Michael D Stillman1, Jason Barber2, Steve Burns3, Steve Williams4, Jeanne M Hoffman4. 1. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: Michael.stillman1972@gmail.com. 2. Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA. 3. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Spinal Cord Injury Service, Veterans Administration Hospital Puget Sound Health Care System, Seattle, WA. 4. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
Abstract
OBJECTIVES: To describe the prevalence and cumulative incidence of secondary complications of spinal cord injury (SCI) in the first year after discharge from inpatient rehabilitation (IR); and to evaluate potential associations between risk of complications and sociodemographic and injury-specific factors. DESIGN: Secondary analysis of data collected for a single-site, single-blind, randomized controlled trial comparing telephone follow-up with usual care. SETTING: Inpatient rehabilitation units. PARTICIPANTS: Adults ages ≥18 years (N=169) within 1 year of discharge from IR after SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-report of 10 secondary complications of SCI. RESULTS: Participants experienced a mean of 4.7 complications over 12 months. The most frequently reported complications were urinary tract infection (UTI), autonomic dysreflexia (AD), and pressure ulcers, with cumulative incidences of 62%, 43%, and 41%, respectively. Bone and soft tissue injuries (cumulative incidence, 35%) and bowel problems, including impaction or severe constipation (cumulative incidence, 33%), were also common. Cumulative incidences of AD, decubitus ulcers, UTI, and problems with bladder were greater in participants with higher level and more complete injuries, and some recurrent complications were common. Age at injury and impairment level significantly affected rates of complications, and subjects developed an average of 2.33 distinct complications during the study period. CONCLUSIONS: People with SCI are at high risk for a number of secondary complications over the first year after discharge from IR. Although these data offer some insight into who with SCI is at highest risk for first time and recurrent complications, further study is needed to refine this understanding and to develop effective educational and prevention strategies.
RCT Entities:
OBJECTIVES: To describe the prevalence and cumulative incidence of secondary complications of spinal cord injury (SCI) in the first year after discharge from inpatient rehabilitation (IR); and to evaluate potential associations between risk of complications and sociodemographic and injury-specific factors. DESIGN: Secondary analysis of data collected for a single-site, single-blind, randomized controlled trial comparing telephone follow-up with usual care. SETTING: Inpatient rehabilitation units. PARTICIPANTS: Adults ages ≥18 years (N=169) within 1 year of discharge from IR after SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-report of 10 secondary complications of SCI. RESULTS:Participants experienced a mean of 4.7 complications over 12 months. The most frequently reported complications were urinary tract infection (UTI), autonomic dysreflexia (AD), and pressure ulcers, with cumulative incidences of 62%, 43%, and 41%, respectively. Bone and soft tissue injuries (cumulative incidence, 35%) and bowel problems, including impaction or severe constipation (cumulative incidence, 33%), were also common. Cumulative incidences of AD, decubitus ulcers, UTI, and problems with bladder were greater in participants with higher level and more complete injuries, and some recurrent complications were common. Age at injury and impairment level significantly affected rates of complications, and subjects developed an average of 2.33 distinct complications during the study period. CONCLUSIONS:People with SCI are at high risk for a number of secondary complications over the first year after discharge from IR. Although these data offer some insight into who with SCI is at highest risk for first time and recurrent complications, further study is needed to refine this understanding and to develop effective educational and prevention strategies.
Authors: Denise G Tate; Tracey Wheeler; Giulia I Lane; Martin Forchheimer; Kim D Anderson; Fin Biering-Sorensen; Anne P Cameron; Bruno Gallo Santacruz; Lyn B Jakeman; Michael J Kennelly; Steve Kirshblum; Andrei Krassioukov; Klaus Krogh; M J Mulcahey; Vanessa K Noonan; Gianna M Rodriguez; Ann M Spungen; David Tulsky; Marcel W Post Journal: J Spinal Cord Med Date: 2020-03 Impact factor: 1.985
Authors: Alessio Conti; Marco Clari; Maeve Nolan; Eva Wallace; Marco Tommasini; Silvia Mozzone; Sara Campagna Journal: Top Spinal Cord Inj Rehabil Date: 2019