Clinical prediction model for acute inpatient complications after traumatic cervical spinal cord injury: a subanalysis from the Surgical Timing in Acute Spinal Cord Injury Study

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  • 1 Department of Surgery, Division of Neurosurgery;
  • 3 Department of Physical Therapy and Rehabilitation Sciences, University of Toronto, Ontario, Canada; and
  • 2 Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
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Object

While the majority of existing reports focus on complications sustained during the chronic stages after traumatic spinal cord injury (SCI), the objective in the current study was to characterize and quantify acute inpatient complications. In addition, the authors sought to create a prediction model using clinical variables documented at hospital admission to predict acute complication development.

Methods

Analyses were based on data from the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) data registry, which contains prospective information on adult patients with cervical SCIs who were enrolled at 6 North American centers over a 7-year period. All patients who underwent a standardized American Spinal Injury Association (ASIA) neurological examination within 24 hours of injury and whose follow-up information was available at the acute hospital discharge were included in the study. For purposes of classification, complications were divided into 5 major categories: 1) cardiopulmonary, 2) surgical, 3) thrombotic, 4) infectious, and 5) decubitus ulcer development. Univariate statistical analyses were performed to determine the relationship between complication occurrence and individual demographic, injury, and treatment variables. Multivariate logistic regression was subsequently performed to create a complication prediction model. Model discrimination was judged according to the area under the receiver operating characteristic curve.

Results

Complete complication information was available for 411 patients at the acute care discharge. One hundred sixty patients (38.9%) experienced 240 complications. The mean age among those who experienced at least one complication was 45.9 years, as compared with 43.5 years among those who did not have a complication (p = 0.18). In the univariate analysis, patients with complications were less likely to receive steroids at admission (p = 0.01), had a greater severity of neurological injury as indicated by the ASIA Impairment Scale (AIS) grade at presentation (p < 0.01), and a higher frequency of significant comorbidity (p = 0.04). In a multivariate logistic regression model, a severe initial AIS grade (p < 0.01), a high-energy injury mechanism (p = 0.07), an older age (p = 0.05), the absence of steroid administration (p = 0.02), and the presence of comorbid illness (p = 0.02) were associated with a greater likelihood of complication development during the period of acute hospitalization. The area under the curve value for the full model was 0.75, indicating acceptable predictive discrimination.

Conclusions

These results will help clinicians to identify patients with cervical SCIs at greatest risk for complication development and thus allowing for the institution of aggressive complication prevention measures.

Abbreviations used in this paper:AIS = ASIA Impairment Scale; ASIA = American Spinal Injury Association; AUC = area under curve; NASCIS = National Acute Spinal Cord Injury Study; ROC = receiver operating characteristic; SCI = spinal cord injury.

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Contributor Notes

Address correspondence to: Michael G. Fehlings, M.D., Ph.D., Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. email: Michael.Fehlings@uhn.on.

Please include this information when citing this paper: DOI: 10.3171/2012.4.AOSPINE1246.

  • 1

    Ackery A, , Tator C, & Krassioukov A: A global perspective on spinal cord injury epidemiology. J Neurotrauma 21:13551370, 2004

  • 2

    American Spinal Injury Association: International Standards for Neurological Classification of Spinal Cord Injury, revised 2002 Chicago, American Spinal Injury Association, 2000

    • Search Google Scholar
    • Export Citation
  • 3

    Annane D, , Bellissant E, , Bollaert PE, , Briegel J, , Keh D, & Kupfer Y: Corticosteroids for treating severe sepsis and septic shock. Cochrane Database Syst Rev 1 CD002243, 2004

    • Search Google Scholar
    • Export Citation
  • 4

    Bracken MB, , Shepard MJ, , Collins WF, , Holford TR, , Young W, & Baskin DS, : A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 322:14051411, 1990

    • Search Google Scholar
    • Export Citation
  • 5

    da Paz AC, , Beraldo PS, , Almeida MC, , Neves EG, , Alves CM, & Khan P: Traumatic injury to the spinal cord. Prevalence in Brazilian hospitals. Paraplegia 30:636640, 1992

    • Search Google Scholar
    • Export Citation
  • 6

    DeVivo M, & Stover S, Long term survival and causes of death. Stover SL, , DeLisa JA, & Whiteneck GG: Spine Cord Injury: Clinical Outcomes from the Model Systems Gaithersburg, MD, Aspen Publishers, 1995. 289316

    • Search Google Scholar
    • Export Citation
  • 7

    Dryden DM, , Saunders LD, , Rowe BH, , May LA, , Yiannakoulias N, & Svenson LW, : The epidemiology of traumatic spinal cord injury in Alberta, Canada. Can J Neurol Sci 30:113121, 2003

    • Search Google Scholar
    • Export Citation
  • 8

    Dryden DM, , Saunders LD, , Rowe BH, , May LA, , Yiannakoulias N, & Svenson LW, : Utilization of health services following spinal cord injury: a 6-year follow-up study. Spinal Cord 42:513525, 2004

    • Search Google Scholar
    • Export Citation
  • 9

    Fehlings MG, , Rao SC, , Tator CH, , Skaf G, , Arnold P, & Benzel E, : The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part II: Results of a multicenter study. Spine (Phila Pa 1976) 24:605613, 1999

    • Search Google Scholar
    • Export Citation
  • 10

    Fehlings MG, & Wilson JR: Timing of surgical intervention in spinal trauma: what does the evidence indicate?. Spine (Phila Pa 1976) 35:21 Suppl S159S160, 2010

    • Search Google Scholar
    • Export Citation
  • 11

    Furlan JC, , Kailaya-Vasan A, , Aarabi B, & Fehlings MG: A novel approach to quantitatively assess posttraumatic cervical spinal canal compromise and spinal cord compression: a multicenter responsiveness study. Spine (Phila Pa 1976) 36:784793, 2011

    • Search Google Scholar
    • Export Citation
  • 12

    Giugliano GR, , Giugliano RP, , Gibson CM, & Kuntz RE: Metaanalysis of corticosteroid treatment in acute myocardial infarction. Am J Cardiol 91:10551059, 2003

    • Search Google Scholar
    • Export Citation
  • 13

    Hadley M, , Walters B, , Grabb P, , Oyesiku N, , Przybylski G, & Resnick D, : Blood pressure management after acute spinal cord injury. Neurosurgery 50:3 Suppl S58S62, 2002

    • Search Google Scholar
    • Export Citation
  • 14

    Hadley M, , Walters B, , Grabb P, , Oyesiku N, , Przybylski G, & Resnick D, : Management of acute spinal cord injuries in an intensive care unit or other monitored setting. Neurosurgery 50:3 Suppl S51S57, 2002

    • Search Google Scholar
    • Export Citation
  • 15

    Haisma JA, , van der Woude LH, , Stam HJ, , Bergen MP, , Sluis TA, & Post MW, : Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation. J Rehabil Med 39:393398, 2007

    • Search Google Scholar
    • Export Citation
  • 16

    Hart C, & Williams E: Epidemiology of spinal cord injuries: a reflection of changes in South African society. Paraplegia 32:709714, 1994

    • Search Google Scholar
    • Export Citation
  • 17

    Hawryluk GW, , Rowland J, , Kwon BK, & Fehlings MG: Protection and repair of the injured spinal cord: a review of completed, ongoing, and planned clinical trials for acute spinal cord injury. A review. Neurosurg Focus 25:5 E14, 2008

    • Search Google Scholar
    • Export Citation
  • 18

    Krassioukov AV, , Furlan JC, & Fehlings MG: Medical co-morbidities, secondary complications, and mortality in elderly with acute spinal cord injury. J Neurotrauma 20:391399, 2003

    • Search Google Scholar
    • Export Citation
  • 19

    Krause JS, , Sternberg M, , Lottes S, & Maides J: Mortality after spinal cord injury: an 11-year prospective study. Arch Phys Med Rehabil 78:815821, 1997

    • Search Google Scholar
    • Export Citation
  • 20

    Levy LF, , Makarawo S, , Madzivire D, , Bhebhe E, , Verbeek N, & Parry O: Problems, struggles and some success with spinal cord injury in Zimbabwe. Spinal Cord 36:213218, 1998

    • Search Google Scholar
    • Export Citation
  • 21

    McDonald JW, & Sadowsky C: Spinal-cord injury. Lancet 359:417425, 2002

  • 22

    Meduri GU, , Headley AS, , Golden E, , Carson SJ, , Umberger RA, & Kelso T, : Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA 280:159165, 1998

    • Search Google Scholar
    • Export Citation
  • 23

    Meyers AR, , Andresen EM, & Hagglund KJ: A model of outcomes research: spinal cord injury. Arch Phys Med Rehabil 81:12 Suppl 2 S81S90, 2000

    • Search Google Scholar
    • Export Citation
  • 24

    Noreau L, , Proulx P, , Gagnon L, , Drolet M, & Laramée MT: Secondary impairments after spinal cord injury: a population-based study. Am J Phys Med Rehabil 79:526535, 2000

    • Search Google Scholar
    • Export Citation
  • 25

    Pickett GE, , Campos-Benitez M, , Keller JL, & Duggal N: Epidemiology of traumatic spinal cord injury in Canada. Spine (Phila Pa 1976) 31:799805, 2006

    • Search Google Scholar
    • Export Citation
  • 26

    Reines HD, & Harris RC: Pulmonary complications of acute spinal cord injuries. Neurosurgery 21:193196, 1987

  • 27

    Rowland JW, , Hawryluk GW, , Kwon B, & Fehlings MG: Current status of acute spinal cord injury pathophysiology and emerging therapies: promise on the horizon. Neurosurg Focus 25:5 E2, 2008

    • Search Google Scholar
    • Export Citation
  • 28

    Sekhon LH, & Fehlings MG: Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 26:(Phila Pa 1976) 24 Suppl S212, 2001

    • Search Google Scholar
    • Export Citation
  • 29

    Valtonen N, , Karlsson A, , Alaranta H, & Viikari-Juntura E: Work participation among persons with traumatic spinal cord injury and meningomyelocele. J Rehabil Med 38:192200, 1998

    • Search Google Scholar
    • Export Citation
  • 30

    Westgren N, & Levi R: Quality of life and traumatic spinal cord injury. Arch Phys Med Rehabil 79:14331439, 1998

  • 31

    Wilson J, & Fehlings M: Adrenal insufficiency as a cause of refractory hypotension in acute period after spinal cord injury: a perspective statement. World Neurosurg [epub ahead of print], 2011

    • Search Google Scholar
    • Export Citation
  • 32

    Winslow C, & Rozovsky J: Effect of spinal cord injury on the respiratory system. Arch Phys Med Rehab 82:803814, 2003

  • 33

    Wyndaele M, & Wyndaele JJ: Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?. Spinal Cord 44:523529, 2006

    • Search Google Scholar
    • Export Citation

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