Respiratory and Cardiovascular Readmissions and Prescription Patterns after Spinal Cord Injury: A National Registry-Based Study from Sweden

Readmission to the Cardiac Surgery Intensive Care Unit

Prospective, cross-sectional, comparative study. To evaluate sexual function in women with spinal cord injury (SCI) using Female Sexual Function Index (FSFI) and to compare results with healthy controls. Secondary objectives were to determine prevalence of sexual dysfunction and to examine associations between sexual function and neurological level, functional independence, bladder and bowel function, and medical complications. Ankara Bilkent City Hospital, Türkiye. Twenty-six women with SCI and 23 age-matched healthy controls were included. Demographic and obstetric characteristics (age, marital status, educational level, employment status, pregnancy history, number of deliveries, mode of delivery, menstrual status, and contraceptive use) were recorded. Sexual function was assessed using the Female Sexual Function Index (FSFI). Functional independence was evaluated with the Spinal Cord Independence Measure III (SCIM III), and bowel dysfunction was assessed using the Neurogenic Bowel Dysfunction (NBD) score. Group comparisons were performed using non-parametric tests and correlations were analyzed using Spearman correlation analysis. Women with SCI had significantly lower FSFI total and domain scores than healthy controls (p < 0.001). Sexual dysfunction (FSFI < 26.55) was highly prevalent in SCI group. FSFI total scores were not significantly associated with neurological level or ASIA classification. FSFI scores showed a strong positive correlation with SCIM III (r = 0.77, p < 0.001) and a moderate negative correlation with NBD scores (r = -0.44, p = 0.024). Urinary incontinence was associated with significantly lower FSFI scores (p = 0.008). FSFI scores differed significantly according to bladder management method with highest scores in spontaneous voiding and lowest in indwelling catheter users (p < 0.001). Sexual function is markedly impaired in women with SCI and is strongly related to functional independence, bladder and bowel function and urinary management than to neurological injury level, highlighting need for a multidisciplinary approach in SCI rehabilitation.

People with spinal cord injury (SCI) are at increased risk of developing coronary heart disease (CHD). This study aimed at predicting CHD risk in a cohort of Saudi patients with SCI in comparison with patients without SCI and to correlate different demographic and clinical factors with Framingham Risk Score (FRS) in SCI patients. The study was conducted at the rehabilitation and the main hospitals of King Fahad Medical City, Riyadh, Saudi Arabia; on sixty patients with SCI and sixty controls of age ≥20years. FRS was calculated on a web-based calculator. For the SCI group, sub-groups were made for statistical analysis based on gender, cigarette smoking, neurological level and completeness of injury. The mean FRS for the SCI group (2±7.9) was significantly higher (P<0.001) than the control group (-2.24±3.4). The 10-year risk of developing CHD was low in 90% of the SCI group and 100% of the controls. The age, systolic blood pressure (SBP) and serum total cholesterol had a positive correlation to FRS in SCI patients and females had a significantly higher mean FRS than males (P=0.03). There was no significant relation of resultant FRS with time since SCI, smoking history and neurological level or completeness of injury. Our sample of Saudi patients with SCI had a higher FRS as compared to controls, however, majority had a low risk of developing CHD in next 10years. The age, SBP and total cholesterol surfaced as positive predictors of CHD in SCI patients. Time since SCI, smoking, and neurological level or completeness of injury did not influence the resultant FRS and thus the development of CHD.

Group cohort design. To determine the influence of spinal cord injury (SCI) and neurological level on heart rate variability (HRV) and associations with fatigue. SCI rehabilitation outpatient and community settings in New South Wales, Australia. Participants included 45 adults with SCI living in the community and 44 able-bodied controls. Socio-demographic, neurological injury, psychological, HRV and eye blink variables were assessed. Multivariate analysis of variance and post hoc protected t-tests were used to determine differences in HRV and fatigue as a function of the neurological level. Pearson's correlation analysis was used to determine the relationships between these factors. Participants with SCI had significantly reduced sympathetic activity. Those with tetraplegia had lowered sympathetic activity compared with those with paraplegia and able-bodied controls. Neither were differences in parasympathetic activity found between groups nor were there any significant differences found for the time domain or non-linear domains. Higher levels of fatigue were found in the SCI sample, and participants with tetraplegia had higher fatigue levels compared with those with paraplegia. Fatigued participants were more likely to have altered autonomic function-that is, reduced sympathetic activity. Higher levels of neurological impairment in people with SCI are more likely to result in disordered cardiovascular control involving reduced sympathetic activity, whereas elevated fatigue was found to be associated with increased sympathetic dysfunction. Findings highlight the need to address risks associated with this dysfunction, such as improved HRV and fatigue screening for people with SCI and improved education on cardiovascular risk factors.

Infections are prevalent after spinal cord injury (SCI), constitute the main cause of death and are a rehabilitation confounder associated with impaired recovery. We hypothesize that SCI causes an acquired lesion-dependent (neurogenic) immune suppression as an underlying mechanism to facilitate infections.The international prospective multicentre cohort study (SCIentinel; protocol registration DRKS00000122; n = 111 patients) was designed to distinguish neurogenic from general trauma-related effects on the immune system. Therefore, SCI patient groups differing by neurological level, i.e. high SCI [thoracic (Th)4 or higher]; low SCI (Th5 or lower) and severity (complete SCI; incomplete SCI), were compared with a reference group of vertebral fracture (VF) patients without SCI. The primary outcome was quantitative monocytic Human Leukocyte Antigen-DR expression (mHLA-DR, synonym MHC II), a validated marker for immune suppression in critically ill patients associated with infection susceptibility. mHLA-DR was assessed from Day 1 to 10 weeks after injury by applying standardized flow cytometry procedures. Secondary outcomes were leucocyte subpopulation counts, serum immunoglobulin levels and clinically defined infections. Linear mixed models with multiple imputation were applied to evaluate group differences of logarithmic-transformed parameters.Mean quantitative mHLA-DR [ln (antibodies/cell)] levels at the primary end point 84 h after injury indicated an immune suppressive state below the normative values of 9.62 in all groups, which further differed in its dimension by neurological level: high SCI [8.95 (98.3% confidence interval, CI: 8.63; 9.26), n = 41], low SCI [9.05 (98.3% CI: 8.73; 9.36), n = 29], and VF without SCI [9.25 (98.3% CI: 8.97; 9.53), n = 41, P = 0.003]. Post hoc analysis accounting for SCI severity revealed the strongest mHLA-DR decrease [8.79 (95% CI: 8.50; 9.08)] in the complete, high SCI group, further demonstrating delayed mHLA-DR recovery [9.08 (95% CI: 8.82; 9.38)] and showing a difference from the VF controls of −0.43 (95% CI: −0.66; −0.20) at 14 days. Complete, high SCI patients also revealed constantly lower serum immunoglobulin G [−0.27 (95% CI: −0.45; −0.10)] and immunoglobulin A [−0.25 (95% CI: −0.49; −0.01)] levels [ln (g/l × 1000)] up to 10 weeks after injury. Low mHLA-DR levels in the range of borderline immunoparalysis (below 9.21) were positively associated with the occurrence and earlier onset of infections, which is consistent with results from studies on stroke or major surgery.Spinal cord injured patients can acquire a secondary, neurogenic immune deficiency syndrome characterized by reduced mHLA-DR expression and relative hypogammaglobulinaemia (combined cellular and humoral immune deficiency). mHLA-DR expression provides a basis to stratify infection-risk in patients with SCI.

Prospective, open-label, comparative study, to assess the effects of sildenafil on blood pressure in a population of patients with spinal cord injury (SCI). To determine the effect of sildenafil on blood pressure in patients with erectile dysfunction secondary to SCI by comparing changes in blood pressure in SCI patients with a neurologic level below T5 versus higher levels. To establish a relationship between the potential hypotensive effect and protective muscle spasm against blood pressure reduction. To assess the effects of age, complexity and duration of SCI on changes in blood pressure. To record any adverse effects occurring during the study. Spinal Cord Injury Unit, Insular University Hospital of Gran Canaria, Canary Islands, Spain. In total, 22 male SCI patients aged 18 years or older with a history of SCI greater than 3 months in duration. Patients with erectile dysfunction secondary to SCI were included in the study, without excluding patients with a neurologic level above 75 or asymptomatic low blood pressure. Patients with specific contraindications for use of the drug were excluded. A personal history was obtained, and the level of injury (ASIA/IMSOP scales of international standards), impairment grade (ASIA impairment scale), spasticity grade (modified Ashworth scale) and baseline sitting and supine blood pressure values were determined. A single dose of 50 mg of sildenafil was administered, and patients remained sitting at 45 degrees . Blood pressure was monitored every 10 min for 4 h and whenever the patient reported symptoms. Any relevant signs and symptoms manifested during the study period were also recorded. Analysis of the changes in blood pressure values was performed using a paired t-test in each group of patients according to neurologic level and spasticity grade. A decrease in blood pressure was observed in all patients, although patients with a level of injury at T5 or above and those with a complete SCI showed a less intense decrease (P<0.05). The spasticity grade of the patients was protective against the fall in blood pressure, as it was less significant in patients with grade 3 (P>0.1) than in those with grade 0. Adverse effects were few and transient. None were related to hypotension. Sildenafil caused a decrease in blood pressure in SCI patients with a neurologic level of injury above T5 and complete injuries (grade A), but did not have clinical implications in the patients studied. A higher spasticity grade tends to protect the patient from the fall in blood pressure. Age and duration of injury do not appear to influence this decrease.

Measurement Characteristics and Clinical Utility of the Spinal Cord Independence Measure-III Among Individuals With Spinal Cord Injury

Cross-sectional study. To evaluate etiologic factors associated with spinal cord injury (SCI) severity and to identify predictive factors of reduction in SCI severity in six countries. SCI centers in Bangladesh, India, Malaysia, Nepal, Sri Lanka, and Thailand. Data from centers collected between October 2015 and February 2021 were analyzed using descriptive statistics and logistic regression. Among 2634 individuals, the leading cause of SCIs was falls (n = 1410, 54%); most occurred from ≥1 meter (n = 1078). Most single-level neurological injuries occurred in the thoracic region (n = 977, 39%). Greater than half of SCIs (n = 1423, 54%) were graded American Spinal Injury Association Impairment Scale (AIS) A. Thoracic SCIs accounted for 53% (n = 757) of all one-level AIS A SCIs. The percentage of thoracic SCIs graded AIS A (78%) was significantly higher than high cervical (52%), low cervical (48%), lumbar (24%), and sacral (31%) SCIs (p < 0.001). Regression analyses isolated predictive factors both of SCI severity and inpatient improvement. Four factors predicted severity: age, neurological level, etiology, and country of residence. Four factors predicted improvement: age, neurological level, AIS grade on intake, and country of residence. Findings can be used by healthcare providers and public health agencies in these countries to inform the public of the risk of SCI due to falls. Future studies should examine the social and occupational milieux of falls. Country-to-country comparisons of prehospital and inpatient care are also justified. Fall prevention policies can encourage the use of safety equipment when performing tasks at heights ≥1 meter.

There is some information about the Functional Independence Measure (FIM) score of patients with spinal cord injury (SCI), but there are a few publications dealing with the relationship between the FIM score and the motor score of the American Spinal Injury Association (ASIA). We have studied the relationship of all FIM items with the motor score, and reviewed the disability of patients with spinal cord injury in greater detail. The purpose of this study was to describe the characteristics of impairment and disability in patients with SCI, using the FIM and motor score of the ASIA. The subjects were 100 inpatients with SCI (Frankel A, B). Neurological level, days from the onset, and the FIM were examined. In addition to these items, the ASIA motor scores were calculated for 22 tetraplegic patients. We investigated the relationships among these various respects. We also examined the changes of the physical items of the FIM score (physical FIM) over time for 18 patients. The mean FIM scores of those with tetraplegia with C4, C5, C6, C7, C8 lesions, and those with paraplegia with above T5 levels, and those below T6 were 35, 61, 82, 90, 116, 114 and 114 respectively. The FIM score reached the plateau in approximately 10 months, 6 months and 3 months post-injury, in tetraplegia, paraplegia above T5 and that below T6 respectively. The FIM scores in C6 patients were widely distributed from 56 to 104. On the other hand, the ASIA motor score could subdivide C6 patients and related well to the FIM score. The mean FIM scores for each neurological level were similar to those previously reported, thus they appeared to be plateau scores. With regard to the motor score, we feel that it could reflect the disability of the patients better than considering the neurological levels alone. Also considering the changes in the physical FIM score over time within a year from the onset of the injury, there were differences in the ADL improvement patterns among patients with different neurological levels. It appears that timing of the highest physical FIM improvement for each neurological level can exist. Thus it is important not to delay the start of the rehabilitation of patients with spinal cord injury in proper time.

<b>Introduction:</b> Viral bronchiolitis in infancy is associated with recurrent wheeze and asthma throughout childhood. Respiratory syncytial virus (RSV) is the commonest cause but other viruses such as RV and HMPV are also implicated. Little is known about respiratory morbidity subsequent to non-RSV bronchiolitis. <b>Aim:</b> To compare respiratory readmission rates in the year following episodes of RSV and non-RSV bronchiolitis. <b>Method:</b> Using national Hospital Episode Statistics database <i>(copyright NHS Digital 2018)</i> we identified all hospital admissions with acute childhood bronchiolitis in England in 1 year. Respiratory readmission rates in the subsequent year were calculated based on bronchiolitis ICD10 codes. <b>Results:</b> In England between December 2015 and November 2016, 40,077 children with acute bronchiolitis (ICD10 code J21) were admitted to hospital for a mean length of stay of 2.1 days, with a total inpatient cost of £56,162,032. The viral cause of hospitalisation was unspecified (J219) in 78%; 18% of bronchiolitis admissions were caused by RSV (J210), 1% by HMPV (J211), 3% by other specified organisms (J218). Overall, 37% of all patients were readmitted within 1 year, 64% of these for respiratory causes. 50% returned within 30 days, 25% within 30-90 days and 25% within 3 - 12 months of the initial admission. Respiratory readmission occurred more frequently following episodes of non-RSV bronchiolitis (41%) than RSV bronchiolitis (22%) (p&lt;0.0001, OR 2.4). <b>Conclusion:</b> Readmission to hospital in the year following a bronchiolitis diagnosis is common, particularly in the first 30 days and following an episode of non-RSV bronchiolitis. A prospective cohort study is needed to explore further.

Clinical trials of therapies for acute traumatic spinal cord injury (tSCI) have failed to convincingly demonstrate efficacy in improving neurologic function. Failing to acknowledge the heterogeneity of these injuries and under-appreciating the impact of the most important baseline prognostic variables likely contributes to this translational failure. Our hypothesis was that neurological level and severity of initial injury (measured by the American Spinal Injury Association Impairment Scale [AIS]) act jointly and are the major determinants of motor recovery. Our objective was to quantify the influence of these variables when considered together on early motor score recovery following acute tSCI. Eight hundred thirty-six participants from the Rick Hansen Spinal Cord Injury Registry were analyzed for motor score improvement from baseline to follow-up. In AIS A, B, and C patients, cervical and thoracic injuries displayed significantly different motor score recovery. AIS A patients with thoracic (T2-T10) and thoracolumbar (T11-L2) injuries had significantly different motor improvement. High (C1-C4) and low (C5-T1) cervical injuries demonstrated differences in upper extremity motor recovery in AIS B, C, and D. A hypothetical clinical trial example demonstrated the benefits of stratifying on neurological level and severity of injury. Clinically meaningful motor score recovery is predictably related to the neurological level of injury and the severity of the baseline neurological impairment. Stratifying clinical trial cohorts using a joint distribution of these two variables will enhance a study's chance of identifying a true treatment effect and minimize the risk of misattributed treatment effects. Clinical studies should stratify participants based on these factors and record the number of participants and their mean baseline motor scores for each category of this joint distribution as part of the reporting of participant characteristics. Improved clinical trial design is a high priority as new therapies and interventions for tSCI emerge.

Objective To investigate the incidence of cardiac arrhythmias at six months following traumatic spinal cord injury (SCI) and to compare the prevalence of arrhythmias between participants with cervical and thoracic SCI. Design A prospective observational study using continuous twenty-four-hour Holter monitoring. Setting Inpatient rehabilitation unit of a university research hospital and patient home setting. Participants Fifty-five participants with acute traumatic SCI were prospectively included. For each participant, the SCI was characterized according to the International Standards for Neurological Classification of SCI by the neurological level and severity according to the American Spinal Injury Association Impairment Scale. Outcome measures Comparisons between demographic characteristics and arrhythmogenic occurrences as early as possible after SCI (4 ± 2 days) followed by 1, 2, 3, 4 weeks and 6 month time points of Holter monitoring. Results Bradycardia (heart rate [HR] <50 bpm) was present in 29% and 33% of the participants with cervical (C1–C8) and thoracic (T1–T12) SCI six months after SCI, respectively. The differences in episodes of bradycardia between the two groups were not significant (P < 0.54). The mean maximum HR increased significantly from 4 weeks to 6 months post-SCI (P < 0.001), however mean minimum and maximum HR were not significantly different between the groups at the six-month time point. There were no differences in many arrhythmias between recording periods or between groups at six months. Conclusions At the six-month timepoint following traumatic SCI, there were no significant differences in occurrences of arrhythmias between participants with cervical and thoracic SCI compared to the findings observed in the first month following SCI.

In the last years, there has been a change in the aetiology of spinal cord injury. There has been an increase in the number of elderly patients with spinal cord injuries caused by diseases or medical procedures. The aim of this study is to investigate the frequency of the occurrence of iatrogenic spinal cord injury in our unit. The secondary aim is to study what variables can be associated with a higher risk of iatrogenesis. A retrospective, descriptive, observational study of patients with acute spinal cord injury admitted from June 2009 to May 2014 was conducted. The information collected included the patient age, aetiology, neurological level and grade of injury when admitted and when discharged, cardiovascular risk factors, a previous history of depression and any prior treatment with anticoagulant or antiplatelet drugs. We applied a logistic regression. The grade of statistical significance was established as P<0.05. In total, 265 patients were included. In 48 of the cases, the cause was iatrogenic (18.18%±4.6% IC). The most frequent level of injury was the thoracic level (48%). The main aetiology of spinal cord injury caused by iatrogenesis was surgery for degenerative spine disease, in patients under the age of 30 were treated with intrathecal chemotherapy. Iatrogenic spinal cord injury is a frequent complication. A statistically significant association between a patient history of depression and iatrogenic spinal cord injury was found as well as with anticoagulant and antiplatelet drug use prior to iatrogenic spinal cord injury.

Cardiovagal baroreflex gain relates to sensory loss after spinal cord injury.

Cross-sectional study using a consecutive sample. To modify the Motor Assessment Scale (MAS) item 3 'balanced sitting' and the Sitting Balance Score (SBS) to ensure suitability for patients with spinal cord injury (SCI), and to assess the inter-rater reliability and validity of these instruments. Spinal Care Unit, clinical setting. Unsupported sitting was tested by three physiotherapists using MAS and SBS in 48 in-patients with SCI. The validity of the scales was tested using neurological level and extent of injury according to the International Standards for Neurological Classification of Spinal Cord Injury, time since injury and the patients' function, as measured by Functional Independence Measure (FIM) item 9-13 and Five Additional Mobility and Locomotor Items (5AML). The inter-rater reliability was for MAS (k(w)=0.83-0.91) and for SBS (k(w)=0.69-0.96). The correlation between the balance scales were in relation to; neurological injury level (r(s)=0.19-0.51), extent of injury (r(s)=0.57-0.68) and the functional tests as measured by FIM items 9-13 (r(s)=0.13-0.68, highest for going up and down stairs) and 5AML (r(s)=0.10-0.49). The spread of data on the scales was poor. The inter-rater reliability of MAS and SBS was very good. The validity was little to moderate, probably because the chosen functional tests measured complex functional tasks and not only unsupported sitting. Both tests appear to be feasible in clinical settings, but will need major revisions. These results can therefore be used as a base for constructing new, better tests of unsupported sitting.