Association of Pneumonia, Wound Infection, and Sepsis with Clinical Outcomes after Acute Traumatic Spinal Cord Injury. J Neurotrauma 2019 Nov 01;36(21):3044-3050
Date
04/23/2019Pubmed ID
31007137Pubmed Central ID
PMC6791472DOI
10.1089/neu.2018.6245Scopus ID
2-s2.0-85071928107 (requires institutional sign-in at Scopus site) 37 CitationsAbstract
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.
Author List
Jaja BNR, Jiang F, Badhiwala JH, Schär R, Kurpad S, Grossman RG, Harrop JS, Guest JD, Toups EG, Shaffrey CI, Aarabi B, Boakye M, Fehlings MG, Wilson JRAuthor
Shekar N. Kurpad MD, PhD Chair, Director, Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultFemale
Humans
Male
Middle Aged
Pneumonia
Recovery of Function
Sepsis
Spinal Cord Injuries
Wound Infection