Hospital-Acquired Pressure Ulcers and Long-Term Motor Score Recovery in Patients With Acute Cervical Spinal Cord Injury.

IF 10.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Marcel A Kopp, Felix W Finkenstaedt, Oliver Schweizerhof, Ulrike Grittner, Peter Martus, Ralf Watzlawick, David Brienza, Vieri Failli, Yuying Chen, Michael J DeVivo, Jan M Schwab
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引用次数: 0

Abstract

Importance: Pressure ulcers (PUs) are (1) prevalent secondary complications after spinal cord injury (SCI), (2) present with elevated systemic inflammatory tone, and (3) may interfere with healing processes underlying neurological recovery (disrepair).

Objective: To investigate whether PUs acquired during initial hospitalization are associated with neurological and functional long-term outcome and survival after SCI.

Design, setting, and participants: Multicenter cohort study at 20 centers of the prospective SCI Model Systems (SCIMS) Database (Birmingham, AL). Patients with acute traumatic cervical SCI with relevant motor impairment (ie, American Spinal Injury Association [ASIA] impairment scale [AIS] A, B, and C) were enrolled from January 1996 to September 2006 and followed up until June 2016. Data were analyzed from April 2021 to September 2024.

Exposures: PUs acquired during surgical or first rehabilitative SCI care.

Main outcomes and measures: The change in the ASIA motor score at 1 year after SCI was the primary end point. Secondary end points included the recovery of functional independence measure (FIM) motor score at 1 year after SCI and mortality up to 10 years. ASIA and FIM motor score were analyzed applying linear mixed models with random intercept adjusted for baseline neurological level, AIS, and sociodemographic factors. Mortality was analyzed using Cox regression.

Results: The study included 1282 patients with a mean (SD) age of 38.0 (15.7) years and consisted of 1028 (80.2%) male patients. Regarding race and ethnicity, 349 of 1249 (27.9%) were African American patients, 1139 of 1273 (89.5%) were non-Hispanic patients, and 834 of 1249 (66.8%) were White patients. During initial hospitalization, 594 patients (45.7%) acquired PUs. Exposure to PUs was associated with impaired motor recovery 1 year after SCI compared with unexposed patients (-9.1 ASIA motor score points; 95% CI, -12.3 to -6.0; P < .001). In addition, PUs were associated with lower recovery of physical independence 1 year after SCI (-8.3 FIM motor score points; 95% CI: -11.1 to -5.5; P < .001). Cox regression confirmed PUs as a risk marker for death up to 10 years after SCI (hazard ratio, 1.41; 95% CI, 1.09 to 1.82; P = .01).

Conclusions and relevance: In this cohort study, PUs acquired during initial hospitalization after SCI were independently associated with poor long-term neurofunctional outcome. PUs constitute a modifiable factor associated with risk for worse long-term disability (recovery confounder) and elevated mortality.

急性颈脊髓损伤患者的医院获得性压疮和长期运动评分恢复
重要性:压疮(PUs)是(1)脊髓损伤(SCI)后常见的继发性并发症,(2)表现为全身性炎症张力升高,(3)可能干扰神经系统恢复的愈合过程(失修)。目的:探讨初次住院期间获得的pu是否与脊髓损伤后神经和功能的长期预后和生存有关。设计、环境和参与者:前瞻性SCI模型系统(SCIMS)数据库(Birmingham, AL)的20个中心的多中心队列研究。纳入1996年1月至2006年9月伴有相关运动损伤的急性外伤性颈脊髓损伤患者(即美国脊髓损伤协会[ASIA]损伤量表[AIS] A、B、C),随访至2016年6月。数据分析时间为2021年4月至2024年9月。暴露:在外科手术或首次SCI康复治疗期间获得脓液。主要结局和测量:SCI后1年ASIA运动评分的变化是主要终点。次要终点包括脊髓损伤后1年的功能独立测量(FIM)运动评分的恢复和长达10年的死亡率。ASIA和FIM运动评分采用线性混合模型进行分析,随机截取基线神经水平、AIS和社会人口因素进行调整。死亡率采用Cox回归分析。结果:研究纳入1282例患者,平均(SD)年龄38.0(15.7)岁,其中男性患者1028例(80.2%)。在种族和民族方面,1249例非裔美国患者中有349例(27.9%),1273例非西班牙裔患者中有1139例(89.5%),1249例白人患者中有834例(66.8%)。在初次住院期间,594例(45.7%)患者获得脓液。与未暴露的患者相比,暴露于PUs与脊髓损伤后1年的运动恢复受损有关(-9.1 ASIA运动评分点;95% CI, -12.3 ~ -6.0;结论和相关性:在这项队列研究中,脊髓损伤后首次住院期间获得的pu与长期神经功能预后不良独立相关。脓肿是一个可改变的因素,与更严重的长期残疾(康复混杂因素)和死亡率升高相关。
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来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
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