[Show abstract][Hide abstract] ABSTRACT: To document the recurrence rate of kidney stones in patients with spinal cord injury and to assess the potential contributing factors and long-term renal function outcome.
A consecutive sample of 77 patients with initial kidney stones followed up on a yearly basis between 1973 and 1999 was used to estimate stone recurrence, stratified by demographic and clinical characteristics. Longitudinal data analyses were performed to assess the change in renal function over time among various post-treatment outcomes.
During an average of 7 years (range 1 to 21) of follow-up after the initial stone episode, 19 patients with recurrence, 15 with residual stones, and 43 who were stone free were documented. It was estimated that approximately 34% of the patients with an initial stone would develop a second stone episode within 5 years. This figure did not significantly change during the past 25 years (P = 0.18). Stone recurrence was two or more times greater for men than for women, for whites than for blacks, and for tetraplegics than for paraplegics, but the differences were not statistically significant (P >0.05). Renal function did not significantly decline over time for any of the post-treatment outcomes of the initial stones.
Despite marked improvement in urologic rehabilitation, little progress has been made during the past 25 years in reducing stone recurrence in persons with spinal cord injury. Future studies are required to determine the critical components of the causal pathway to stone formation, which may lead to the establishment of effective prophylactic interventions.
[Show abstract][Hide abstract] ABSTRACT: To summarize a 25-year history of the Model Spinal Cord Injury Program and the coexistent National Spinal Cord Injury Database and provide the status of the Database with a discussion of the strengths and weaknesses.
Model spinal cord injury systems throughout the United States.
As of September 1998, the National Spinal Cord Injury Database included abbreviated registry records on 6,085 new patients, more complete initial injury and hospitalization records on 18,969 new patients, and 78,627 annual follow up records on those persons. Although stability and continuity of the Database has been a priority since it was started, some changes were needed to meet the changes in health care, health care policy, and new technology.
This large database can now provide a wealth of information about short- and long-term outcomes, provide data on which future health care policies can be evaluated, and act as a source for answers to future research questions.
Archives of Physical Medicine and Rehabilitation 12/1999; 80(11):1365-71. DOI:10.1016/S0003-9993(99)90246-0 · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the effect of different bladder management methods on long-term renal function in persons with spinal cord injury (SCI).
Model SCI care system within a large teaching hospital.
Consecutive sample of 1,114 persons with SCI who were injured between 1969 and 1994.
Total and individual kidney effective renal plasma flow (ERPF).
ERPF was generally lower in persons with cervical injuries or kidneys that had a renal stone, older persons, and women. Overall, there was very little change in renal function as time postinjury increased, and there were no clinically meaningful differences in the change in renal function over time among persons using different bladder management methods.
Renal function was adequately preserved in the great majority of persons and did not appear to be influenced to any great extent by method of bladder management.
Archives of Physical Medicine and Rehabilitation 10/1997; 78(9):992-7. DOI:10.1016/S0003-9993(97)90063-0 · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study identifies skin and nail complications other than pressure ulcers after spinal cord injury and correlate these complications to the level of injury. A prospective study was performed at the time of 679 annual spinal cord injury clinic visits from 1988 to 1991 at which time the skin and nails were examined for changes or other lesions. Clinical skin thickening and nail hypertrophy were the most frequent findings. Skin thickening occurred in 57.9% of cervical injuries, 31.6% of higher thoracic injuries, 23.6% of lower thoracic injuries, and 16.0% of thoracolumbar injuries, p < .0001. Skin thickening was also seen more commonly with increasing time after injury, 20.3% at 1 year and 51.2% at 5 years, p < .0001. Nail hypertrophy occurred in the lower extremities and was not correlated with the level of injury. Denervation and autonomic dysfunction may be implicated in these changes.
Archives of Physical Medicine and Rehabilitation 09/1994; 75(9):987-93. · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dermatohistopathologic studies were performed in persons with spinal cord injury to evaluate the clinical observation of skin thickening. Twenty subjects were included in a prospective acute study and 59 subjects in a chronic study. Skin biopsies of the lower lateral thigh were studied by routine histopathology. The most common histopathologic findings included dermal fibrosis and perivascular inflammatory infiltrate. Dermal fibrosis was already identified within two months after injury in the acute study. In chronic patients, dermal fibrosis was found in 65 percent of persons with tetraplegia compared to 25 percent with paraplegia (p = .0038). Perivascular inflammatory infiltrate was less frequent and its presence was not associated with the level of injury. Histopathologic findings were generally not as prominent as the clinical picture. This disparity may be explained by a combination of edema and dermal fibrosis. Loss of autonomic nervous system control or other neuroendocrine dysfunction is suspected as a causative factor in the pathogenesis of these findings.
The Journal of the American Paraplegia Society 05/1994; 17(2):44-9.
[Show abstract][Hide abstract] ABSTRACT: The Spinal Cord Injury Model Systems of Care have served a unique role in the provision of integrated and coordinated care for persons with spinal cord injuries (SCI), and in collaborative research efforts to advance available technologies. Although the basic mission of the model systems remains viable, contemporary issues and trends indicate that the model systems concept ought to be expanded in terms of roles and functions to meet current needs.
[Show abstract][Hide abstract] ABSTRACT: A study of 9,135 persons injured between 1973 and 1984 and treated at any of 13 regional spinal cord injury care systems was conducted to compare their age-, sex-, race-, and cause-specific mortality rates with those of the general population. All subjects survived at least 24 hours. Follow-up was terminated in December, 1985 when 854 persons (9.3%) had died. Although many persons had multiple causes of death, the leading primary causes were pneumonia, nonischemic heart disease, septicemia, symptoms and ill-defined conditions, pulmonary emboli, and ischemic heart disease. During the study period, spinal cord injured persons were 82.2 times more likely to die of septicemia, 46.9 times more likely to die of pulmonary emboli, and 37.1 times more likely to die of pneumonia than comparable individuals from the general population. Though some cause-specific mortality rates for spinal cord injured persons have declined dramatically, many remain substantially above normal. Before life expectancies increase further, improved methods for preventing and managing these fatal complications must be developed.
Archives of Physical Medicine and Rehabilitation 04/1993; 74(3):248-54. · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: As life expectancies of persons with spinal cord injuries increase, this population is aging rapidly. This trend requires that increasing attention be given to the healthcare needs of older persons with spinal cord injury. Follow up data on 11,117 persons injured since 1973 were analyzed by current age at 15-year intervals. Mean time postinjury was 4.7 years. Several trends were observed when comparing persons currently in the 16-30 year age group with persons in the oldest age group (age 76+). The percentage of persons independent in selfcare decreased from 61.9% to 29.1%. Ventilator use increased from 1.7% to 4.3%. Nursing home residence increased from 1.4% to 22.2%. The percentage of persons rehospitalized during the most recent year increased from 26.5% to 33.7%. Age was an important predictor of health status, but time postinjury was less important, perhaps due to the study's short postinjury time frame. While few differences in health status were observed in individuals between 16 and 60 years of age, persons in the oldest two age groups demonstrated lower levels of health status than younger individuals.
[Show abstract][Hide abstract] ABSTRACT: A study of the National Spinal Cord Injury Statistical Center database on 6,563 persons treated at Spinal Cord Injury Care Systems was conducted to detect demographic and treatment outcome trends over time. Data from the initial hospitalization and first two years postinjury were divided into four time periods based on injury year (1973 to 1977, 1978 to 1980, 1981 to 1983, 1984 to 1986). Between 1973 and 1986, mean age at injury increased, as did the percentage of nonwhites and the percentage of persons with quadriplegia, while the percentage of neurologically complete lesions decreased. There was an increase in long-term use of intermittent catheterization. Ventilator use during hospitalization also increased. Mean lengths of stay for acute care and rehabilitation decreased, although mean inflation-adjusted hospital charges increased. The percentage of persons rehospitalized during the second postinjury year decreased substantially. From 1973 to 1986, for persons admitted to the model system within 24 hours of injury, there was a 66% decrease in the risk of dying within the first two years postinjury. Overall, these data document changing demographics and treatment practices as well as an improved prognosis for persons with spinal cord injuries.
Archives of Physical Medicine and Rehabilitation 06/1992; 73(5):424-30. · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A study of 9,135 persons injured between 1973 and 1984 and treated at any of 13 model regional spinal cord injury care systems was conducted to determine both overall survival and the effects of prognostic factors. All subjects survived at least 24 hours, and followup ended December 31, 1985. Cumulative 12-year survival was 85.1% (88.2% of normal). Survival ranged from almost 95% (more than 96% of normal) for persons who were younger than 25 years at time of injury and who had neurologically incomplete lesions, to 18.1% (26.9% of normal) for persons who were at least 50 years old at time of injury and who had neurologically complete quadriplegia. Spinal cord injury mortality rates ranged from 1.68 to 15.98 times higher than corresponding rates for non-spinal-injured persons. Although mortality rates for many persons with spinal cord injuries have declined dramatically during the past few decades, these data confirm the continued poor prognosis for older persons with neurologically complete quadriplegia.
Archives of Physical Medicine and Rehabilitation 03/1992; 73(2):156-62. · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A study of 9135 persons injured between 1973 and 1984 and treated at any of 13 model regional spinal cord injury (SCI) care systems was conducted. Follow-up ended December 31, 1985, by which time 50 persons had committed suicide (6.3% of deaths). Based on age-sex-race-specific rates for the general population, 10.2 suicides were expected to occur. Therefore, the standardized mortality ratio (SMR) for suicide was 4.9. The highest SMR occurred 1 to 5 years after injury. The SMR was also elevated for the first post-injury year, but was not significantly elevated after the fifth year. The SMR was significantly elevated for all neurological groups, but was highest for persons with complete paraplegia. The SMR was highest for persons aged 25 to 54 years, but was also elevated for persons aged less than 25 years. Suicide was the leading cause of death for persons with complete paraplegia and the second leading cause of death for persons with incomplete paraplegia. The most common means of committing suicide was by gunshot. These figures demonstrate the need for increased staff, patient and family awareness of this problem, and improved follow-up assessment and psychosocial support programmes.
[Show abstract][Hide abstract] ABSTRACT: Even though renal failure secondary to the urologic complications of chronic or recurrent urinary tract infection has decreased markedly due to advances in diagnostic, preventive, and therapeutic measures, infection and its sequelae continue to be major problems in patients with spinal cord injury regardless of the bladder emptying method employed. Although lower urinary tract complications have decreased with intermittent catheterization, the effects of increased intravesicular pressure, inflammation, and chronic bacterial colonization or invasion of the urinary tract on long-term renal function are still undetermined. Thorough evaluation of the urologic status on a regular basis in all patients with spinal cord injury is encouraged. Treatment of urinary tract infection should be guided by scientific data and drug susceptibilities of etiologic bacteria. The general consensus is that the presence of asymptomatic bacteriuria, particularly in the absence of pyuria, usually does not warrant antibiotic treatment, and that prophylaxis or suppression of infection with systemic antibiotics is not effective for any considerable length of time. Preservation of renal function is the ultimate goal of all bladder management strategies.
[Show abstract][Hide abstract] ABSTRACT: The National Spinal Cord Injury Statistical Center data base contains information collected prospectively on 13,763 persons injured since 1973 and treated at model systems of care throughout the United States. These data clearly demonstrate improved neurologic status and independent function in activities of daily living following acute care and rehabilitation for most persons with spinal cord injuries. Decreased lengths of initial and subsequent hospital stays and increased survival rates are also documented. Most persons are discharged to a private residence in the community and remain there. Many complete their educations and return to gainful employment after injury. Spinal cord injury has only a short-term effect on marriage and divorce rates, which appears to dissipate within a few years after injury. Overall, these figures demonstrate the dramatic improvements in length and quality of life achieved by most persons with spinal cord injuries during the past two decades.
Western Journal of Medicine 06/1991; 154(5):602-6.
[Show abstract][Hide abstract] ABSTRACT: Extensive heterotopic ossification may occur after a spinal cord injury. Surgical removal of the heterotopic bone is considered only in patients who develop limitations of function or related skin pressure areas. In a prospective study of 21 patients, a total of 43 surgical procedures were performed to resect heterotopic bone. Long-term follow-up study was available for 18 patients who had 38 surgical procedures. This was a descriptive study since preoperative, surgical, and postoperative care varied slightly over time and were dependent on newer advances in surgical techniques and therapeutic agents. Primary complications included excessive bleeding, infection, fractures, and recurrence of the heterotopic ossification. Procedures are outlined that may reduce the incidence of postoperative infection. Fractures are related to the degree of regional osteoporosis. Recurrence is still a common problem, and any or all therapeutic agents that may reduce the extent of postoperative recurrence should be considered before surgical excision is planned.
Clinical Orthopaedics and Related Research 03/1991; &NA;(263):71-7. DOI:10.1097/00003086-199102000-00007 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients admitted to the University of Alabama Hospital between 1973 and 1985 were studied to determine the benefits, if any, of early admission to an organised, multidisciplinary spinal cord injury (SCI) care system. Patients admitted within 1 day of injury who received all subsequent care within the system were compared with patients who received their acute care services elsewhere and who were admitted to the system solely for rehabilitation. Both patient groups were comparable with respect to age, neurologic level and extent of spinal cord lesion, pre-existing major medical conditions, associated injuries, ventilator dependency and acute surgical procedure experience. Findings included statistically significant reductions in acute care and total lengths of stay coupled with a highly significant reduction in the incidence of pressure ulcers for patients admitted within 1 day of injury. Moreover, for patients admitted within 1 day of injury, mortality rates were lower than reported previously for patients not admitted to an organised SCI care system.
[Show abstract][Hide abstract] ABSTRACT: The prevention or minimization of future pain is often cited as a reason for removal of the bullet from patients who have incurred a spinal cord injury secondary to a gunshot wound. In an attempt to examine this assumption, multimodal pain ratings were recorded for 14 patients with spinal cord injury due to a gunshot wound in whom the bullet was still present, 14 neurologically matched patients with spinal cord injury due to a gunshot wound in whom the bullet was removed, and 28 control patients with spinal cord injury unrelated to a gunshot wound who were neurologically matched to the first two groups. The results suggest that persons who sustain a spinal cord injury secondary to gunshot wounds report more pain than those injured in other ways. In addition, there was no indication that surgical removal of the bullet was helpful in reducing subsequent pain either early in the rehabilitation process or at 1 year postinjury. The location of the bullet and the type of pain that subsequently developed were not correlated with the initial decision to surgically remove the bullet. Implications for further study and clinical practice are discussed.
Journal of Neurosurgery 10/1990; 73(3):401-4. DOI:10.3171/jns.1990.73.3.0401 · 3.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to compare the experiences of older and younger patients with spinal cord injury. Data from 866 patients hospitalized between 1973 and 1985 were analyzed by age at injury. Outcomes were measured at discharge and 2 years after injury. Patients who were at least 61 years of age were 2.1 times more likely to have developed pneumonia, 2.7 times more likely to have experienced a gastrointestinal hemorrhage, 5.6 times more likely to have developed pulmonary emboli, and 16.8 times more likely to have had renal stones prior to first definitive discharge than their 16- to 30-year-old counterparts. Patients who were at least 61 years of age were 3.9 times more likely to have been rehospitalized during the second postinjury year than patients in the 16- to 30-year-old age group; 2.1 times more likely to have required artificial ventilatory support prior to discharge; 22.7 times more likely to have been discharged to a nursing home; 71.8 times more likely to be in a nursing home 2 years after injury; and 7.3 times more likely to have used hired attendants during the second postinjury year. Two-year survival rates were 59% for patients aged 61 to 86 years and 95% for patients aged 16 to 30 years. Although the prognosis for most patients with spinal cord injury has improved in recent years, older patients still have a comparatively poor prognosis.
[Show abstract][Hide abstract] ABSTRACT: Anemia is a frequent complication during the acute phase of spinal cord injury (SCI), even in the absence of detectable blood loss. Since an improved understanding of the etiology of anemia in this population is a prerequisite to its ultimate prevention, a prospective study was conducted on 28 persons with SCI whose lesions were between C3 and C7. The injuries were either neurologically complete, incomplete with sensory sparing only, or incomplete with nonfunctional motor preservation. Laboratory profiles were obtained during the first few weeks postinjury. No persons had below-normal plasma volumes, while 9% had below-normal blood volumes. However, 82% had below-normal red cell masses, 25% had below-normal serum erythropoietin levels, and 11% had below-normal reticulocyte counts. Other below-normal values included erythrocyte count (75%), hemoglobin (79%), hematocrit (71%), mean corpuscular volume (11%), mean corpuscular hemoglobin (11%), serum iron (50%), total iron binding capacity (86%), iron saturation (50%), serum total protein (57%), serum albumin (89%), serum globulin (32%), and serum transferrin (79%). Most persons (71%) were found to have normochromic, normocytic anemia, although 14% had normochromic, microcytic anemia. Only 14% did not develop anemia. Although these cases of anemia were not severe enough to require transfusions, they might be an important factor in the development of other secondary complications and may combine with other nutritional and hematologic deficiencies to prolong the rehabilitation process.
Archives of Physical Medicine and Rehabilitation 02/1990; 71(1):3-7. · 2.57 Impact Factor