Strategies to prevent long-term opioid use following trauma: a Canadian practice survey.

PURPOSE: To evaluate how Canadian clinicians involved in trauma patient care and prescribing opioids perceive the use and effectiveness of strategies to prevent long-term opioid therapy following trauma. Barriers and facilitators to the implementation of these strategies were also assessed. METHODS: We conducted a web-based cross-sectional survey. Potential participants were identified by trauma program managers and directors of the targeted departments in three Canadian provinces. We designed our questionnaire using standard health survey research methods. The questionnaire was administered between April 2021 and November 2021. RESULTS: Our response rate was 47% (350/744), and 52% (181/350) of participants completed the entire survey. Most respondents (71%, 129/181) worked in teaching hospitals. Multimodal analgesia (93%, 240/257), nonsteroidal anti-inflammatory agents (77%, 198/257), and physical stimulation (75%, 193/257) were the strategies perceived to be the most frequently used. Several preventive strategies were perceived to be very effective by over 80% of respondents. Of these, some that were reported as not being frequently used were perceived to be among the most effective ones, including guidelines or protocols, assessing risk factors for opioid misuse, physical health follow-up by a professional, training for clinicians, patient education, and prescription monitoring systems. Staff shortages, time constraints, and organizational practices were identified as the main barriers to the implementation of the highest ranked preventive strategies. CONCLUSIONS: Several strategies to prevent long-term opioid therapy following trauma are perceived as being effective by those prescribing opioids in this population. Some of these strategies appear to be commonly used in everyday practice and others less so. Future research should focus on which preventive strategies should be given higher priority for implementation before assessing their effectiveness.

RéSUMé: OBJECTIF: Évaluer comment les cliniciens canadiens impliqués dans les soins aux patients traumatisés et prescrivant des opioïdes perçoivent l'utilisation et l'efficacité des stratégies visant à prévenir le traitement prolongé par opioïde après un traumatisme. Les obstacles et facilitateurs de la mise en œuvre de ces stratégies ont aussi été analysés. MéTHODES: Nous avons réalisé une enquête transversale via le Web. Les participants potentiels ont été identifiés par les gestionnaires et directeurs de programmes de traumatologie des départements ciblés dans trois provinces canadiennes. Nous avons conçu notre questionnaire en utilisant la méthodologie de recherche usuelle des enquêtes de santé. Le questionnaire a été administré entre avril 2021 et novembre 2021. RéSULTATS: Notre taux de réponse a été de 47 % (350/744) et 52 % (181/350) des participants ont complété l'enquête dans sa totalité. La majorité des personnes interrogées (71 %, 129/181) travaillait dans des hôpitaux universitaires. L'analgésie multimodale (93 %, 240/257), les anti-inflammatoires non stéroïdiens (77 %, 198/257) et la stimulation physique (75 %, 193/257) étaient les stratégies perçues comme étant le plus fréquemment utilisées. Plusieurs stratégies préventives étaient perçues comme étant très efficaces par plus de 80 % des répondants. Parmi celles-ci, certaines étaient signalées comme n'étant pas utilisées très souvent, mais perçues comme étant les plus efficaces, notamment les lignes directrices et protocoles évaluant les facteurs de risque d'utilisation abusive des opioïdes, le suivi de la santé physique par un professionnel, la formation des cliniciens, l'éducation des patients et les systèmes de suivi des prescriptions. La pénurie de personnels, les contraintes de temps et les pratiques de l'établissement ont été identifiées comme étant les principaux obstacles à la mise en place des stratégies préventives classées parmi les premières. CONCLUSIONS: Plusieurs stratégies de prévention du traitement par opioïdes à long terme après un traumatisme sont perçues comme efficaces par ceux qui les prescrivent à cette population de patients. Certaines de ces stratégies apparaissent comme couramment utilisées dans la pratique quotidienne et d'autres moins souvent. La recherche future devrait se concentrer sur la détermination des stratégies préventives auxquelles il faudrait accorder la plus grande priorité de mise en œuvre avant d'évaluer leur efficacité.

Optoelectronic Pressure Sensor Based on the Bending Loss of Plastic Optical Fibers Embedded in Stretchable Polydimethylsiloxane.

We report the design and testing of a sensor pad based on optical and flexible materials for the development of pressure monitoring devices. This project aims to create a flexible and low-cost pressure sensor based on a two-dimensional grid of plastic optical fibers embedded in a pad of flexible and stretchable polydimethylsiloxane (PDMS). The opposite ends of each fiber are connected to an LED and a photodiode, respectively, to excite and measure light intensity changes due to the local bending of the pressure points on the PDMS pad. Tests were performed in order to study the sensitivity and repeatability of the designed flexible pressure sensor.

Factors associated with discharge destination following inpatient functional rehabilitation in patients with traumatic spinal cord injury.

STUDY DESIGN: Retrospective review of data from a prospective database of a Level 1 trauma center. OBJECTIVES: This project aims to identify factors collected during the acute and rehabilitative care following a traumatic spinal cord injury (TSCI) associated with success and failure to return home after inpatient intensive functional rehabilitation (IFR). SETTING: Level 1 trauma center specialized in TSCI care in Montreal, Canada. METHODS: All eligible patients from our prospective database were separated into two groups according to discharge destination following IFR. Clinical variables collected during the acute and rehabilitative care as well as demographic variables were compared between patients who managed to return home (Group 1) and those who were discharged elsewhere (Group 2). Multivariable regression analyses were conducted with variables that were significant at the univariate level. RESULTS: Out of the 193 patients included, 22 (11%) failed to return home following IFR. Six variables were associated with failure to return home at the univariate level: longer acute length of stay (LOS), longer rehabilitation LOS, living alone, higher neurological level of injury, having comorbidities, and having a pressure injury (PI) during acute care. Three variables remained significant at the multivariate level: living alone, increasing acute LOS and presenting a high cervical (C1-C4) neurological level of injury. CONCLUSIONS: It is important that acute care clinicians recognize the aforementioned factors early after TSCI in order to optimize patients for community reintegration.

Are early clinical manifestations of spasticity associated with long-term functional outcome following spinal cord injury? A retrospective study.

STUDY DESIGN: Retrospective study of a prospective cohort of patients with traumatic spinal cord injury (SCI). OBJECTIVES: Determine the relationship between the occurrence of early spasticity, defined as the development of signs and/or symptoms of spasticity during the hospitalization in traumatology, and the functional outcome 6-12 months following a SCI. Secondly, to determine the specific impact of early clonus, velocity-dependent hypertonia and/or muscle spasms on the functional outcome at the same timepoint. SETTING: Single trauma center specialized in SCI care. METHODS: One hundred sixty-two patients sustaining an acute traumatic SCI were included in the analyses. Comparative analysis was performed to describe the characteristics of patients with early spasticity. Correlations were performed to determine the relationship between the clinical signs of spasticity and the Spinal Cord Independence Measure (SCIM) scores collected 6-12 months after SCI. RESULTS: 51.9% of the cohort developed clinical signs of spasticity during the hospitalization in traumatology (29.7 days) following SCI. These showed a significantly lower total SCIM score and subscores compared to individuals without early spasticity at follow-up (p < 0.05). After adjusting for confounding factors, the occurrence of early spasms was only clinical sign of spasticity significantly associated with a decreased mobility at follow-up (r = -0.17, p = 0.04). CONCLUSIONS: The development of signs and symptoms of spasticity, in particular the occurrence of spasms in the first month following the injury may be associated with decreased functional outcome and mobility. Early assessment of spasticity following SCI is thus recommended.

An evaluation of the representativeness of a national spinal cord injury registry: a population-based cohort study.

STUDY DESIGN: Population-based cohort study for the western part of Quebec. OBJECTIVES: To determine the impact of declining to participate in a national spinal cord injury (SCI) registry on patient outcomes and continuum of care. SETTING: Level-1 trauma center specialized in SCI care in Montreal, Canada. METHODS: This cohort study compared the outcomes of 444 patients who were enrolled in the Rick Hansen SCI registry and 140 patients who refused. Logistic regression analyses were performed to assess the association between voluntary participation and the outcomes, while adjusting for confounding factors. The main outcomes were: attendance to follow-up 6- to 12-month post injury, 1-year mortality, and the occurrence of pressure injury during acute care. RESULTS: Declining to be enrolled in the registry was a significant predictor of lower attendance to specialized follow-up (adjusted odds ratio [OR] 0.04, 95% confidence interval [CI] 0.02-0.08). It was also associated with a higher 1-year mortality rate (OR 12.50, CI 4.50-33.30) and higher occurrence of pressure injury (OR 2.56, CI 1.56-4.17). CONCLUSIONS: This study sheds invaluable insight on individuals that researchers and clinicians are usually blind to in SCI cohort studies. This study suggests that decline to participate in a registry during the care hospitalization may be associated with worsened health, poorer outcomes, and reduced follow-up to specialized care. Declining the enrollment to voluntary registry could represent a potential prognostic factor for future research.

Clinical judgment is a cornerstone for validating and using clinical prediction rules: a head-to-head study on ambulation outcomes for spinal cord injured patients.

STUDY DESIGN: Retrospective comparative study. OBJECTIVE: Clinical prediction rules (CPRs) are an effervescent topic in the medical literature. Recovering ambulation after a traumatic spinal cord injury (tSCI) is a priority for patients and multiple CPRs have been proposed for predicting ambulation outcomes. Our objective is to confront clinical judgment to an established CPR developed for patients with tSCI. SETTINGS: Level one trauma center specialized in tSCI and its affiliated rehabilitation center. METHOD: In this retrospective comparative study, six physicians had to predict the ambulation outcome of 68 patients after a tSCI based on information from the acute hospitalization. Ambulation was also predicted according to the CPR of van Middendorp (CPR-vM). The success rate of the CPR-vM and clinicians to predict ambulation was compared using criteria of 5% for defining clinical significance, and a level of statistical significance of 0.05 for bilateral McNemar tests. RESULTS: There was no statistical difference between the overall performance of physicians (success rate of 79%) and of the CPR-vM (81%) for predicting ambulation. The differences between the CPR-vM and physicians varied clinically and significantly with the level of experience, clinical setting, and field of expertise. CONCLUSION: Confronting CPRs with the judgment of a group of clinicians should be an integral part of the design and validation of CPRs. Head-to-head comparison of CPRs with clinicians is also a cornerstone for defining the optimal strategy for translation into the clinical practice, and for defining which clinician and specific clinical context would benefit from using the CPR.

Morphological features of thoracolumbar burst fractures associated with neurological outcome in thoracolumbar traumatic spinal cord injury.

PURPOSE: To identify specific morphological characteristics in thoracolumbar burst fractures associated with neurological outcome after severe traumatic spinal cord injury (TSCI). METHODS: We retrospectively analyzed the clinical and radiological (CT scan morphological characteristics) data of 25 consecutive patients admitted for TSCI secondary to a burst fracture at levels from T11 to L2 between 2010 and 2017 in single level-1 trauma center. We included severe TSCI, defined as American Spinal Injury Association Impairment Scale (AIS) grade A, B or C. RESULTS: Among the 25 patients with severe TSCI, 14 were AIS A, 5 were AIS B, and 6 were AIS C upon initial preoperative neurological evaluation. The AIS grade and the burden of associated injuries (Injury Severity Score, ISS) were the only clinical factors significantly associated with poor neurological recovery. The trauma level of energy was not associated with neurological outcome. Several fractures parameters were independently related to neurological recovery: the postero-inferior corner translation, presence of retropulsed fragment comminution and complete lamina fracture. The magnitude of sagittal kyphosis angle, vertebral kyphosis index and vertebral body comminution were not associated with the neurological outcome. CONCLUSIONS: Morphological features of the bony structures involving the spinal canal in thoracolumbar burst fractures with severe TSCI are associated with the chronic neurological outcome and could provide more insight than the AIS clinical grading. The fracture pattern may better reflect the actual level of energy transferred to the spinal cord than distinguishing between low- and high-energy trauma.

Patterns and predictors of functional recovery from the subacute to the chronic phase following a traumatic spinal cord injury: a prospective study.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To determine the extent of functional recovery between 6 and 12 months following a traumatic spinal cord injury (TSCI) and to identify individuals achieving a small clinical functional improvement during this period. SETTING: A single level-1 trauma center specialized in SCI care. METHODS: A cohort of 125 patients sustaining TSCI was studied. The Spinal Cord Independence Measure (SCIM) version III at 6 and 12 months post injury was used as the main outcome measure. RESULTS: The observed functional improvement for the final cohort did not reach a clinically significant level between 6 and 12 months post injury. However, 30.4% of individuals achieved this level (≥4 points in the SCIM-III total score). This group showed a higher proportion of motor-complete TSCI (AIS grade A or B) and showed a tendency toward older age and higher trauma severity. Longer duration of intensive functional rehabilitation was the single factor associated with reaching a small clinically important improvement in the SCIM-III total score. CONCLUSIONS: Functional status between 6 and 12 months following a TSCI may be considered clinically similar, regardless of the level of injury. However, 30% may reach a small clinical functional improvement in the subacute to chronic phase following TSCI, particularly individuals sustaining severe deficits and older age, which may highlight the importance of functional compensation during this period for these patients.

The use of classification and regression tree analysis to identify the optimal surgical timing for improving neurological outcomes following motor-complete thoracolumbar traumatic spinal cord injury.

STUDY DESIGN: Observational cohort study. OBJECTIVES: To identify the optimal surgical timing for improving neurological outcomes in patients that sustained a motor-complete traumatic spinal cord injury (TSCI) secondary to a thoracolumbar injury. SETTING: Level 1 trauma center specialized in TSCI care. METHODS: We prospectively analyzed clinical data of 35 patients admitted for motor-complete TSCI secondary to a thoracolumbar injury. We quantified neurological recovery with three different outcomes: the improvement of at least one grade on the American Spinal Injury Association Impairment Scale (AIS), of at least one neurological level of injury (NLI), and of at least 10-points on the motor score (MS). Classification and regression tree analysis was used to identify outcome predictors and to provide cutoff values of surgical timing associated with recovery. RESULTS: The proportion of the patients improving by at least one AIS grade was higher in the group undergoing early surgery within 25.7 h of the TSCI (46% vs 0%). The proportion of patients that improved by at least one NLI was also higher in the group undergoing early surgery within 21.5 h of the TSCI (71% vs 18%). Lastly, 25% of the AIS grade A patients undergoing early surgery within 25.6 h of the TSCI improved 10 MS points or more as compared with 0% in the other group. CONCLUSIONS: Earlier surgery was effective in improving neurological outcome in motor-complete TSCI at the thoracolumbar levels. Performing surgery within 21.5 h from the traumatic event in these patients increases the likelihood of improving the neurological recovery. SPONSORSHIP: This study was supported by the Fonds de Recherche du Québec-Santé (FRQS), Department of the Army-United States Army Medical Research Acquisition Activity, Rick Hansen Spinal Cord Injury Registry and Medtronic research chair in spinal trauma at Université de Montréal.

The relevance of MRI for predicting neurological recovery following cervical traumatic spinal cord injury.

STUDY DESIGN: Retrospective cohort study of 82 patients with cervical traumatic spinal cord injury (TSCI). OBJECTIVES: Determine the relevance of preoperative MRI to predict neurological recovery following cervical TSCI. SETTING: Level I trauma center specialized in TSCI. METHODS: The following three MRI parameters were assessed: presence of an intramedullary hemorrhage, intramedullary lesion length and maximal compression of the spinal cord compression (MSCC). Analyses were performed to assess the relationship between MRI parameters and three neurological outcomes: ASIA motor score (AMS), improvement by at least one ASIA impairment scale (AIS) grade (conversion of AIS grade), and reaching AIS grade D or E. RESULTS: Predicting AMS based on initial AIS grade and intramedullary hemorrhage resulted in a validation R-squared of 0.662, and of 0.636 when using only the initial AIS grade. Predicting conversion of AIS grade based on initial AIS grade, intramedullary hemorrhage and lesion length resulted in a validation c-index of 0.704, and of 0.727 when using only the initial AIS grade. Predicting the likelihood of a follow-up AIS grade D or E based on initial AIS grade and intramedullary hemorrhage in a validation c-index of 0.903, and of 0.873 when using only the initial AIS grade. CONCLUSIONS: Intramedullary hemorrhage and lesion length assessed from preoperative MRI were predictors of the neurological recovery following cervical TSCI. However, the clinical benefit of these MRI parameters to predict the neurological recovery remains limited when the initial AIS grade is available, confirming that the initial neurological status remains the most important predictor of the neurological outcome.

Quality of life in the subacute period following a cervical traumatic spinal cord injury based on the initial severity of the injury: a prospective cohort study.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To evaluate the relationship between quality of life (QOL) after a traumatic spinal cord injury (TSCI) and acute predictors, with a particular emphasis on the initial severity of the neurological injury. Secondarily, to compare the QOL after a TSCI with the general population. SETTING: A single Level-1 SCI-trauma centre. METHODS: A cohort of 119 individuals admitted after a cervical TSCI between April 2010 and September 2016 was studied. QOL was assessed using the SF-36v2 questionnaire 6-12 months following the injury, and compared to the general population. The relationship between the initial severity of the neurological injury and the SF-36 summary scores was assessed using linear multivariable regression analyses. RESULTS: Individuals sustaining less severe neurological injury (grade D) exhibited higher PCS than individuals with grades A, B or C injury. Individuals with initial grade A injury showed increased MCS than individuals with incomplete grade B, C or D injury, with 42.9% scoring higher than the general population. The initial grade was significantly associated with chronic PCS and MCS. CONCLUSIONS: The initial severity of the neurological injury after a cervical TSCI may be used to estimate QOL in the subacute period following the injury. Individuals with complete tetraplegia may report good mental QOL despite severe physical impairment. Our findings could help clinicians to determine realistic expectations for patients in terms of QOL, and optimize the rehabilitation plan based on the initial evaluation after a TSCI.

The use of classification tree analysis to assess the influence of surgical timing on neurological recovery following severe cervical traumatic spinal cord injury.

STUDY DESIGN: Post hoc analysis of prospectively collected data. OBJECTIVES: Assess the influence of surgical timing on neurological recovery using classification tree analysis in patients sustaining cervical traumatic spinal cord injury. SETTING: Hôpital du Sacré-Coeur de Montreal METHODS: 42 patients sustaining cervical SCI were followed for at least 6 months post injury. Neurological status was assessed from the American Spinal Injury Association impairment scale (AIS) and neurological level of injury (NLI) at admission and at follow-up. Age, surgical timing, AIS grade at admission and energy of injury were the four input parameters. Neurological recovery was quantified by the occurrence of improvement by at least one AIS grade, at least 2 AIS grades and at least 2 NLI. RESULTS: Proportion of patients that improved at least one ASIA grade was higher in the group that received early surgery (75 vs. 41 %). The proportion of patients that improved two AIS grades was also higher in the group that received early surgery (67 vs. 38 %). Finally, 30 % of the patients that received early decompression improved two NLI as compared with 0% in the other group. Early surgery was also associated with a non-statistically significant improvement in functional recovery. CONCLUSIONS: Neurological recovery of patients sustaining cervical traumatic spinal cord injury can be improved by early decompression surgery performed within 19 h post trauma. SPONSORSHIP: U.S. Army Medical Research and Material Command, Rick Hansen Institute.

The impact of a specialized spinal cord injury center as compared with non-specialized centers on the acute respiratory management of patients with complete tetraplegia: an observational study.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To compare the proportion of tracheostomy placement and duration of mechanical ventilation (MV) in patients with a complete cervical spinal cord injury (SCI) that were managed early or lately in a specialized acute SCI-center. The second objective was to determine the impact of the timing of admission to the SCI-center on the MV support duration. SETTING: A single Level-1 trauma center specialized in SCI care in Quebec (Canada). METHODS: A cohort of 81 individuals with complete tetraplegia over a 6-years period was included. Group 1 (N = 57- early group-) was admitted before surgical management in one specialized acute SCI-center, whereas Group 2 (N = 24 -late group-) was surgically managed in a non-specialized center and transferred to the SCI-center for post-operative management only. The proportion of tracheostomy placement and MV duration were compared. Multivariate regression analysis was used to assess the impact of the timing of admission to the SCI-center on the MV duration during the SCI-center stay. RESULTS: Patients in Group 2 had a higher proportion of tracheostomy (70.8 vs. 35.1%, p = 0.004) and a higher mean duration of MV support (68.0 ± 64.2 days vs. 21.8 ± 29.7 days, p = 0.006) despite similar age, trauma severity (ISS), neurological level of injury and proportion of pneumonia. Later transfer to the specialized acute SCI-center was the main predictive factor of longer MV duration, with a strong impact factor (s = 946.7, p < 0.001). CONCLUSIONS: Early admission to a specialized acute SCI-center for surgical and peri-operative management after a complete tetraplegia is associated with lower occurrence of tracheostomy and shorter mechanical ventilation duration support. SPONSORSHIP: MENTOR Program of the Canadian Institute of Health Research and US Department of Defense Spinal Cord Injury Research Program.

Effectiveness of a multi-layer foam dressing in preventing sacral pressure ulcers for the early acute care of patients with a traumatic spinal cord injury: comparison with the use of a gel mattress.

Individuals with spinal cord injury are at risk of sacral pressure ulcers due to, among other reasons, prolonged immobilisation. The effectiveness of a multi-layer foam dressing installed pre-operatively in reducing sacral pressure ulcer occurrence in spinal cord injured patients was compared to that of using a gel mattress, and stratified analyses were performed on patients with complete tetraplegia and paraplegia. Socio-demographic and clinical data were collected from 315 patients admitted in a level-I trauma centre following a spinal cord injury between April 2010 and March 2016. Upon arrival to the emergency room and until surgery, patients were transferred on a foam stretcher pad with a viscoelastic polymer gel mattress (before 1 October 2014) or received a multi-layer foam dressing applied to their sacral-coccygeal area (after 1 October 2014). The occurrence of sacral pressure ulcer during acute hospitalisation was similar irrespective of whether patients received the dressing or the gel mattress. It was found that 82% of patients with complete tetraplegia receiving the preventive dressing developed sacral ulcers as compared to only 36% of patients using the gel mattress. Although multi-layer dressings were suggested to improve skin protection and decrease pressure ulcer occurrence in critically ill patients, such preventive dressings are not superior to gel mattresses in spinal cord injured patients and should be used with precaution, especially in complete tetraplegia.

Does Improvement in American Spinal Injury Association Impairment Scale Grade Correlate With Functional Recovery in All Patients With a Traumatic Spinal Cord Injury?

OBJECTIVE: The aim of the study is to determine what improvement on the American Spinal Injury Impairment Scale correlates with functional status after a traumatic spinal cord injury. DESIGN: We performed an observational cohort study, analyzing prospective data from 168 patients with traumatic spinal cord injury admitted to a single level 1 trauma center. A multivariable analysis was performed to assess the relationship between functional status (from the Spinal Cord Independence Measure) at 1-year follow-up and American Spinal Injury Impairment Scale grade (baseline and 1-yr follow-up), while taking into account covariables describing the sociodemographic status, trauma severity, and level of neurological injury. RESULTS: Individuals improving to at least American Spinal Injury Impairment Scale grade D had significantly higher Spinal Cord Independence Measure score compared with those not reaching American Spinal Injury Impairment Scale D (89.3 ± 15.2 vs. 52.1 ± 20.4) and were more likely to reach functional independence (68.5% vs. 3.6%), regardless of the baseline American Spinal Injury Impairment Scale grade. Higher final Spinal Cord Independence Measure was more likely with an initial American Spinal Injury Impairment Scale grade D (ß = 1.504; 95% confidence interval = 0.46-2.55), and a final American Spinal Injury Impairment Scale grade D (ß = 3.716; 95% CI = 2.77-4.66) or E (ß = 4.422; 95% CI = 2.91-5.93). CONCLUSIONS: Our results suggest that reaching American Spinal Injury Impairment Scale grade D or better 1 yr after traumatic spinal cord injury is highly predictive of significant functional recovery, more so than the actual improvement in American Spinal Injury Impairment Scale grade from the injury to the 1-yr follow-up.

OBJECTIVE: The aim of the study is to determine what improvement on the American Spinal Injury Impairment Scale correlates with functional status after a traumatic spinal cord injury. DESIGN: We performed an observational cohort study, analyzing prospective data from 168 patients with traumatic spinal cord injury admitted to a single level 1 trauma center. A multivariable analysis was performed to assess the relationship between functional status (from the Spinal Cord Independence Measure) at 1-year follow-up and American Spinal Injury Impairment Scale grade (baseline and 1-yr follow-up), while taking into account covariables describing the sociodemographic status, trauma severity, and level of neurological injury. RESULTS: Individuals improving to at least American Spinal Injury Impairment Scale grade D had significantly higher Spinal Cord Independence Measure score compared with those not reaching American Spinal Injury Impairment Scale D (89.3 ± 15.2 vs. 52.1 ± 20.4) and were more likely to reach functional independence (68.5% vs. 3.6%), regardless of the baseline American Spinal Injury Impairment Scale grade. Higher final Spinal Cord Independence Measure was more likely with an initial American Spinal Injury Impairment Scale grade D (ß = 1.504; 95% confidence interval = 0.46­2.55), and a final American Spinal Injury Impairment Scale grade D (ß = 3.716; 95% CI = 2.77­4.66) or E (ß = 4.422; 95% CI = 2.91­5.93). CONCLUSIONS: Our results suggest that reaching American Spinal Injury Impairment Scale grade D or better 1 yr after traumatic spinal cord injury is highly predictive of significant functional recovery, more so than the actual improvement in American Spinal Injury Impairment Scale grade from the injury to the 1-yr follow-up.

Classifying clinical phenotypes of functional recovery for acute traumatic spinal cord injury. An observational cohort study.

PURPOSE: Identify patient subgroups with different functional outcomes after SCI and study the association between functional status and initial ISNCSCI components. METHODS: Using CART, we performed an observational cohort study on data from 675 patients enrolled in the Rick-Hansen Registry(RHSCIR) between 2014 and 2019. The outcome was the Spinal Cord Independence Measure (SCIM) and predictors included AIS, NLI, UEMS, LEMS, pinprick(PPSS), and light touch(LTSS) scores. A temporal validation was performed on data from 62 patients treated between 2020 and 2021 in one of the RHSCIR participating centers. RESULTS: The final CART resulted in four subgroups with increasing totSCIM according to PPSS, LEMS, and UEMS: 1)PPSS < 27(totSCIM = 28.4 ± 16.3); 2)PPSS ≥ 27, LEMS < 1.5, UEMS < 45(totSCIM = 39.5 ± 19.0); 3)PPSS ≥ 27, LEMS < 1.5, UEMS ≥ 45(totSCIM = 57.4 ± 13.8); 4)PPSS ≥ 27, LEMS ≥ 1.5(totSCIM = 66.3 ± 21.7). The validation model performed similarly to the original model. The adjusted R-squared and F-test were respectively 0.556 and 62.2(P-value <0.001) in the development cohort and, 0.520 and 31.9(P-value <0.001) in the validation cohort. CONCLUSION: Acknowledging the presence of four characteristic subgroups of patients with distinct phenotypes of functional recovery based on PPSS, LEMS, and UEMS could be used by clinicians early after tSCI to plan rehabilitation and establish realistic goals. An improved sensory function could be key for potentiating motor gains, as a PPSS ≥ 27 was a predictor of a good function.

After a traumatic Spinal Cord Injury (SCI), early neurological examination using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is recommended to determine initial injury severity and prognosis.This study identified three initial ISNCSCI components defining four subgroups of SCI patients with different expectations in functional outcomes, namely the initial pinprick sensory score, the Lower Extremity Motor Score, and the Upper Extremity Motor Score.Clinicians could use these subgroups early after tSCI to plan rehabilitation and set realistic therapeutic goals regarding functional outcomes.In clinical practice, careful and accurate assessment of pinprick sensation early after the SCI is crucial when predicting function or stratifying patients based on the expected function.

Educational needs and preferences of adult patients with acute pain: a mixed-methods systematic review.

ABSTRACT: Many patients experience acute pain, which has been associated with numerous negative consequences. Pain education has been proposed as a strategy to improve acute pain management. However, studies report limited effects with educational interventions for acute pain in adults, which can be explained by the underuse of the person-centered approach. Thus, we aimed to systematically review and synthetize current evidence from quantitative, qualitative and mixed-methods studies describing patients' needs and preferences for acute pain education in adults. We searched original studies and gray literature in 7 databases, from January 1990 to October 2023. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A total of 32 studies were included (n = 1847 patients), two-thirds of which were qualitative studies of high methodological quality. Most of the studies were conducted over the last 15 years in patients with postsurgical and posttraumatic pain, identified as White, with a low level of education. Patients expressed the greatest need for education when it came to what to expect in pain intensity and duration, as well how to take the medication and its associated adverse effects. The most frequently reported educational preferences were for in-person education while involving caregivers and to obtain information first from physicians, then by other professionals. This review has highlighted the needs and preferences to be considered in pain education interventions, which should be embedded in an approach cultivating communication and partnership with patients and their caregivers. The results still need to be confirmed with different patient populations.

Is the level of consent to a national research registry associated with patient outcomes following traumatic spinal cord injury? A population-based study from the Rick Hansen Spinal Cord Injury Registry (RHSCIR).

OBJECTIVE: We examined the impact of consenting to the Rick Hansen Spinal Cord Injury Registry (RHSCIR) on outcomes: acute length of stay (LOS), in-hospital mortality, medical complications (pressure injuries and pneumonia), and the final discharge destination following a spinal cord injury (SCI) using the national RHSCIR dataset. DESIGN: A retrospective cohort study was conducted using RHSCIR participant data from 2014 to 2019. Participants approached for enrollment were grouped into 1) PC: provided full consent including community follow-up (CFU) interviews, 2) DWC: declined CFU interviews but accepted minimal data collection that may include initial/final interviews and/or those who later withdrew consent, and 3) DC: declined consent to any participation. As no data was collected for the DC group, descriptive, bivariate, and multivariable regression analysis was limited to the PC and DWC groups. RESULTS: Of 2811 participants, 2101 (74.7%) were PC, 553 (19.7%) were DWC, and 157 (5.6%) were DC. DWC participants had significantly longer acute LOS, more acute pneumonias/pressure injuries, and were less likely to be discharged home than PC participants. All these associations - except pneumonia - remained significant in the multivariable analyses. CONCLUSION: Not participating fully in RHSCIR was associated with more complications and longer hospital stays.

Acute global outcome in patients with mild uncomplicated and complicated traumatic brain injury.

PRIMARY OBJECTIVE: This study assesses the influence of socio-demographic, psychosocial, clinical and radiological variables on the outcome of patients with mild traumatic brain injury (MTBI) in an acute care inpatient setting. RESEARCH DESIGN: Retrospective cohort study. METHODS AND PROCEDURE: A total of 2127 inpatients with MTBI were included. Outcomes measured were Extended Glasgow Outcome Scale (GOS-E), the FIM® instrument, length of stay (LOS) and discharge destination. MAIN OUTCOMES AND RESULTS: Fifty-four per cent of patients with MTBI with a median GOS-E of 2 were discharged home with no need for further follow-up. Age, LOS, lower Glasgow score (GCS) at admission, insurance coverage and positive CT scans were associated with rehabilitation referrals on discharge. Age, LOS, alcohol and drug abuse, motor vehicle collision and lower GCS at admission were associated with greater physical disabilities and functional impairment at discharge. FIM® cognitive functional scores were higher in women, younger patients and patients without psychiatric disorders. Brain lesions were correlated with longer LOS. CT scan findings in patients with MTBI may help clinicians predict the final outcome and resources required for patient care during their hospitalization and on discharge. CONCLUSION: This study can help healthcare professionals in treating and planning future care of patients with MTBI.