Impact of multiple injuries on functional and neurological outcomes of patients with spinal cord injury.
Impact of multiple injuries on functional and neurological outcomes of patients with spinal cord injury.
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DOI：
10.1186/1757-7241-21-42
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发表时间：
2013-05-30
期刊：
影响因子：
--
通讯作者：
Molinari M
中科院分区：
文献类型：
--
作者：
Scivoletto G;Farchi S;Laurenza L;Tamburella F;Molinari M
多发性损伤对创伤性脊髓损伤（SCI）患者的神经和功能结局的影响存在争议-一些研究小组已经表明，多发性损伤的受试者与无损伤的受试者具有相同的神经和功能结局，而另一些人发现伴有创伤性脑损伤的SCI患者在入院和出院时的功能状态比没有创伤性脑损伤的患者更差，脑损伤因此，本研究的目的是比较有或没有多发伤的SCI受试者的结果。共有245名创伤性SCI患者在病变发展后的第一次康复期间接受了转诊检查（202名男性和43名女性;年龄39.8 ± 17岁;病变至入院时间51.1 ± 58天）。采用以下指标对患者进行评估：美国脊髓损伤协会标准、Barthel指数、Rivermead活动指数和脊髓损伤行走指数。统计学分析包括Poisson回归模型，相对风险和95%置信区间，调整了以下混杂因素：年龄，性别，病变水平和ASIA损伤量表（AIS）分级。使用Student's T检验比较按AIS损害和病变水平划分的患者的结局。有无多发伤的SCI患者在损伤的水平和完整性方面存在显著差异。总体而言，多发伤患者入院和出院时的功能状态比单一创伤受试者差。然而，当调整神经功能特征时，这些人群在入院和出院时的功能和神经功能状态相当，并发症发生率和出院目的地相似。根据每个病变/AIS等级水平进行的单独分析显示，在某些组中，多发性损伤患者在康复入院时（但不是出院时）的住院时间或功能状态明显长于单创伤患者。多发性损伤不影响脊髓损伤的神经学或康复预后。在出院时，有和没有多发性损伤的脊髓损伤患者在神经和功能改善方面取得了相似的结果。一些多发伤患者的住院时间较长。
The effects of multiple injuries on the neurological and functional outcomes of patients with traumatic spinal cord injury (SCI) are debated—some groups have shown that subjects with multiple injuries have the same neurological and functional outcomes of those without them, whereas others have found that SCI patients with associated traumatic brain injury have worse functional status at admission and discharge and longer rehabilitation stays than patients without brain injury. Thus, the aim of this study was to compare the outcomes of SCI subjects with or without multiple injuries. A total of 245 patients with a traumatic SCI during the first rehabilitation stay after the development of the lesion (202 males and 43 females; age 39.8 ± 17 years; lesion to admission time 51.1 ± 58 days) were examined on a referral basis. Patients were assessed using the following measures: American Spinal Injury Association standards, Barthel Index, Rivermead Mobility Index, and Walking Index for Spinal Cord Injury. The statistical analysis comprised Poisson regression models with relative risks and 95% confidence intervals, adjusted for the following confounders: age, sex, lesion level, and ASIA impairment scale (AIS) grade. Student’s T test was used to compare the outcomes of patients divided by AIS impairment and lesion level. SCI patients with and without multiple injuries differed significantly with regard to the level and completeness of the lesion. Overall, patients with multiple injuries had worse functional status at admission and discharge than monotraumatic subjects. However, when adjusted for neurological features, the populations had comparable functional and neurological status at admission and discharge and similar rates of complications and discharge destinations. The separate analysis per each level of lesion/AIS grade showed that in some groups, patients with multiple injuries had a significant longer length of stay or worse functional status at rehabilitation admission (but not at discharge) than their monotraumatic counterparts. Multiple injuries do not affect the neurological or rehabilitative prognosis of spinal cord injuries. At discharge, patients with spinal cord injuries with and without multiple injuries achieved similar results with regard to neurological and functional improvement. Some groups of patients with multiple injuries had a longer length of stay.
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作者：
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