Acute Adverse Events After Spinal Cord Injury and Their Relationship to Long-term Neurologic and Functional Outcomes: Analysis From the North American Clinical Trials Network for Spinal Cord Injury

North American Clinical Trials Network Collaborators

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: There are few contemporary, prospective multicenter series on the spectrum of acute adverse events and their relationship to long-term outcomes after traumatic spinal cord injury. The goal of this study is to assess the prevalence of adverse events after traumatic spinal cord injury and to evaluate the effects on long-term clinical outcome. DESIGN: Multicenter prospective registry. SETTING: Consortium of 11 university-affiliated medical centers in the North American Clinical Trials Network. PATIENTS: Eight-hundred one spinal cord injury patients enrolled by participating centers. INTERVENTIONS: Appropriate spinal cord injury treatment at individual centers. MEASUREMENTS AND MAIN RESULTS: A total of 2,303 adverse events were recorded for 502 patients (63%). Penalized maximum logistic regression models were fitted to estimate the likelihood of neurologic recovery (ASIA Impairment Scale improvement ≥ 1 grade point) and functional outcomes in subjects who developed adverse events at 6 months postinjury. After accounting for potential confounders, the group that developed adverse events showed less neurologic recovery (odds ratio, 0.55; 95% CI, 0.32-0.96) and was more likely to require assisted breathing (odds ratio, 6.55; 95% CI, 1.17-36.67); dependent ambulation (odds ratio, 7.38; 95% CI, 4.35-13.06) and have impaired bladder (odds ratio, 9.63; 95% CI, 5.19-17.87) or bowel function (odds ratio, 7.86; 95% CI, 4.31-14.32) measured using the Spinal Cord Independence Measure subscores. CONCLUSIONS: Results from this contemporary series demonstrate that acute adverse events are common and are associated with worsened long-term outcomes after traumatic spinal cord injury.

Original languageEnglish (US)
Pages (from-to)e854-e862
JournalCritical care medicine
Volume47
Issue number11
DOIs
StatePublished - Nov 1 2019

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Spinal Cord Injuries
Nervous System
Odds Ratio
Clinical Trials
Dependent Ambulation
Logistic Models
Registries
Spinal Cord
Respiration
Urinary Bladder
Therapeutics

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Acute Adverse Events After Spinal Cord Injury and Their Relationship to Long-term Neurologic and Functional Outcomes : Analysis From the North American Clinical Trials Network for Spinal Cord Injury. / North American Clinical Trials Network Collaborators.

In: Critical care medicine, Vol. 47, No. 11, 01.11.2019, p. e854-e862.

Research output: Contribution to journalArticle

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title = "Acute Adverse Events After Spinal Cord Injury and Their Relationship to Long-term Neurologic and Functional Outcomes: Analysis From the North American Clinical Trials Network for Spinal Cord Injury",
abstract = "OBJECTIVES: There are few contemporary, prospective multicenter series on the spectrum of acute adverse events and their relationship to long-term outcomes after traumatic spinal cord injury. The goal of this study is to assess the prevalence of adverse events after traumatic spinal cord injury and to evaluate the effects on long-term clinical outcome. DESIGN: Multicenter prospective registry. SETTING: Consortium of 11 university-affiliated medical centers in the North American Clinical Trials Network. PATIENTS: Eight-hundred one spinal cord injury patients enrolled by participating centers. INTERVENTIONS: Appropriate spinal cord injury treatment at individual centers. MEASUREMENTS AND MAIN RESULTS: A total of 2,303 adverse events were recorded for 502 patients (63{\%}). Penalized maximum logistic regression models were fitted to estimate the likelihood of neurologic recovery (ASIA Impairment Scale improvement ≥ 1 grade point) and functional outcomes in subjects who developed adverse events at 6 months postinjury. After accounting for potential confounders, the group that developed adverse events showed less neurologic recovery (odds ratio, 0.55; 95{\%} CI, 0.32-0.96) and was more likely to require assisted breathing (odds ratio, 6.55; 95{\%} CI, 1.17-36.67); dependent ambulation (odds ratio, 7.38; 95{\%} CI, 4.35-13.06) and have impaired bladder (odds ratio, 9.63; 95{\%} CI, 5.19-17.87) or bowel function (odds ratio, 7.86; 95{\%} CI, 4.31-14.32) measured using the Spinal Cord Independence Measure subscores. CONCLUSIONS: Results from this contemporary series demonstrate that acute adverse events are common and are associated with worsened long-term outcomes after traumatic spinal cord injury.",
author = "{North American Clinical Trials Network Collaborators} and Fan Jiang and Jaja, {Blessing N.R.} and Kurpad, {Shekar N.} and Badhiwala, {Jetan H.} and Bizhan Aarabi and Grossman, {Robert G.} and Harrop, {James S.} and Guest, {Jim D.} and Sch{\"a}r, {Ralph T.} and Shaffrey, {Chris I.} and Max Boakye and Toups, {Elizabeth G.} and Wilson, {Jefferson R.} and Fehlings, {Michael G.}",
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AU - Jiang, Fan

AU - Jaja, Blessing N.R.

AU - Kurpad, Shekar N.

AU - Badhiwala, Jetan H.

AU - Aarabi, Bizhan

AU - Grossman, Robert G.

AU - Harrop, James S.

AU - Guest, Jim D.

AU - Schär, Ralph T.

AU - Shaffrey, Chris I.

AU - Boakye, Max

AU - Toups, Elizabeth G.

AU - Wilson, Jefferson R.

AU - Fehlings, Michael G.

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