Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.011
Filtrar
2.
Pan Afr Med J ; 33: 82, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448044

RESUMO

Introduction: Surviving a traumatic cervical Spinal Cord Injury (SCI) has an immense effect on an individual's physical function and independence. It also predisposes them to financial, social, psychological and several medical complications throughout their life. In high-income countries, improved multidisciplinary care has led to better long term outcomes, however in low-income countries, the burden of the condition and its associated mortality remain high. The aim of this study was to illustrate the sociodemographic and clinical characteristics of cervical level Traumatic Spinal Cord Injuries (TSCIs) at Kilimanjaro Christian Medical Centre (KCMC) in northern Tanzania. Methods: This was a retrospective hospital-based study of 105 cervical TSCI cases admitted to KCMC from January 2012 to December 2016. Results: We included 105 patients in the study cohort, with a male preponderance of 86.7%, giving a male-to-female ratio of 6.5:1. The mean age at injury was 44.1 years. Overall, 65.7% were farmers and 69 patients were from within the Kilimanjaro region. Road Traffic Crashes (RTCs) accounted for 47.6% of the injuries, 17.9% had associated injuries, 38.1% sustained complete TSCIs and 45.7% developed secondary complications during the ward stay. The mortality rate before discharge from hospital care was 35.2%. Conclusion: The majority of patients were males from a low socioeconomic background and the most common cause of injury was RTCs. The secondary complication rates and mortality rates before discharge from hospital care are high.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Medula Cervical/lesões , Mortalidade Hospitalar , Traumatismos da Medula Espinal/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/mortalidade , Tanzânia/epidemiologia , Adulto Jovem
3.
Dis Colon Rectum ; 62(9): 1095-1104, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318774

RESUMO

BACKGROUND: In the literature on chronic spinal cord injury, neurogenic bowel dysfunction has not gained as much attention as bladder dysfunction, the traditional cause of morbidity and mortality. OBJECTIVE: The purpose of this study was to investigate the prevalence of fecal incontinence and conditions associated with fecal incontinence in women with spinal cord injury. DESIGN: In this cross-sectional study, data were obtained from an electronic medical chart database containing standardized questionnaires. SETTINGS: The study was conducted at the Clinic for Spinal Cord Injuries, Rigshospitalet, where patients from Eastern Denmark are followed every second year. PATIENTS: Women who sustained a spinal cord injury between September 1999 and August 2016 and attended a consultation between August 2010 and August 2016 were included. If the bowel function questionnaire had never been answered, the woman was excluded. MAIN OUTCOME MEASURES: The newest completed questionnaire regarding bowel function, urinary bladder function, quality of life, neurologic level/completeness/etiology of injury, mobility status, and spousal relationship was obtained from each woman. RESULTS: Among the 733 identified women, 684 were included, of whom only 11% had a complete motor injury. A total of 35% experienced fecal incontinence, varying from daily to less than monthly, and 79% experienced bowel dysfunction. Fecal incontinence was associated with urinary incontinence and decreased satisfaction with life in general and psychological health. In the multivariate logistic regression analysis, the odds of daily-monthly fecal incontinence increased significantly with increasing age, myelomeningocele as etiology of injury, a more complete paraplegic injury, use of wheelchair permanently, and follow-up <3 months. LIMITATIONS: There were missing data in the study, including 12% with no answer to the fecal incontinence question. CONCLUSIONS: Fecal incontinence is a severe problem that affects more than one third of women with spinal cord injury and is associated with decreased quality of life. The present study emphasizes that women with myelomeningocele, a more complete paraplegic injury, older age, short follow-up period, and permanent wheelchair use have an increased risk of fecal incontinence. See Video Abstract at http://links.lww.com/DCR/A985. INCONTINENCIA FECAL Y DISFUNCIÓN NEUROGÉNICA DEL INTESTINO EN MUJERES CON LESIÓN DE LA MEDULA ESPINAL TRAUMÁTICA Y NO TRAUMÁTICA: En la literatura sobre la lesión crónica de la médula espinal, la disfunción neurógena del intestino no ha ganado tanta atención como la disfunción de la vejiga, la causa tradicional de morbilidad y mortalidad. OBJETIVÓ:: Investigar la prevalencia de la incontinencia fecal y las condiciones asociadas con la incontinencia fecal en mujeres con lesión de la médula espinal. DISEÑO:: En este estudio transversal, los datos se obtuvieron de una base de datos de registros médicos electrónicos que contenía cuestionarios estandarizados. CONFIGURACIÓN:: Clínica para Lesiones de la Médula Espinal, Rigshospitalet, donde los pacientes del Este de Dinamarca son seguidos cada dos años. PACIENTES: Mujeres que sufrieron una lesión en la médula espinal entre Septiembre de 1999 a Agosto de 2016 y asistieron a una consulta entre Agosto de 2010 a Agosto de 2016. Si nunca se había respondido el cuestionario de la función intestinal, se excluyó a la mujer. MEDIDA DE RESULTADOS PRINCIPALES: Se obtuvo el cuestionario más reciente y completo sobre la función intestinal, la función de la vejiga urinaria, la calidad de vida, el nivel neurológico/integridad/etiología de la lesión, el estado de movilidad y la relación con el cónyuge. RESULTADOS: Entre las 733 mujeres identificadas, se incluyeron 684, de las cuales solo el 11% tenía una lesión de motor completa. Un total de 35% experimentó incontinencia fecal que varió de diaria a menos de mensual, y el 79% experimentó disfunción intestinal. La incontinencia fecal se asoció con incontinencia urinaria y disminución de la satisfacción de vida en general y con la salud psicológica. En el análisis de regresión logística multivariable, las probabilidades de incontinencia fecal diaria-mensual aumentaron significativamente con el aumento de la edad, el mielomeningocele como etiología de la lesión, una lesión parapléjica más completa, el uso de silla de ruedas de forma permanente y el seguimiento <3 meses. LIMITACIONES: Faltaban datos en el estudio, incluyendo el 12% sin respuesta a la pregunta sobre incontinencia fecal. CONCLUSIONES: La incontinencia fecal es un problema grave que afecta a más de un tercio de las mujeres con lesión de la médula espinal y se asocia con una disminución de calidad de vida. El presente estudio enfatiza que las mujeres con mielomeningocele, una lesión parapléjica más completa, mayor edad, corto período de seguimiento y uso de silla de ruedas permanente tienen un mayor riesgo de incontinencia fecal. Vea el Video del Resumen en http://links.lww.com/DCR/A985.


Assuntos
Incontinência Fecal/etiologia , Intestino Neurogênico/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Estudos Transversais , Dinamarca/epidemiologia , Incontinência Fecal/epidemiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Morbidade/tendências , Intestino Neurogênico/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Traumatismos da Medula Espinal/epidemiologia , Inquéritos e Questionários , Taxa de Sobrevida/tendências
4.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 633-636, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31198154

RESUMO

OBJECTIVE: To observe the incidence of spinal cord injury (SCI) following aortic surgery in Fuwai Hospital of Chinese Academy of Medical Sciences, and evaluate the effect of standardized multidisciplinary spinal cord protection strategies, to summarize the experience in the prevention and treatment of SCI at perioperative period of aortic surgery. METHODS: The clinical data of patients underwent aortic surgery admitted to vascular center of Fuwai Hospital from January 2011 to December 2018 were retrospectively analyzed. The patients receiving traditional spinal cord protection strategies from January 2011 to December 2016 were defined as the control group, while the patients receiving standardized multidisciplinary spinal cord protection strategies from January 2017 to December 2018 were defined as the standardized treatment group. The standardized multidisciplinary treatment included preoperative cerebrospinal fluid drainage (CSFD), respiratory tract management, and maintenance of effective circulation of the lowest venous pressure; at the same time, anticoagulation, glucocorticoid, improve microcirculation, scavenge oxygen free radicals and other adjuvant treatments were started, and nerve function was monitored to prevent complications. The changes in SCI incidence after aortic surgery between the two groups were observed in order to evaluate the effect of standardized multidisciplinary spinal cord protection strategies. Meanwhile, the types of SCI after operation and the safety of CSFD were analyzed. RESULTS: During the 8-year period, 7 724 patients underwent aortic surgery at vascular center of Fuwai Hospital, 64 of which suffered from SCI after aortic surgery with total incidence of 0.83%. The onset of SCI was immediate in 39 patients (60.94%) and was delayed in 25 patients (39.06%), more than half of patients were immediate SCI. Of 64 patients with SCI, 52 patients (81.25%) underwent paraplegia and 12 (18.75%) underwent paraparesis. SCI persisted beyond discharge in 38 patients (59.38%) and 25 patients (39.06%) fully or partly recovered form SCI. One patient (1.56%) died. Compared with the control group, the incidence of SCI was decreased significantly after application of standardized multidisciplinary spinal cord protection strategies. The total incidence of SCI after aortic surgery was decreased from 1.06% (52/4 893) to 0.42% (12/2 831), the incidence after aortic arch replacement under deep hypothermic circulatory arrest was decreased from 3.66% (40/1 092) to 1.11% (5/450), and the incidence after thoraco-abdominal aortic replacement was decreased from 9.40% (11/117) to 2.47% (2/81) with statistically significant difference (all P < 0.05). Perioperative CSFD analysis showed that the incidence of CSFD-related complications was low, the overall incidence was 5.45% (3/55), including 1 patient of cerebrospinal fluid leakage, 2 patients of blood cerebrospinal fluid. No serious complications such as hemorrhage and infection of central nervous system occurred. CONCLUSIONS: The main type of SCI after aortic surgery was immediate, about 39% SCI patients fully or partly recovered. Standardized multidisciplinary spinal cord protection strategies which included preoperative CSFD, reduced incidence of SCI after aortic surgery. The incidence of CSFD-related complications was low, which was safe and effective.


Assuntos
Aorta/cirurgia , Traumatismos da Medula Espinal/prevenção & controle , China/epidemiologia , Hospitais , Humanos , Período Perioperatório , Estudos Retrospectivos , Traumatismos da Medula Espinal/epidemiologia , Resultado do Tratamento
5.
BMC Health Serv Res ; 19(1): 391, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208427

RESUMO

BACKGROUND: Fall prevention is a priority in Canadian tertiary rehabilitation hospitals. We aimed to understand the perspectives of hospital administrators on the challenges experienced when implementing fall prevention policies/procedures for patients with spinal cord injury (SCI) in tertiary rehabilitation hospitals. METHODS: Semi-structured interviews were conducted with 10 administrators employed in six Canadian tertiary rehabilitation hospitals. Guided by an interpretive description framework, interviews were analyzed using a constant comparison approach. RESULTS: Challenges with fall prevention experienced by administrators fell into the three categories: 1) fall prevention policy and procedural challenges (e.g. fall prevention policy not SCI-specific, expectation of zero falls, determining contributing factors, learning from falls, and overall effectiveness of the fall prevention policy), 2) clinician-related challenges (e.g. variable staff adherence with the organizations' fall prevention procedures, inconsistent delivery of fall prevention education, and integrating individualized fall risks to guide clinical practice), and 3) patient-related challenges (e.g. balancing risk vs independence and rehabilitation progress, responsibility for fall prevention, and non-preventable falls). CONCLUSIONS: Fall prevention policies/procedures required by the hospitals were insufficient for clinical practice in SCI rehabilitation.


Assuntos
Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Administradores Hospitalares , Hospitais de Reabilitação , Traumatismos da Medula Espinal/reabilitação , Canadá/epidemiologia , Coleta de Dados , Comportamentos Relacionados com a Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Guias de Prática Clínica como Assunto , Fatores de Risco , Traumatismos da Medula Espinal/epidemiologia
6.
Med J Aust ; 210(8): 360-366, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31055854

RESUMO

OBJECTIVE: To investigate trends in the incidence and causes of traumatic spinal cord injury (TSCI) in Victoria over a 10-year period. DESIGN, SETTING, PARTICIPANTS: Retrospective cohort study: analysis of Victorian State Trauma Registry (VSTR) data for people who sustained TSCIs during 2007-2016. MAIN OUTCOMES AND MEASURES: Temporal trends in population-based incidence rates of TSCI (injury to the spinal cord with an Abbreviated Injury Scale [AIS] score of 4 or more). RESULTS: There were 706 cases of TSCI, most the result of transport events (269 cases, 38%) or low falls (197 cases, 28%). The overall crude incidence of TSCI was 1.26 cases per 100 000 population (95% CI, 1.17-1.36 per 100 000 population), and did not change over the study period (incidence rate ratio [IRR], 1.01; 95% CI, 0.99-1.04). However, the incidence of TSCI resulting from low falls increased by 9% per year (95% CI, 4-15%). The proportion of TSCI cases classified as incomplete tetraplegia increased from 41% in 2007 to 55% in 2016 (P < 0.001). Overall in-hospital mortality was 15% (104 deaths), and was highest among people aged 65 years or more (31%, 70 deaths). CONCLUSIONS: Given the devastating consequences of TSCI, improved primary prevention strategies are needed, particularly as the incidence of TSCI did not decline over the study period. The epidemiologic profile of TSCI has shifted, with an increasing number of TSCI events in older adults. This change has implications for prevention, acute and post-discharge care, and support.


Assuntos
Mortalidade Hospitalar/tendências , Traumatismos da Medula Espinal/epidemiologia , Escala Resumida de Ferimentos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Análise de Regressão , Estudos Retrospectivos , Distribuição por Sexo , Traumatismos da Medula Espinal/mortalidade , Vitória/epidemiologia , Adulto Jovem
7.
World Neurosurg ; 128: e107-e115, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30980979

RESUMO

BACKGROUND: Perioperative neurologic complication after an anterior cervical discectomy and fusion (ACDF) is uncommon but may have significant clinical consequences. OBJECTIVE: We aim to estimate the incidence of perioperative neurologic complications, identify their risk factors, and evaluate their impact on morbidity and mortality after ACDF. METHODS: ACDF cases (n = 317,789 patients) were extracted from the National Inpatient Sample between 1999 and 2011. Based on their Elixhauser-van Walraven score (VWR), patients were classified as low (VWR < 5), moderate (5-14), or high risk (>14) for surgery. The primary outcome was perioperative neurologic complications. Secondary outcomes included morbidity (hospital length of stay >14 days or discharge disposition to a location other than home) and in-hospital mortality. RESULTS: The rate of perioperative neurologic complications, morbidity, and mortality after ACDF was 0.4%, 8.4%, and 0.1%, respectively. Perioperative neurologic complications were highly associated with in-house morbidity (odds ratio [OR], 3.7 [3.1-4.4]) and mortality (OR, 8.0 [4.1-15.5]). The strongest predictors for perioperative neurologic complications were moderate- (OR, 3.1 [2.6-3.7]) and high-risk VWR (OR, 5.4 [3.3-8.9]), postoperative hematoma/seroma formation (OR, 5.4 [3.9-7.4]), and obesity (OR, 1.9 [1.6-2.3]). The rate of perioperative neurologic complications increased from 0.2% to 0.7% from 1999 to 2011, which was temporally associated with the rise in moderate- (P = 0.002) and high-risk patients (P = 0.001) undergoing ACDF. CONCLUSIONS: Perioperative neurologic complications are independent predictors of in-hospital morbidity and mortality after ACDF. Both morbidity and perioperative neurologic complications have increased between 1999 and 2011, which may be due, in part, to increasing numbers of moderate- and high-risk patients undergoing ACDF.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Mortalidade Hospitalar , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/métodos , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Hipóxia Encefálica/epidemiologia , Monitorização Neurofisiológica Intraoperatória , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Radiculopatia/cirurgia , Fatores de Risco , Doenças da Medula Espinal/cirurgia , Traumatismos da Medula Espinal/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
8.
Spine (Phila Pa 1976) ; 44(17): 1228-1237, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30973511

RESUMO

STUDY DESIGN: Observational study (Ethics Committee Number 973.648). OBJECTIVE: Evaluating the social and clinical factors associated with sexual dysfunction in men with traumatic spinal cord injury, as well as predictive factors for sexual dysfunction. SUMMARY OF BACKGROUND DATA: Besides the motor and sensory loss, sexual function changes after spinal cord injury, ranging from decreased sexual desire to erectile disorders, orgasm, and ejaculation. METHODS: Performed with 45 men, with traumatic spinal cord injury and sexually active. Sexual function was assessed by the International Index of Erectile Function and the level and degree of injury were determined following guidelines of International Standards for Neurological and Functional Examination Classification of Spinal Cord Injury. Bi and multivariate analysis was applied, with a 0.05 significance level. RESULTS: Forty-five subjects with mean injury time of 7.5 years (CI 5.2-9.9) were evaluated. Having a fixed partner is a protective factor (OR: 0.25; 95% CI: 0.07-0.92) of erectile dysfunction. Sexual desire is associated with the fixed partner (OR: 0.12; 95% CI: 0.02-0.66), masturbation (OR: 0.13; 95% CI: 0.02-0.62), and sexual intercourse in the last month (OR: 0.13; 95% IC: 0.01-0.92). Ejaculation (OR: 0.01; 95% CI: 0.00-0.15) and erectile dysfunction (OR: 15.7; 95% CI: 1.38-178.58) are associated with orgasm. Psychogenic erection (OR: 0.07; 95% CI: 0.01-0.69), monthly frequency of sexual intercourse (OR: 11.3; 95% CI: 2.0-62.8), and orgasmic dysfunction (OR: 7.1; 95% CI: 1.1-44.8) are associated with satisfaction. CONCLUSION: Fixed partner, ejaculation, masturbation are protective factors for sexual dysfunction. Erectile dysfunction, orgasmic, and infrequent sex dysfunction are predictors of sexual dysfunction. LEVEL OF EVIDENCE: 3.


Assuntos
Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Traumatismos da Medula Espinal , Humanos , Masculino , Fatores de Risco , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/epidemiologia , Disfunções Sexuais Psicogênicas/etiologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia
9.
World Neurosurg ; 126: e1494-e1502, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30910750

RESUMO

OBJECTIVE: Spine trauma management in children varies from one team to another, and to date, no clear consensus has been reached. The goal of this study was to describe the epidemiology of spine trauma in children and evaluate the timing and techniques of surgery when it was required. METHODS: A retrospective review of all patients admitted to our pediatric trauma center for spine traumas that required surgical management, between 2005 and 2016, was performed. All patients were followed with clinical and radiologic examination to evaluate the quality of fusion and realignment. RESULTS: Seventy-three children, with a mean age of 14.1 years, were admitted. Spinal injuries were more common in the teenage group (14-18 years). The predominant etiology of spine injuries was motor vehicle collision (36%). The spinal level of injury varied according to the age group: young children presented more cervical traumas (P < 0.01), while teenagers presented more lumbar traumas. There were more fractures alone in the teenage group (P < 0.005), while there were more luxations alone in the school-age group (P < 0.05). Median timing for surgical intervention in patients with neurologic deficits was 1 day. Patients with posterior wall recession >5 mm underwent surgical management quicker than patients with no posterior wall recession (P < 0.03). At follow-up, out of the 37 patients with initial neurologic deficits, 14 had improved (38%). CONCLUSIONS: Diskoligament maturation is an essential concept in spine traumas in children, as well as in surgical management. Surgical procedures should be carried out as soon as possible when patients present with neurologic deficits. At the thoracolumbar junction, a 2-level up-and-down fixation is recommended.


Assuntos
Traumatismos da Coluna Vertebral/cirurgia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Seguimentos , Fixação Intramedular de Fraturas , Humanos , Lactente , Vértebras Lombares/lesões , Masculino , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Estudos Retrospectivos , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/epidemiologia , Tempo para o Tratamento , Tomografia Computadorizada por Raios X
10.
Curr Urol Rep ; 20(5): 21, 2019 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-30904966

RESUMO

PURPOSE OF REVIEW: We highlight the substantial gaps in knowledge on urologic care of female spinal cord injury (SCI) patients. RECENT FINDINGS: Males account for approximately 80% of people living with SCI in developed nations. Although there is a robust body of literature in some aspects of urologic care of individuals with SCI, such as treatments for neurogenic detrusor overactivity, there are relatively few studies focusing specifically on females. There are also few studies focusing on other aspects of urologic care of women with SCI such as sexual dysfunction, pelvic organ prolapse, and bladder cancer. Established guidelines for bladder management exist, generally recommending intermittent catheterization, but the fact remains that a substantial number of women with SCI utilize indwelling catheters for bladder management. There remains a paucity of literature using patient-reported measures regarding both outcomes and experiences of urologic management in the SCI population. Bladder management is challenging for many women with SCI. There are few studies on other urologic concerns in women with SCI.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/terapia , Cateteres de Demora , Feminino , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Medidas de Resultados Relatados pelo Paciente , Prolapso de Órgão Pélvico/etiologia , Prolapso de Órgão Pélvico/fisiopatologia , Prolapso de Órgão Pélvico/terapia , Qualidade de Vida , Fatores Sexuais , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/terapia , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/mortalidade , Uretra/patologia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/terapia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/terapia
11.
Mymensingh Med J ; 28(1): 182-192, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30755568

RESUMO

Spine injuries, a common component in Polytrauma are usually affects the young people and is a major cause of morbidity and poses a significant health care expenditure and considerable threats to survival and quality of life. We retrospectively assess the demographics, incidence, mode of trauma, associated spine injuries, complications, neurological improvement and mortality. Records of total 1695 admitted patients, spinal injuries were 262 patients. Among them 30(11.45%) patients were associated with Polytrauma victims. Eleven patients (36.67%) were admitted through Ortho emergency dept, 14(46.67%) patients through Intensive care unit (ICU), 5(16.66%) patients through other department (CVS, Urology). Most (56%) of the patients were young in the age range of 16 to 40 years. Cervical spines were most commonly (44%) affected followed by lumbar (31%), thoracic (13%), thoraco-lumbar (9%) and Cervico-thoracic (3%) spines. Road traffic accident was the common cause (80%). Twelve patients (40%) had problems at various steps of management and maximum problems occur in step III. Nineteen patients (63.33%) management needs co-ordination between various specialties. Significant number of patients (76.67%) required operative treatment (p<0.05) and 13.33% were managed conservatively. Mortality rate (10%) was insignificant (p>0.05%). Of these patients, 73.33% had shown neurological improvement of at least one ASIA grade. The treatment of spinal injury in polytrauma patient should follow the principle of Advanced Trauma Life Support (ATLS). Once life and limb-threatening injuries have been identified and addressed, suspected spinal cord injury patients should be immobilized as early as possible to reduced the secondary injury, improve motor and sensory function as well as reduced the extend of permanent paralysis.


Assuntos
Traumatismo Múltiplo/cirurgia , Traumatismos da Medula Espinal/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Adolescente , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Traumatismo Múltiplo/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
12.
World Neurosurg ; 125: e1016-e1022, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30771543

RESUMO

BACKGROUND: Depression is a prevalent and disabling condition associated with spinal cord injury (SCI). Such associated negative factor warrants the use of valid and reliable psychological assessment tools among this group. One of the available assessment means is the Patient Health Questionnaire-9 (PHQ-9), a short screening measure that evaluates depression status. Our aim is to test the psychometric properties of the Arabic version of the PHQ-9 including validity and reliability among Lebanese individuals with SCI. METHODS: This is a cross-sectional study conducted between January and June 2018, including 51 participants with SCI. Questionnaire and assessment measures were administered to the subjects. The internal consistency, test-retest reliability, and the factor structure of the PHQ-9 were evaluated in addition to the convergent validity, which was established by comparing the scale's total score with the scores of the Hamilton Depression Rating Scale. RESULTS: Exploratory factor analysis revealed 3 factors accounting for 66.2% of the total variance. The scale demonstrated good internal consistency (Cronbach's alpha = 0.71) and test-retest reliability (Intraclass correlation coefficient = 0.88). Significant correlation was found between the PHQ-9 and the Hamilton Depression Rating Scale (r = 0.71) suggesting good convergent validity. CONCLUSIONS: Our findings suggest that the PHQ-9 has good psychometric properties and is a valid and reliable measure of depression among the Lebanese individuals with SCI.


Assuntos
Depressão/diagnóstico , Questionário de Saúde do Paciente/normas , Traumatismos da Medula Espinal/psicologia , Adulto , Grupo com Ancestrais do Continente Asiático/psicologia , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Análise Fatorial , Feminino , Humanos , Líbano/epidemiologia , Masculino , Escalas de Graduação Psiquiátrica/normas , Curva ROC , Reprodutibilidade dos Testes , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia
13.
Adv Skin Wound Care ; 32(3): 122-130, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30801350

RESUMO

OBJECTIVE: Scientific literature suggests pressure ulcer (PU) risk increases as immobility increases, indicating that more extensive paralysis confers a greater risk of PU. Yet the specific level of paralysis (ie, hemiplegia vs paraplegia vs quadriplegia), apart from neurodegenerative diagnoses, has never been examined in the long-term care (LTC) population. This study examined the prevalence of PU among LTC residents with different paralysis levels. METHODS: The authors conducted a secondary data analysis of the 2012 US Minimum Data Set of LTC facilities (n = 51,664 residents). Measures included PU stage, level of paralysis, functional impairments, comorbidities, and sociodemographic factors. After removing residents with neurodegenerative disease, comatose patients, and those with hip fractures from the analysis, logistic regressions were used to examine the association of risk factors and sociodemographic characteristics with the presence of PU. MAIN RESULTS: The sample included 7,540 patients with quadriplegia, 11,614 patients with paraplegia, and 32,510 patients with hemiplegia in LTC facilities. The PU prevalence in the sample (stages 2, 3, and 4; suspected deep-tissue injury; and unstageable PUs) was 33.9% for patients with quadriplegia, 47.4% for patients with paraplegia, and 9.6% for patients with hemiplegia. CONCLUSIONS: Within paralysis groups (quadriplegic, paraplegic, hemiplegic), risk factors for PU differed in type and magnitude. The PU rates associated with quadriplegia and paraplegia are much higher than LTC residents without paralysis, and PU prevalence for hemiplegia is similar to the rate in LTC residents without paralysis. When the risk factor of paraplegia versus quadriplegia was isolated, PU prevalence for patients with paraplegia was significantly higher.


Assuntos
Assistência de Longa Duração , Lesão por Pressão/epidemiologia , Índice de Gravidade de Doença , Traumatismos da Medula Espinal/epidemiologia , Adulto , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia/complicações , Lesão por Pressão/etiologia , Quadriplegia/epidemiologia , Traumatismos da Medula Espinal/complicações
14.
PLoS One ; 14(2): e0206069, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785880

RESUMO

OBJECTIVES: To evaluate socioeconomic inequalities in social relationships, and to assess whether socioeconomic conditions and social relationships are independently related to mental health problems in individuals with a physical disability due to spinal cord injury (SCI). METHODS: We analyzed cross-sectional data from 511 individuals with SCI aged over 16 years who participated in the community survey of the Swiss SCI Cohort Study (SwiSCI). Indicators for socioeconomic conditions included years of formal education, household income, and financial strain. Social relationships were operationalized by three structural (partner status; social contact frequency; number of supportive relationships) and four functional aspects (satisfaction with: overall social support; family relationships; contacts to friends; partner relationship). General mental health was assessed by the Mental Health Inventory (MHI-5) of SF-36 and depressive symptoms were measured by the Hospital Anxiety and Depression Scale (depression subscale, HADS-D). Established cut-offs for general mental health problems (MHI-5 ≤56) and depressive symptomatology (HADS-D ≥8) were used to dichotomize outcomes. Associations were assessed using logistic regressions. RESULTS: Lower household income was predominantly associated with poor structural social relationships, whereas financial strain was robustly linked to poor functional social relationships. Financial strain was associated with general mental health problems and depressive symptomatology, even after controlling for social relationships. Education and household income were not linked to mental health. Poor structural and functional social relationships were related to general mental health problems and depressive symptomatology. Notably, trends remained stable after accounting for socioeconomic conditions. CONCLUSION: This study provides evidence for socioeconomic inequalities in social relationships as well as for independent associations of financial strain and poor social relationships with mental health problems in individuals with SCI. Further research may develop strategies to improve mental health in SCI by strengthening social relationships. Such interventions may be especially beneficial for individuals with low income and financial strain.


Assuntos
Relações Interpessoais , Saúde Mental , Comportamento Social , Apoio Social , Traumatismos da Medula Espinal/psicologia , Estudos de Coortes , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Traumatismos da Medula Espinal/epidemiologia
16.
Br J Neurosurg ; 33(2): 131-134, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30681374

RESUMO

BACKGROUND: Several cervical laminectomy techniques have been described. One commonly used method involves making bilateral trough laminotomies using either a Kerrison rongeur or a high speed burr, and then removing the lamina en-bloc. Alternatively, some surgeons prefer to thin the lamina with the burr, and then remove the lamina in a piecemeal fashion using Kerrison rongeurs. Some surgeons have warned against the potential risk of iatrogenic spinal cord injury from inserting the Kerrison footplate into a stenotic canal. We aim to quantify the amount of canal encroachment for various methods of cervical laminectomies. METHODS: Three attending spine surgeons and two fellows each performed laminectomies using C5 sawbones models. The canal was completely filled with modeling putty to simulate a stenotic spinal cord. Bilateral trough laminotomies were performed using a 1 mm Kerrison, a 2 mm Kerrison, and a 3 mm matchstick high-speed burr. Piecemeal laminectomies were performed with a 2 mm Kerrison. A blinded spine surgery fellow performed all quantitative measurements. Three blinded researchers qualitatively ranked the amount of "canal encroachment". RESULTS: The average canal encroachment was 0.50 ± 0.45mm for the burr, 1.37 ± 0.68 mm for the 1 mm Kerrison, and 1.47 ± 0.37 mm for the 2 mm Kerrison (p = .002). There was a statistically significant difference between the burr and 1 mm Kerrison (p = .01) and between the burr and the 2 mm Kerrison (p = .001). There was no statistical difference between the 1 mm and 2 mm Kerrison (p = .78). The mean rank of the burr group, the Kerrison rongeur group, and the piecemeal group were 1.41, 1.94, and 2.65, respectively, on an ordinal scale of 1-3. CONCLUSION: When performing a trough laminotomy, the high-speed burr results in less canal encroachment compared to 1 mm or 2 mm Kerrison rongeurs. In the setting of a stenotic spinal canal, spine surgeons should consider using the burr to perform laminectomy to minimize the degree of canal encroachment.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Canal Vertebral/lesões , Traumatismos da Medula Espinal/etiologia , Instrumentos Cirúrgicos/efeitos adversos , Descompressão Cirúrgica , Desenho de Equipamento , Humanos , Modelos Anatômicos , Risco , Traumatismos da Medula Espinal/epidemiologia , Estenose Espinal/cirurgia , Cirurgiões
17.
Am J Surg ; 217(4): 648-652, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30665737

RESUMO

BACKGROUND: We aimed to determine the incidence, risk factors, and outcomes of cervical spinal cord injury (CSCI) after blunt assault. METHODS: The ACS National Trauma Data Bank (NTDB) 2012 Research Data Set was used to identify victims of blunt assault using the ICD-9 E-codes 960.0, 968.2, 973. ICD-9 codes 805.00, 839.00, 806.00, 952.00 identified cervical vertebral fractures/dislocations and CSCI. Multivariable analyses were performed to identify independent predictors of CSCI. RESULTS: 14,835 (2%) out of 833,311 NTDB cases were blunt assault victims and thus included. 217 (1%) had cervical vertebral fracture/dislocation without CSCI; 57 (0.4%) had CSCI. Age ≥55 years was independently predictive of CSCI; assault by striking/thrown object, facial fracture, and intracranial injury predicted the absence of CSCI. 25 (0.02%) patients with CSCI underwent cervical spinal fusion. CONCLUSIONS: CSCI is rare after blunt assault. While the odds of CSCI increase with age, facial fracture or intracranial injury predicts the absence of CSCI. SUMMARY: The incidence, risk factors, and outcomes of cervical spinal cord injury (CSCI) after blunt assault was investigated. 14,835 blunt assault victims were identified; 217 had cervical vertebral fracture/dislocation without CSCI; 57 had CSCI. Age ≥55 years was found to independently predict CSCI, while assault by striking/thrown object, facial fracture, and intracranial injury predicted the absence of CSCI.


Assuntos
Vértebras Cervicais/lesões , Fratura-Luxação/complicações , Lesões do Pescoço/complicações , Traumatismos da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Violência , Ferimentos não Penetrantes/complicações , Adulto , Bases de Dados Factuais , Feminino , Fratura-Luxação/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/epidemiologia , Fatores de Risco , Traumatismos da Medula Espinal/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Estados Unidos/epidemiologia , Ferimentos não Penetrantes/epidemiologia
18.
BMC Neurol ; 19(1): 10, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30646840

RESUMO

BACKGROUND: A few reliable national data concerning the etiology of non-traumatic spinal cord injury (SCI) in sub-Sahara Africa exists, mainly because of the limitations of diagnostic imaging. These are both expensive and mostly unavailable in several resource-limited settings. Only a few studies have employed the magnetic resonance imaging (MRI) in documenting non-traumatic SCI and most of these studies are from South Africa. We sought to describe the clinical presentation, MRI radiological patterns, and one-year survival among subjects with non-traumatic SCI in Uganda. METHODS: We enrolled a prospective cohort of 103 participants with non-traumatic SCI at Mulago National Referral Hospital Kampala, Uganda in 2013-2015. Participants received standard of care management, with surgical intervention as needed, with one-year follow up. Data were analyzed using Descriptive statistics. RESULTS: In 103 participants with non-traumatic SCI, the median (IQR) age was 37 (18, 85) years and 25% of the participants were HIV-infected. Paraplegia/paraparesis was the most common clinical presentation in 70% (n = 72). Severe disease was present in 82% (n = 85) as per American Spinal Injury Association (ASIA) scale A-C. On MRI, 50% had extradural lesions. However, bone lesions accounted for only 75% of all the extradural lesions. More than 60% of the patients had lesions that could only be diagnosed on MRI. Deaths occurred in 42% (n = 44) of participants, with the highest mortality among those with extradural lesions (60%). CONCLUSION: The mortality following non-traumatic spinal cord injuries in Uganda is high. We demonstrated an equal distribution between extradural and intradural lesions, which differs from the historical predominance of extradural lesions. Increased utilization of MRI particularly among young age groups is needed to make a diagnosis.


Assuntos
Imagem por Ressonância Magnética , Traumatismos da Medula Espinal/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Traumatismos da Medula Espinal/diagnóstico por imagem , Uganda/epidemiologia , Adulto Jovem
19.
Spinal Cord ; 57(3): 240-246, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30327495

RESUMO

STUDY DESIGN: Retrospective single-institution observational study. OBJECTIVE: Spinal cord injury (SCI) is associated with a high prevalence of hyponatremia, which can cause various clinical symptoms and increase mortality. We aimed to analyze the risk factors for hyponatremia in patients with acute SCI. SETTING: Trauma Center, Tohoku University Hospital, Japan METHODS: We reviewed the medical records of patients with SCI admitted between January 2008 and November 2016. Least angle regression analyses was performed to assess the association between hyponatremia and other parameters. RESULTS: Of the 213 enrolled patients, 85 (40%) had hyponatremia (serum Na < 135 mmol/L) whilst 19 (9%) had severe hyponatremia (serum Na < 130 mmol/L). Least angle regression analyses revealed that hyponatremia was significantly associated with higher American Spinal Injury Association impairment scale, nosocomial pneumonia, deep vein thrombosis, bradycardia, and surgery for SCI before developing hyponatremia. Severe hyponatremia was significantly associated with traumatic brain injury with an abbreviated injury scale score ≥3, higher American Spinal Injury Association impairment scale, bradycardia, vasopressors, and nosocomial pneumonia. CONCLUSION: Various factors including traumatic brain injury with an abbreviated injury scale score ≥3 and higher American Spinal Injury Association impairment scale may be associated with hyponatremia in patients with acute SCI. These factors can help clinicians identify and monitor SCI patients with a higher hyponatremia risk, and potentially help patients to avoid severe complications.


Assuntos
Hiponatremia/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Doença Aguda , Adulto , Idoso , Feminino , Humanos , Hiponatremia/sangue , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Medula Espinal/sangue
20.
Spine (Phila Pa 1976) ; 44(7): 479-487, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30234810

RESUMO

STUDY DESIGN: Multi-center, retrospective cohort study. OBJECTIVE: To determine the epidemiology, identify predictors of early mortality, and develop predictive models for traumatic spinal cord injury (SCI). SUMMARY OF BACKGROUND DATA: Despite improved initial care and management strategies, traumatic SCI remains a devastating event. Knowledge of the epidemiological state and predictive factors for mortality is important for developing strategies and counseling; however, they have not been adequately investigated, and predictive modeling regarding outcomes remains an underused modality for patients with traumatic SCI. METHODS: Using a nationwide trauma registry-the Japan Trauma Data Bank-we identified adult (≥18 yrs) patients with SCI between 2004 and 2015. The endpoint was in-hospital mortality. Characteristics of each patient were described. Multivariate logistic regression analyses were performed to identify factors significantly associated with in-hospital mortality and develop a predictive model. RESULTS: In total, 236,698 patients were registered in the database. Of the 215,835 adult patients, 8069 (3.7%) had SCI. The majority had SCI at the cervical level with falls at ground level being the primary etiology. Over the study period, median age, the proportion of cervical SCI, and the etiology of falls at ground level increased. The mortality rate was 5.6%. The following eight factors, age, sex, Glasgow Coma Scale on arrival (GCS), hypotension on arrival, bradycardia on arrival, severe head injury, Injury Severity Score (ISS), and neurological severity of SCI, were independently associated with mortality. A predictive model consisting of these variables predicted mortality with area under the receiver operating characteristic curve of 0.88 (95% confidence interval [CI], 0.86-0.90). CONCLUSION: Over the 12-year period, patient characteristics, etiology, and post-SCI outcomes significantly changed. We identified eight prognostic factors of early mortality. A predictive model including these factors showed excellent performance and may improve treatment strategies, healthcare resource allocation, and counseling. LEVEL OF EVIDENCE: 3.


Assuntos
Mortalidade Hospitalar , Modelos Estatísticos , Traumatismos da Medula Espinal/mortalidade , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bradicardia/epidemiologia , Feminino , Previsões/métodos , Escala de Coma de Glasgow , Humanos , Hipotensão/epidemiologia , Escala de Gravidade do Ferimento , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/etiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA