Mortality benefit of statin use in traumatic spinal cord injury: a retrospective analysis.

STUDY DESIGN: An observational study based on retrospective review of the medical charts and death records of 163 individuals with traumatic spinal cord injuries (SCI). OBJECTIVES: To determine whether HMG coA Reductase Inhibitor ('statin') use in a cohort of patients with traumatic SCI reduced overall and cause-specific mortality. SETTING: An outpatient clinic designated for veterans with SCI at the Oklahoma City Veterans Administration Hospital. METHODS: Review and analysis of the medical records of 163 veterans with traumatic SCI cared for between the years 2000 and 2014. Data collected included statin use, duration of statin use and intensity of statin therapy, as well as cause-specific mortality. RESULTS: Seventy five participants had taken statins for an average of 5.7 ± 3.7 years, and had greater cardiovascular risk burdens than those who had not taken statins (n = 88). Statin use was associated with a reduced risk of death. The mortality rate for those patients on statins was 33.8-49.9 per 1000 person-years, depending on assumptions made regarding residual effects of statin use. Under most assumptions this was significantly lower than the mortality rate seen in those not on statins (47.4-66.8 deaths per 1000 person-years). Within the statin group, neither duration nor average intensity of statin therapy affected mortality. CONCLUSION: Statin use among a cohort of veterans with traumatic SCI reduced all-cause mortality. This retrospective study ought to spur further investigations into the potential benefits of statin use among people with chronic SCI, and begin a discussion as to whether individuals with injuries should routinely be offered statin therapy.

Complications and urologic risks of neurogenic bladder in veterans with traumatic spinal cord injury.

OBJECTIVES: This observational study aimed to determine the types of urological lesion encountered in veterans with traumatic spinal cord injury (SCI) with neurogenic bladder (NGB), and the usage of bladder management programs to deal with NGB. SETTING: NGB (detrusor muscle and urethral sphincter dysfunction with loss of bladder sensation to void) is common in daily practice; however, information on types of urological lesions encountered in these veterans with NGB and how best to manage their NGB is limited. METHODS: We retrospectively reviewed the electronic charts of veterans with SCI enrolled in our program and regularly followed in our SCI clinic. Demographic data collected included: age, gender, ethnicity and age, level, severity and cause of spinal injury. Also noted was presence of NGB, episodes of urinary tract infection (UTI), bladder program followed and urological lesions found on renal nuclear scans, renal ultrasounds and cystoscopies. RESULTS: Of the 161 veterans with SCI, symptoms of NGB was present in 133 (82.6%). Veterans with NGB had more severe spinal injury and more frequent UTI (P<0.05). Renal atrophy and hydronephrosis were the most common urological lesions seen in patients with UTI. Clean intermittent catheterization (CIC) was the most frequently used bladder program resulting in less frequent occurrence of UTI. CONCLUSION: Renal atrophy and hydronephrosis were the most common urological lesions encountered in veterans with NGB especially in those with UTI. CIC was the most frequently used bladder management program with the least risk for UTI.

Predictors of mortality in veterans with traumatic spinal cord injury.

STUDY DESIGN: Retrospective. OBJECTIVES: To determine the predictors of mortality in veterans with traumatic spinal cord injury (tSCI). SETTING: Tertiary clinic in the state of Oklahoma. METHODS: One hundred and forty-seven patients with tSCI who were enrolled in our Spinal Cord Injury program from 1 January 2000 to 31 December 2011 were retrospectively studied. The study sample was divided into two groups, based on the survival status by 31 December 2011. RESULTS: In this sample of 147 patients with tSCI, survival at the end of the 12-year study period was 60%. There were three major causes of death: infection-related, such as pneumonia (21%), urinary infection (14%), and infection of the pressure ulcers (11%); cardiovascular-related, such as congestive heart failure (16%), coronary arterial disease (13%), and atrial fibrillation (2%); and cancer-related (16%). In veterans with complete SCI, deaths were mainly infection-related and occurred in the hospital (51%), while deaths in veterans with incomplete SCI were primarily cardiovascular and cancer-related and occurred in the community. A Cox regression analysis showed the age at the time of injury to be the main predictor of SCI-related mortality. CONCLUSION: This study suggests that an older age at the time of injury is a significant predictor of mortality following tSCI with patients more likely to die from cardiovascular deaths than the general population. These findings support the need for preventative strategies, including a focus on cardiovascular risk factor management, in order to decrease long-term mortality.

Intensive nutritional supplements can improve outcomes in stroke rehabilitation.

OBJECTIVE: Poor nutrition is a common complication of strokes severe enough to require inpatient rehabilitation. We therefore tested whether intensive nutritional supplements given to undernourished patients from the time of their admission to a specialized stroke rehabilitation service would improve patient outcomes. METHODS: Randomized, prospective, double-blind, single center study comparing intensive nutritional supplementation to routine nutritional supplementation in 116 undernourished patients admitted to a stroke service. The analysis included the 90% of patients who were not lost to follow-up due to acute or subacute hospitalization (n = 102; 51 in each group). The nutritional supplements are commercially available and Food and Drug Administration approved. The primary outcome variable was change in total score on the Functional Independence Measure (FIM). The secondary outcome measurements included the FIM motor and cognitive subscores, length of stay (taken from day of admission), 2-minute and 6-minute timed walk tests measured at admission and on discharge, and discharge disposition (home/not home). RESULTS: Patients receiving intensive nutritional supplementation improved more than those on standard nutritional supplements on measures of motor function (total FIM, FIM motor subscore, 2-minute and 6-minute timed walk tests, all significant at p < 0.002). They did not, however, improve on measures of cognition (FIM cognition score). A higher proportion of patients who received the intensive nutritional supplementation went home compared to those on standard supplementation (p = 0.05). CONCLUSION: Intensive nutritional supplementation, using readily available commercial preparations, improves motor recovery in previously undernourished patients receiving intensive in-patient rehabilitation after stroke.

The cumulative effect of repetitive concussion in sports.

The increased popularity of contact sports worldwide exposes a large number of participants to both acute and chronic traumatic brain injury. Chronic traumatic brain injury (CTBI) represents the cumulative, long-term neurological consequences of repetitive concussive and subconcussive blows to the brain. Although this condition has been described primarily in boxing, it may be anticipated in other contact sports such as soccer, football, ice hockey, and the martial arts. Since treatment options in CTBI are relatively limited, the prevention of CTBI is of paramount importance. Minimizing the frequency and severity of acute brain injury in sport will be instrumental in accomplishing this goal. The prevention of CTBI will need to be sport specific and will undoubtedly rely on limiting the exposure of high-risk athletes, utilizing of protective equipment, enforcing strict rule adherence, training and supervising athletes, and increasing medical surveillance.

Berg balance scale and outcome measures in acquired brain injury.

OBJECTIVE: To examine the relationship of the Berg Balance Scale (BBS) to outcome after acquired brain injury. METHODS: Forty consecutive patients with acquired brain injury were admitted for multidisciplinary rehabilitation. Patients were assessed with the BBS. The BBS was originally designed as a quantitative measure of balance and risk for falls in community-dwelling elderly patients. The BBS comprises 14 different tasks graded on a 56-point scale. Community-dwelling elders with a BBS score of < or = 42 have > 90% risk for falls. RESULTS: In our study, there were 27 patients with a low BBS score (< or = 42) and 13 patients with a high BBS score (> or = 43). The discharge total Functional Independence Measure (FIM) scores were lower in the low BBS patients (96.4 +/- 21.2) compared with the high BBS patients (111.5 +/- 12.5) (p < 0.007). The length of stay (LOS) was significantly longer in the low BBS patients (38.9 +/- 18.5 days) compared with the high BBS patients (14.2 +/- 6.1 days; p < 0.000). Among the three patients that experienced falls during their hospitalization, all exhibited low BBS scores. The admission BBS score strongly correlated with admission total FIM scores (r = 0.86; p < 0.000) and moderately correlated with discharge total FIM scores (r = 0.56; p < 0.000) and LOS (r = -0.55; p < 0.000). Using a multiple regression analysis, the admission FIM score was found to be the better predictor of discharge FIM scores, and time admitted after injury was the better predictor of LOS. CONCLUSIONS: Prediction of rehabilitative outcome might be enhanced by the use of the BBS scores in combination with other clinical measures on admission to inpatient acute rehabilitation.