41–3.23) and road traffic collisions (RTCs) (OR 1.91, 95% CI 1.83–2.00) were predictors for spinal fractures/dislocations. Age 45 years (C45 years OR 0.78– 0.90), male gender (female OR 0.78, 95% CI 0.72–0.85), GCS 15 (OR 1.36–1.93), associated chest injury (OR 1.10, 95% CI 1.01–1.20), sports injuries (OR 3.98, 95% CI 3.04–5.21), falls [2 m (OR 3.60, 95% CI 3.21–4.04), RTCs (OR 2.20, 95% CI 1.96–2.46) and shooting (OR 1.91, 95% CI 1.21–3.00) were predictors for spinal cord injury. Multilevel injury was found in 10.4% of fractures/ dislocations and in 1.3% of cord injury patients. As spinal trauma occurred in [10% of major trauma patients, aggressive evaluation of the spine is warranted, especially, in males, patients45 years, with a GCS15, concomitant chest injury and/or dangerous injury mechanisms (falls [2 m, sports injuries, RTCs and shooting). Diagnostic imaging of the whole spine and a diligent search for associated injuries are substantial. A. K. Exadaktylos H. Zimmermann Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstr, 3010 Bern, Switzerland Keywords Spinal cord injury Spinal fractures/ dislocations TARN registry Major trauma Predictors L. M. Benneker Department of Orthopedic Surgery, Inselspital, University Hospital Bern, Freiburgstr, 3010 Bern, Switzerland Introduction M. Clancy Department of Emergency Medicine, Southampton University Hospitals Trust, Tremona Rd, Southampton SO 16 6YD, UK R. Sieber Department of Emergency Medicine, Cantonal Hospital, Rorschacherstrasse 9007 St., Gallen, Switzerland 123 Civilian trauma accounts for 14% of years of life lost and 10% of death and is the leading cause of death in people aged 5–44 years in developed countries [1, 2]. Discussion: Spinal Cord Injury Disability Fact Sheet For patients suffering spinal injuries, the overall mortality has remained relatively unchanged at 17% over the last 20 years [3]. The reported annual incidence rates vary from 19 to 88 per Eur Spine J (2011) 20:2174–2180 100,000 persons for spinal fractures [4–6], and 14 to 53 per million for spinal cord injury [3, 4, 7–9]. About half of severe spine injuries are reported not to be suspected in the pre-hospital setting [10]. Identification of spinal injuries during initial trauma evaluation is challenging, as patients often have a reduced level of consciousness due to other injuries or are under the influence of sedative and/or analgesic medication. Early detection of spinal injuries in the Emergency Department is important in order to initiate further diagnostic testing and treatment and to avoid additional spinal injury. The prevalence of spinal cord injury, which represents a small part of all spinal injuries [3], has been previously well documented, mainly in studies from the US and Canada [8, 11–13]. Only a few smaller studies exist on the epidemiology of both spinal fractures and cord injuries, and possible risk factors leading to such injuries [4, 5]. We, therefore, present the largest survey from Europe on the epidemiology of spinal trauma with the aim of defining predictors for such injuries. Materials and methods Patients This is a cohort study using prospectively collected data from the Trauma Audit and Research Network (TARN), a European trauma registry [14]. TARN collects data using a web based data collection and reporting system. Eligible patients included as follows: those presenting with trauma to one of the participating hospitals, who either (a) require hospital admission for C72 h or are transferred into a participating hospital for specialist care; (b) require high dependency or intensive care; or (c) die as a result of their injuries within 93 days. Excluded are patients transferred for rehabilitation only, patients with brain injury unrelated to trauma, simple skin lacerations, contusions or abrasions and minor penetrating injuries resulting in blood loss 20%, patients with single uncomplicated limb injuries, and patients over 65 years with isolated fracture of the femoral neck or pubic ramus [15]. Procedures and outcomes The pre-specified primary outcomes were spinal fractures/ dislocations alone or spinal cord injury with or without spinal fractures/dislocations. The inclusion criteria were based on the Abbreviated Injury Scale (AIS) for spinal fractures/dislocations (i.e. fractures/dislocations of spinal vertebrae, pedicles, facets, laminae or the odontoid) and for spinal cord injuries (i.e. cord contusions and lacerations and incomplete and complete spinal cord syndromes). Injuries to the brachial plexus, traumatic disc injuries, fractures of the spinous and transverse processes, spinous 2175 ligament, nerve root injuries and strains of the spine were classified as other spine injuries. GCS (Glasgow Coma Score) was determined on admission to the Emergency Department. Injuries were classified using the AIS. The Injury Severity Score (ISS) was calculated [16]. Statistical methods We included all adult TARN patients (C16 years) admitted to a TARN hospital between January 1988 and December 2009. We excluded patients with missing data for GCS. To determine the predictors for spinal injury, univariate regression analyses (UVA) were performed followed by a multivariate analysis (MVA) including age, gender, GCS, injury mechanism and associated injuries. Patients were grouped according to their age (16–24; 25–34; 35–44; 45–54; 55–64; 65–74; C75) and according to their GCS (15; 13–14; 9–12; 3–8). The injury mechanisms were categorised as road traffic collisions (RTC), falls 2 m (e.g. falling off a chair or ladder or trapping over something), falls [2 m, shooting, stabbing, sports and other injuries (e.g. blast or crush injuries). Associated injuries were divided into head injuries (AIS C 3), and chest, abdomen, extremities and pelvis injuries (AIS C 2 each). Model performance was assessed using the area under the receiver operator characteristic curve. In a sensitivity analysis, we performed multivariable regression analysis after multiple imputation of missing data in the covariate GCS. Finally, we compared characteristics of included patients with those with missing GCS using Mann–Whitney U and v2 tests. All P values are two-sided. Analyses were performed in SPSS Release 16 (SPSS Schweiz AG, Zu?rich). Results 250,584 (100%) adult patients were entered into the TARN data base between January 1988 and December 2009 (Fig. 1). 33,139 (13.22%) suffered spinal trauma. 24,000 (9.58%) of 250,584 patients had spinal fractures/dislocations alone without clinical neurological deficits. 24.50% (n = 5,879) involved the cervical, 28.06% (n = 6,734) the thoracic and 37.09% (n = 8,902) the lumbar spine. Multilevel injury was observed in 2,485 (10.35%) patients with spinal fractures/dislocations. 4,489 (1.79%) of 250,584 patients had suffered a spinal cord injury with or without a spinal fractures/dislocations. 45.42% (n = 2,039) of cord injuries involved the cervical, 29.43% (n = 1,321) the thoracic and 23.81% (n = 1,069) the lumbar spine. 60 (1.34%) of cord injury patients suffered multiple level cord injury. 416 (9.27%) of cord injury patients were diagnosed with spinal cord injury without radiographic (plain radiography and tomographic scans) abnormality. 123 2176 Eur Spine J (2011) 20:2174–2180 Table 2 presents the results from univariate (UVA) and multivariate analysis (MVA) of patients with spinal fractures/dislocations alone and of patients with spinal cord injury with or without fractures/dislocations. Patients with spinal fractures/dislocations or spinal cord injury had a median age of 44.5 years (IQR = 28.8–64.0). 64.94% (n = 18,502) were male. Median ISS was 9 (IQR = 4–17) and median GCS 15 (IQR = 15–15). In patients with spinal fractures/dislocations alone, 36.08% of injuries resulted from RTCs, 30.44% from falls [2 m, 24.38% from falls 2 m and 7.27% from other injuries (Table 1). A similar pattern was observed in patients with spinal cord injury with or without fractures/dislocations (RTC: 40.05%; falls [2 m: 29.90%; falls 2 m: 16.08%; other injuries: 9.56%). Injuries from sports, shooting or stabbing were rare (3% each). 45% of patients with both spinal fractures/dislocations or spinal cord injury suffered associated injuries to other body regions. A breakdown of associated injuries is shown in Table 1. 26.05% of spinal fractures/dislocations patients had associated injuries involving the extremities, 17.78% the chest, 12.32% the head, 4.98% the abdomen and 3.29% the pelvis. Patients with spinal cord injury had concomitant injuries to the chest in 24.04% of cases, extremities in 23.32%, head in 13.59%, abdomen in 5.93% and to the pelvis in 2.92%. Fig. 1 Flow chart of major trauma patients (1988–2009). Discussion: Spinal Cord Injury Disability Fact Sheet 1 Patients with fractures/ dislocations of spinal vertebrae, pedicles, facets, laminae or the odontoid. Cord contusions and lacerations and incomplete and complete spinal cord syndromes. Injuries to the brachial plexus, traumatic disc injuries, fractures of the spinous and transverse processus, spinous ligament and nerve root injuries and strains of the spine. 2 Patients with injuries to the brachial plexus, traumatic disc injuries, fractures of the spinous and transverse processus, spinous ligament and nerve root injuries and strains of the spine. 3 Patients with exclusively fractures/dislocations of spinal vertebrae, pedicles, facets, laminae or the odontoid 4 Patients with Cord contusions and lacerations and incomplete and complete spinal cord syndromes, combined with or without spinal fractures/ dislocations. 5 Patients with SCIWORA (spinal cord injury without radiographic abnormality) Spinal fractures/dislocations Odds ratios (OR) for spinal fractures/dislocations were decreased in patients aged over 44 years in the UVA and MVA (Table 2). The reduced OR for female gender in the UVA (OR 0.86, 95% CI 0.83–0.88) disappeared after full adjustment (OR 1.01, 95% CI 0.98–1.05). Patients with a GCS of 3 to 8 had an increased OR for spinal fractures/ dislocations in the MVA (OR 1.10, 95% CI 1.02–1.19) with respect to patients without spinal fractures/dislocations. We observed the highest OR for spinal fractures/dislocations in falls [2 m, followed by sports injuries and RTCs in the fully adjusted model (fall [2 m: OR 4.17; sports: OR 2.79; RTCs: OR 1.91). Injuries resulting from stabbing had an especially low OR in the crude (OR 0.09, 95% CI 0.06–0.14) and in the adjusted analysis (OR 0.04, 95% CI 0.03–0.06). In the UVA, ORs for associated injuries were 250,584 (100%) Patients >16years, from1988-2009 with major trauma 217,445 (86.8%) Patients with other than spine injuries 33,139 (13.2%/100%) Patients with spine injury1 9,477 7,853 11,277 1,488 469 2,326 249 (28.6%) (23.7%) (34.0%) (4.5%) (1.4%) (7.0%) (0.8%) 4,650 24,000 (1.9%/14.0%) (9.6%/72.4%) Patients with other spine 2 injuries Patients with exclusitvely spineal 3 fractures/dislocations 5,879 6,734 8,902 650 197 1,562 76 (24.5%) (28.1%) (37.1%) (2.7%) (0.8%) (6.5%) (<0.3%) 4,489 (1.8%/13.5 %) Patients with spinal cord injury 2,039 1,321 1,069 21 9 30 0 (45.4%) (29.4%) (23.8%) (0.5%) (0.2%) (0.7%) (0%) 416 (0.2%/1.3 %) Patients with SCIWORA5 123 4 Eur Spine J (2011) 20:2174–2180 2177 Table 1 Study population All spine injuries n = 28,489 (n [%]) Fractures/dislocations n = 24,000 (n [%]) Cord injuries n = 4,489 (n [%]) Age (years) 16–24 5,147 (18.07) 4,223 (17.60) 924 (20.58) 25–34 4,812 (16.89) 3,970 (16.54) 842 (18.76) 35–44 4,426 (15.54) 3,623 (15.10) 803 (17.89) 45–54 3,878 (13.61) 3,249 (13.54) 629 (14.01) 55–64 3,313 (11.63) 2,801 (11.67) 512 (11.41) 65–74 2,685 (9.42) 2,328 (9.70) 357 (7.95) 75 and above 4,228 (14.84) 3,806 (15.86) 422 (9.40) Male 18,502 (64.94) 15,207 (63.36) 3,295 (73.40) Female GCS 9,987 (35.06) 8,793 (36.64) 1,194 (26.60) 1,528 (5.36) 1,213 (5.05) 315 (7.02) Gender 3–8 9–12 594 (2.09) 462 (1.93) 132 (2.94) 1,841 (6.46) 1,526 (6.36) 315 (7.02) 19,631 (68.91) 17,029 (70.95) 2,602 (57.96) 10,457 (36.71) 8,659 (36.08) 1,798 (40.05) Fall [2 m 8,648 (30.36) 7,306 (30.44) 1,342 (29.90) Fall 2 m 6,572 (23.07) 5,850 (24.38) 722 (16.08) 13–14 15 Injury mechanism RTC Shooting 54 (0.19) 27 (0.11) Stabbing 74 (0.26) 26 (0.11) 48 (1.07) 511 (1.79) 388 (1.62) 123 (2.74) 2,173 (7.63) 1,744 (7.27) 429 (9.56) Head Chest 3,567 (12.52) 5,346 (18.77) 2,957 (12.32) 4,267 (17.78) 610 (13.59) 1,079 (24.04) Abdomen 1,460 (5.12) 1,194 (4.98) 266 (5.93) Extremities 7,299 (25.62) 6,252 (26.05) 1,047 (23.32) 921 (3.23) 790 (3.29) 131 (2.92) Sports GCS Glasgow Coma Score, RTC road traffic collision a Total of patients greater than total of injured body regions as only patients with injuries with a severity of AIS C 2 (chest, abdomen, extremities, pelvis) and AIS C 3 (head), respectively, are displayed Other Body region Pelvis 27 (0.60) a increased for thoracic (OR 1.37, 95% CI 1.33–1.42) and pelvic injuries (OR 1.44, 95% CI 1.33–1.55), but results were not robust when adjusting for covariates. Limb injuries were associated with a very low OR for spinal fractures/ dislocations in the crude (OR 0.20, 95% CI 0.19–0.20) and adjusted model (OR 0.13, 95% CI 0.13–0.13). Indeed, in the adjusted model all associated injuries reduced the OR of spinal fractures/dislocations (Table 2). Multilevel injuries were found in 10.35% (n = 2,485) of patients, and predominantly involved the thoracic and lumbar spine. 197 (7.9%) of these patients suffered fractures/dislocations at non-consecutive levels. 76 (3.05%) of 2,485 patients sustained fractures/dislocations at all three levels (Fig. 1). Spinal cord injury In patients [44 years, ORs for spinal cord injury gradually decreased with increasing age, in the UVA and MVA (Table 2). Females had a lower OR for cord injury then males in the UVA (OR 0.54, 95% CI 0.51–0.58) and MVA (OR 0.78, 95% CI 0.72–0.85). The OR for spinal cord injury increased with decreasing GCS, before and after full adjustment (Table 2). Injury mechanisms associated with higher ORs for spinal cord injury were sports injuries, followed by falls [2 m, RTCs and shooting injuries in the MVA (sports: OR 3.98; falls [2 m: OR 3.60; RTCs: OR 2.20; shooting: OR 1.19). Chest (OR 1.94, 95% CI 1.81–2.08), abdominal (OR 1.24, 95% CI 1.09–1.40) and pelvic injuries (OR 1.22, 95% CI 1.02–1.45) were related to increased odds ratio for spinal cord trauma in the UVA, but only the effect of associated chest injuries (OR 1.10, 95% CI 1.01–1.20) was robust to full adjustment. Limb injuries showed a low association with spinal cord trauma in the UVA (OR 0.20, 95% CI 0.18–0.21) and MVA (OR 0.17, 95% CI 0.15–0.18). Patients with head injuries had no increased OR for spinal cord trauma in the crude analysis 123 2178 Eur Spine J (2011) 20:2174–2180 Table 2 Univariate and multivariate regression analyses OR (95% CI) Fractures/dislocations (n = 24,000) Cord injury (n = 4,489) Univariate Univariatea Multivariate Multivariatea Age (years) 16–24 1.00Discussion: Spinal Cord Injury Disability Fact Sheet (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference) 25–34 1.00 (0.96–1.05) 1.02 (0.97–1.08) 0.97 (0.88–1.07) 0.98 (0.87–1.09) 35–44 1.04 (0.99–1.09) 1.03 (0.97–1.09) 1.05 (0.95–1.15) 1.08 (0.96–1.21) 45–54 0.96 (0.92–1.01) 0.90 (0.85–0.96) 0.86 (0.77–0.95) 0.90 (0.79–1.01) 55–64 0.79 (0.75–0.83) 0.83 (0.78–0.89) 0.67 (0.60–0.75) 0.81 (0.71–0.93) 65–74 75 and older 0.91 (0.86–0.96) 0.93 (0.89–0.97) 0.90 (0.84–0.96) 0.94 (0.88–1.00) 0.65 (0.57–0.73) 0.47 (0.42–0.53) 0.78 (0.67–0.91) 0.60 (0.52–0.70) Gender Male 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference) Female 0.86 (0.83–0.88) 1.01 (0.98–1.05) 0.54 (0.51–0.58) 0.78 (0.72–0.85) 3–8 0.95 (0.89–1.01) 1.10 (1.02–1.19) 1.62 (1.44–1.82) 1.93 (1.66–2.23) 9–12 0.79 (0.72–0.87) 0.76 (0.68–0.85) 1.51 (1.26–1.80) 1.57 (1.30–1.89) 13–14 1.07 (1.01–1.13) 0.98 (0.92–1.05) 1.44 (1.28–1.62) 1.36 (1.20–1.54) 15 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference) RTC 1.98 (1.92–2.05) 1.91 (1.83–2.00) 3.15 (2.88–3.43) 2.20 (1.96–2.46) Fall [2 m 4.66 (4.49–4.84) 4.17 (3.98–4.37) 5.66 (5.16–6.20) 3.60 (3.21–4.04) Fall 2 m 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference) Shooting 0.46 (0.31–0.67) 0.29 (0.19–0.44) 3.82 (2.59–5.64) 1.91 (1.21–3.00) Stabbing Other 0.09 (0.06–0.14) 0.73 (0.69–0.78) 0.04 (0.03–0.06) 0.50 (0.46–0.53) 1.48 (1.10–1.99) 1.49 (1.32–1.68) 0.48 (0.34–0.67) 0.83 (0.71–0.96) Sports 3.55 (3.17–3.98) 2.79 (2.41–3.23) 7.89 (6.48–9.60) 3.98 (3.04–5.21) Head 0.74 (0.71–0.77) 0.29 (0.27–0.31) 0.85 (0.78–0.93) 0.29 (0.25–0.33) Chest 1.37 (1.33–1.42) 0.76 (0.73–0.80) 1.94 (1.81–2.08) 1.10 (1.01–1.20) Abdomen 1.03 (0.97–1.10) 0.66 (0.61–0.71) 1.24 (1.09–1.40) 0.65 (0.56–0.76) Extremities 0.20 (0.19–0.20) 0.13 (0.13–0.13) 0.20 (0.18–0.21) 0.17 (0.15–0.18) Pelvis 1.44 (1.33–1.55) 0.83 (0.76–0.92) 1.22 (1.02–1.45) 0.81 (0.66–1.00) GCS Injury mechanism Body region RTC road traffic collision a After imputation for missing GCS (OR 0.85, 95% CI 0.78–0.93) and the OR further dropped in the MVA (OR 0.29, 95% CI 0.25–0.33). In 60 (1.33%) of 4,489 patients we observed cord injuries to more than one level. 9 (15.0%) of these patients suffered cord injury to non-consecutive levels (Fig. 1). Table 3 indicates that patients with spinal fractures/ dislocations alone and missing GCS (n = 3,770, 15.71%) showed a slightly lower age and higher ISS and were more often male. However, the differences were not clinically significant. Patients with spinal cord injury with or without fractures/dislocations (n … ce . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10