Systemic inflammatory response syndrome in patients with spinal cord injury: does its presence at admission affect patient outcomes?

Clinical article

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  • Division of Orthopaedics, Department of Surgery, Schulich School of Medicine, University of Western Ontario; and Orthopaedic Spine Program, Victoria Hospital, London Health Sciences Centre, London, Ontario, Canada
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Object

The object in this study was to determine whether the presence of systemic inflammatory response syndrome (SIRS) in patients with traumatic spinal cord injury (SCI) on admission is related to subsequent clinical outcome in terms of length of stay (LOS), complications, and mortality.

Methods

The authors retrospectively reviewed the charts of 193 patients with acute traumatic SCI who had been hospitalized at their institution between 2006 and 2012. Patients were excluded from analysis if they had insufficient SIRS data, a cauda equina injury, a previous SCI, a preexisting neurological condition, or a condition on admission that prevented appropriate neurological assessment. Complications were counted only once per patient and were considered minor if they were severe enough to warrant treatment and major if they were life threatening. Demographics, injury characteristics, and outcomes were compared between individuals who had 2 or more SIRS criteria (SIRS+) and those who had 0 or 1 SIRS criterion (SIRS−) at admission. Multivariate logistic regression (enter method) was used to determine the relative contribution of SIRS+ at admission in predicting the outcomes of mortality, LOS in the intensive care unit (ICU), hospital LOS, and at least one major complication during the acute hospitalization. The American Spinal Injury Association Impairment Scale grade and patient age were included as covariates.

Results

Ninety-three patients were eligible for analysis. At admission 47.3% of patients had 2 or more SIRS criteria. The SIRS+ patients had higher Injury Severity Scores (24.3 ±10.6 vs 30.2 ±11.3) and a higher frequency of both at least one major complication during acute hospitalization (26.5% vs 50.0%) and a fracture-dislocation pattern of injury (26.5% vs 59.1%) than the SIRS− patients (p < 0.05 for each comparison). The SIRS+ patients had a longer median hospital stay (14 vs 18 days) and longer median ICU stay (0 vs 5 days). However, mortality was not different between the groups. Having SIRS on admission predicted an ICU LOS > 10 days, hospital LOS > 25 days, and at least one complication during the acute hospitalization.

Conclusions

A protocol to identify SCI patients with SIRS at admission may be beneficial with respect to preventing adverse outcomes and decreasing hospital costs.

Abbreviations used in this paper:

AIS = American Spinal Injury Association Impairment Scale; AUC = area under the curve; BUN = blood urea nitrogen; DVT = deep venous thrombosis; ICU = intensive care unit; ISS = Injury Severity Score; LOS = length of stay; SCI = spinal cord injury; SIRS = systemic inflammatory response syndrome; UTI = urinary tract infection.

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