Initial Heart Rate Predicts Functional Independence in Patients With Spinal Cord Injury Requiring Surgery: A Registry-Based Study in a Mature Trauma System Over the Past 10 Years.

STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To determine the ability of early vital sign abnormalities to predict functional independence in patients with SCI that required surgery. METHODS A retrospective analysis of data extracted from the Pennsylvania Trauma Outcome Study database. Inclusion criteria were patients >18 years with a diagnosis of SCI who required urgent spine surgery in Pennsylvania from 1/1/2010-12/31/2020 and had complete records available. RESULTS A total of 644 patients met the inclusion criteria. The mean age was 47.1 ± 14.9 years old and the mean injury severity score (ISS) was 22.3 ± 12.7 with the SCI occurring in the cervical, thoracic, and lumbar spine in 61.8%, 19.6% and 18.0%, respectively. Multivariable logistic regression analyses for predictors of functional independence at discharge showed that higher HR at the scene (OR 1.016, 95% CI 1.006-1.027, P = .002) and lower ISS score (OR .894, 95% CI .870-.920, P < .001) were significant predictors of functional independence. Similarly, higher admission HR (OR 1.015, 95% CI 1.004-1.027, P = .008) and lower ISS score (OR .880, 95% CI 0.864-.914, P < .001) were significant predictors of functional independence. Peak Youden indices showed that patients with HR at scene >70 and admission HR ≥83 were more likely to achieve functional independence. CONCLUSIONS Early heart rate is a strong predictor of functional independence in patients with SCI. HR at scene >70 and admission HR ≥83 is associated with improved outcomes, suggesting lack of neurogenic shock.

[1]  R. Marino,et al.  Factors associated with post-acute functional status and discharge dispositions in individuals with spinal cord injury , 2021, The journal of spinal cord medicine.

[2]  A. Krassioukov,et al.  Incidence and Natural Progression of Neurogenic Shock after Traumatic Spinal Cord Injury. , 2017, Journal of neurotrauma.

[3]  David M. Brandman,et al.  Optimization of the mean arterial pressure and timing of surgical decompression in traumatic spinal cord injury: a retrospective study , 2017, Spinal Cord.

[4]  Adam R Ferguson,et al.  Higher Mean Arterial Pressure Values Correlate with Neurologic Improvement in Patients with Initially Complete Spinal Cord Injuries. , 2016, World neurosurgery.

[5]  S. Hou,et al.  Cardiovascular dysfunction following spinal cord injury , 2016, Neural regeneration research.

[6]  B. Meyer,et al.  Spinal cord injury--incidence, prognosis, and outcome: an analysis of the TraumaRegister DGU. , 2015, The spine journal : official journal of the North American Spine Society.

[7]  E. Hagen.  Acute complications of spinal cord injuries. , 2015, World journal of orthopedics.

[8]  G. Jin,et al.  Persistent hypoalbuminemia is a predictor of outcome in cervical spinal cord injury. , 2014, The spine journal : official journal of the North American Spine Society.

[9]  S. Harkema,et al.  A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors. , 2012, Journal of neurotrauma.

[10]  A. Krassioukov,et al.  Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: a meta-analysis , 2012, Spinal Cord.

[11]  Chester H Ho,et al.  Spinal cord injury medicine. 3. Rehabilitation phase after acute spinal cord injury. , 2007, Archives of physical medicine and rehabilitation.

[12]  B. Böttiger,et al.  Spinal cord injury (SCI)--prehospital management. , 2005, Resuscitation.

[13]  F. Geisler,et al.  Injury severity as primary predictor of outcome in acute spinal cord injury: retrospective results from a large multicenter clinical trial. , 2003, The spine journal : official journal of the North American Spine Society.

[14]  T. Ryken,et al.  Blood pressure management after acute spinal cord injury. , 2002, Neurosurgery.

[15]  L. D. de Witte,et al.  Predictors of health status and life satisfaction in spinal cord injury. , 1998, Archives of physical medicine and rehabilitation.

[16]  F. Vale,et al.  Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. , 1997, Journal of neurosurgery.

[17]  K. Lehmann,et al.  Cardiovascular abnormalities accompanying acute spinal cord injury in humans: incidence, time course and severity. , 1987, Journal of the American College of Cardiology.

[18]  W. Haddon,et al.  The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. , 1974, The Journal of trauma.

[19]  O. Bouamra,et al.  The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department. , 2008, Resuscitation.