Initial blood pressure is important for long-term outcome after traumatic spinal cord injury

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OBJECTIVE

Patients with traumatic spinal cord injury (TSCI) are at risk of developing neurogenic shock that causes hypotension and thereby secondary injury to the spinal cord due to ischemia. Hemodynamic treatment of patients with acute TSCI remains inadequately elucidated. Guidelines for management are divergent and based on limited evidence. To this end, the authors evaluated whether mean arterial blood pressure (MABP) during the prehospital and initial hospital phases of TSCI treatment is correlated with long-term neurological outcome.

METHODS

The authors performed a retrospective cohort study based on a chart review of MABP data collected during the prehospital transport, in the operating room (OR), and in the neurointensive care unit (NICU) during the first 7 days after trauma. Data from the NICU were divided into two periods: days 1–2 and days 3–7. Data were analyzed using Spearman’s rank correlation to evaluate for any correlation between MABP and changes in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) score 1 year postinjury. In the analysis, the MABP target value was 80 mm Hg. Hypotension was treated with metaoxedrin or norepinephrine. Statistically significant differences were evaluated using Spearman’s rank correlation coefficient.

RESULTS

The chart review yielded 129 patients treated for TSCI. The inclusion period was 2010–2017. For the prehospital transport measurements of MABP, the Spearman’s rank correlation coefficient was a rho of 0.5662 (p < 0.001), for OR measurements it was a rho of 0.6818 (p < 0.001), and for the NICU measurements it was a rho of 0.4611 (p < 0.001); for NICU unit days 1–2 and days 3–7, the Spearman’s rank correlation coefficient was a rho of 0.2209 (p = 0.0681).

CONCLUSIONS

Continuous MABP levels exceeding 80 mm Hg have a significant impact on neurological outcome—from earliest possible stabilization in the prehospital care, through hospital admission, the surgical phase, and into the first 2 days in the NICU.

ABBREVIATIONS AIS = American Spinal Injury Association Impairment Scale; ISNCSCI = International Standards for Neurological Classification of Spinal Cord Injury; MABP = mean arterial blood pressure; NICU = neurointensive care unit; OR = operating room; SCI = spinal cord injury.
Article Information

Contributor Notes

Correspondence Mette Haldrup: Aarhus University Hospital, Aarhus, Denmark. methalje@rm.dk.INCLUDE WHEN CITING Published online March 20, 2020; DOI: 10.3171/2020.1.SPINE191005.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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