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J Neurotrauma. 2019 Jun 17. doi: 10.1089/neu.2018.6245. [Epub ahead of print]

Association of Pneumonia, Wound Infection, and Sepsis with Clinical Outcomes after Acute Traumatic Spinal Cord Injury.

Author information

1
1 Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
2
2 Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada.
3
3 Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
4
4 Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ontario, Canada.
5
5 Division of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
6
6 Division of Neurosurgery, Methodist Hospital, Houston, Texas.
7
7 Division of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
8
8 Division of Neurosurgery, University of Miami, Miami, Florida.
9
9 Division of Neurosurgery, University of Virginia, Chalottesville, Virginia.
10
10 Division of Neurosurgery, Shock Trauma, University of Maryland, Baltimore, Maryland.
11
11 Division of Neurosurgery, University of Louisville, Louisville, Kentucky.

Abstract

Pneumonia, wound infections, and sepsis (PWS) are the leading causes of acute mortality after traumatic spinal cord injury (SCI). However, the impact of PWS on neurological and functional outcomes is largely unknown. The present study analyzed participants from the prospective North American Clinical Trials Network (NACTN) registry and the Surgical Timing in Acute SCI Study (STASCIS) for the association between PWS and functional outcome (assessed as Spinal Cord Independence Measure subscores for respiration and indoor ambulation) at 6 months post-injury. Neurological outcome was analyzed as a secondary end-point. Among 1299 participants studied, 180 (14%) developed PWS during the acute admission. Compared with those without PWS, participants with PWS were mostly male (76% vs. 86%; p = 0.007), or presented with mostly American Spinal Injury Association Impairment Scale (AIS) grade A injury (36% vs. 61%; p < 0.001). There were no statistical differences between participants with or without PWS with respect to time from injury to surgery, and administration of steroids. Dominance analysis showed injury level, baseline AIS grade, and subject pre-morbid medical status collectively accounted for 77.7% of the predicted variance of PWS. Regression analysis indicated subjects with PWS demonstrated higher odds for respiratory (odds ratio [OR] 3.91, 95% confidence interval [CI]: 1.42-10.79) and ambulatory (OR 3.94, 95% CI: 1.50-10.38) support at 6 month follow-up in adjusted analysis. This study has shown an association between PWS occurring during acute admission and poorer functional outcomes following SCI.

KEYWORDS:

outcomes; pneumonia; sepsis; spinal cord injury; wound infection

PMID:
31007137
DOI:
10.1089/neu.2018.6245

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