Outcomes 2 years after traumatic spinal cord injury in Botswana: a follow-up study (original) (raw)
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A multicentre follow-up of clinical aspects of traumatic spinal cord injury
Spinal Cord, 2006
Study design: Prospective, multicentred follow-up (FU) observational study. Objectives: Prospectively evaluate survival, complications, re-admissions and maintenance of clinical outcome in people experiencing traumatic spinal cord injury (SCI). Setting: Seven spinal units and 17 rehabilitation centres participating in the previous GISEM (ie Italian Group for the Epidemiological Study of Spinal Cord Injuries) study. Method: A total of 511 persons with SCI, discharged between 1997 and 1999 after their first hospitalisation, were enrolled. A standardised questionnaire was administered via telephone. Results: Of the 608 persons originally enrolled, 36 died between discharge and follow-up (mean 3.870.64 years). Of the remainder, 403 completed telephone interviews, 72 refused to participate and 97 could not be contacted. More than half of the patients interviewed (53.6%) experienced at least one SCI-related clinical problem in the 6 months preceding interview; the most frequent being urological complications (53.7%). At least one re-admission was recorded in 56.8% of patients between discharge and FU interview. Of the patients interviewed, 70.5% reported bowel autonomy and 86% bladder management autonomy. On multivariate analysis, lack of bowel/bladder autonomy was the most common variable with a strong predicting value for mortality, occurrence of complications and re-admissions. Conclusion: Re-admission and major complications seem common after SCI and should be considered when planning facilities. Failure to obtain bowel/bladder autonomy upon discharge from rehabilitation proved to be the most common predictive factor of poor outcome during the period between discharge and FU interview.
Prediction of Bladder Outcomes after Traumatic Spinal Cord Injury: A Longitudinal Cohort Study
PLoS medicine, 2016
Neurogenic bladder dysfunction represents one of the most common and devastating sequelae of traumatic spinal cord injury (SCI). As early prediction of bladder outcomes is essential to counsel patients and to plan neurourological management, we aimed to develop and validate a model to predict urinary continence and complete bladder emptying 1 y after traumatic SCI. Using multivariate logistic regression analysis from the data of 1,250 patients with traumatic SCI included in the European Multicenter Spinal Cord Injury study, we developed two prediction models of urinary continence and complete bladder emptying 1 y after traumatic SCI and performed an external validation in 111 patients. As predictors, we evaluated age, gender, and all variables of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and of the Spinal Cord Independence Measure (SCIM). Urinary continence and complete bladder emptying 1 y after SCI were assessed through item 6 of S...
Conflict and Health, 2014
Background: The final months of the conflict in Sri Lanka in 2009 resulted in massive displacement of the civilian population and a high volume of orthopedic trauma including spinal cord injury. In response to this need, Médecins Sans Frontières implemented a multidisciplinary rehabilitation program. Methods: Patients were admitted to the program if they had a spinal cord injury, a stable spine and absence of a high-grade pressure ulcer. All patients were assessed on admission with a standardized functional scale the Spinal Cord Independence Measure II (SCIM) and the American Spinal Injury Association Impairment Scale (ASIA). A multidisciplinary team provided nursing care, physiotherapy, bowel and bladder training, mental health care, and vocational rehabilitation. Patients were discharged from the program when medically stable and able to perform activities of daily living independently or with assistance of a caregiver. The primary outcome measures were discharge to the community, and change in SCIM score on discharge. Secondary outcome measures were measured at 6-12 weeks post-discharge, and included SCIM score and presence of complications (pressure ulcers, urinary tract infections and bowel problems).
2018
Background: A spinal cord injury (SCI) results in a change, either temporary or permanent, in the cord's normal motor, sensory or autonomic function. In addition, secondary medical complications are common, following an SCI. As such, mortality risk in the spinal cord community remains higher, when compared to the general population. Understanding the complexity of factors related to mortality, remains paramount. Aim: The overarching aim was to assess mortality and secondary medical complications, four years after traumatic spinal cord injury (TSCI) in the City of Cape Town, South Africa. Secondarily, factors associated with mortality and the development of secondary medical complications were assessed. Methods: A prospective, population-based design was used. The study population consisted of all respondents with TSCI, who were enrolled in an earlier incidence study that was conducted in 2013/2014. For this follow-up study, an inclusive sampling strategy was used. All eligible respondents (N=145), or a family member of the deceased, were initially telephonically contacted and requested to complete a valid and reliable interview-administered questionnaire, to be completed face-to-face, or telephonically. Of those patients who were deceased, a close family member, or former caretaker was asked to participate in this current study. In order to aid the generalisability of the findings to the immediate source population, every non-responder with information available from baseline data collected in 2013/2014, were accounted for. Descriptive statistics were used to describe the cohort and to present the mortality rate, as well as point-prevalence of secondary medical complications. Inferential statistics, namely, bivariate logistic regression analysis, were used to identify factors associated with mortality and the development of secondary medical complications. Results: The response rate of the initial 145 persons was 60% (N=87). Of the 87 accounted participants, a total number of 55 persons (63%) were alive and completed the full survey on health status and functioning, 21 persons (24%) were deceased by the follow-up date, and 11 people (13%) were classified as alive, but did not complete the survey due to declining participation in the follow up study or did not arrive for their scheduled interview. There were no differences in the key variables, namely, gender, age, as well as level and completeness of injury, found between the responders and non-responders. The mortality rate was 24%, four http://etd.uwc.ac.za/ v DECLARATION I declare that Survival and secondary medical conditions of persons with traumatic spinal cord injury in South Africa, is my own work, has not been submitted for any degree, or examination, at any other university, and all the resources I have used, or quoted, have been indicated, and acknowledged by complete references.
Data on Spinal Injuries-Part II. Outcome of the Treatment of 352 Consecutive Admissions
Australian and New Zealand Journal of Surgery, 2008
The data collection system described in a previous study has been used to analyze some of the results of treatment of 352 consecutive admissions to the Spinal Injuries Unit, Austin Hospital. The results indicate that the basically conservative approach to the management of the spinal injury, supplemented by surgery in selected cases, appears to be vindicated by the low rate of instability of the spine, and good neurological sequelae of the spinal cord injury. An intermittent catheter regimen for management of the neurogenic bladder has resulted in a low rate of permanent indwelling catheterization on discharge from hospital and a low rate of urinary infections. The survival rate of patients in a well integrated unit, with a multi-disciplinary team, is high. The relatively long periods of hospitalization are justified by the return to the community of a high proportion of independent, healthy, disabled people.
Study protocol: patient reported outcomes for bladder management strategies in spinal cord injury
BMC urology, 2017
The majority of spinal cord injury (SCI) patients have urinary issues, such as incontinence, retention, and frequency. These problems place a significant burden on patients' physical health and quality of life (QoL). There are a wide variety of bladder management strategies available to patients with no clear guidelines on appropriate selection. Inappropriate bladder management can cause hospitalizations and serious complications, such as urosepsis and renal failure. Patients believe that both independence and ability to carry out daily activities are just as important as physical health in selecting the right bladder-management strategy but little is known about patient's QoL with different bladder managements. Our study's aim is to assess patient reported QoL measures with various bladder managements after SCI. This manuscript describes the approach, study design and common data elements for our central study. This is a multi-institutional prospective cohort study comp...
Journal of Rehabilitation Medicine, 2007
Objective: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation. Design: Multicentre longitudinal study. Subjects: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres. Methods: Assessments at the start of active rehabilitation (n = 212), 3 months later (n = 143), at discharge (n = 191) and 1 year after discharge (n = 143). Results: Multi-level random coefficient analyses revealed that complications were common following spinal cord injury. Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, complications remained common: urinary tract infections and pressure sores affected 49% and 36% of the population, respectively. The degree of pain decreased, whereas the degree of spasticity increased significantly during inpatient rehabilitation. Overall, increased age, increased body mass index, traumatic lesion, tetraplegia, and complete lesion all increased the risk of complications. Conclusion: Complications are common following spinal cord injury. They need specific attention after discharge from inpatient rehabilitation and within subpopulations.
Vojnosanitetski pregled, 2012
Background/Aim. Spinal cord injuries (SCI) could be associated with a significant functional impairment in the areas of mobility, self-care, bowel and bladder emptying and sexuality. The aim of this study was to compare demographic characteristics and functional outcomes of nontraumatic and traumatic spinal cord injury patients. Methods. This study was designed as retrospective case series study. A detailed medical history including sex, age, mode of trauma, and clinical and radiological examination was taken for all patients. Hospital records were used to classify the patients according to the following: mechanism of injury, neurological level of injury, functional outcomes, associated injuries, method of treatment, secondary complications and length of stay. The following clinical scores were measured in the patients: American Spinal Injury Association standards (CASTA), Functional Independence Measure (FIM), and Modified Aschworth score (MAS). Results. Out of totally 441 patients...