The relationship between magnetic resonance imaging, clinical findings, treatment modalities, and neurological outcomes in acute traumatic spinal cord injury in the emergency department.
Mustafa Ulusoy, Neşe Çolak, Servan Küçük, Serap Sarı, Ali Balcı
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引用次数: 0
Abstract
Objectives: Spinal cord injury (SCI) can lead to motor, sensory, or autonomic dysfunction and is associated with increased morbidity and mortality. This study aimed to investigate the impact of magnetic resonance imaging (MRI) and clinical findings in the Emergency Department (ED) on neurological outcomes in patients with traumatic SCI.
Methods: This observational study included 59 patients with traumatic SCI admitted to Dokuz Eylül University Hospital's ED between January 1 2009, and October 1, 2019. Clinical findings were assessed using the American Spinal Injury Association (ASIA) scale. Demographics, clinical findings, MRI parameters, treatment, and short-term (28 ± 7 days) neurological outcomes were compared between the complete (ASIA A) and incomplete (ASIA B, C, D, and E) injury groups.
Results: The incidence of SCI was 98.7 per million. The median age was 37 years (IQR: 27-52), with 86.4% of the patients being male. Common causes included diving into shallow water (30.5%) and falling from heights (25.4%). Complete injury (ASIA A) was observed in 40.7% of cases, while incomplete injury (ASIA B, C, D, and E) was found in 59.3%. The most frequently affected levels were C4 (18.6%) and C5 (23.7%). No improvement was observed in the complete injury group, whereas 44% of the incomplete injury group showed improvement (P < 0.001). Common MRI findings included cord edema (96.6%), vertebral fracture/dislocation (86.4%), and soft-tissue injury (84.7%). Significant differences in MRI findings between the complete and incomplete SCI groups were observed in vertebral fracture/dislocation (P = 0.016), cord compression (P = 0.003), canal stenosis (P = 0.008), intramedullary hemorrhage (P ≤ 0.001), hemorrhage/hemorrhagic contusion (P ≤ 0.001), anterior ligament damage (P = 0.001), posterior ligament damage (P = 0.01), maximum canal compression (MCC) (P = 0.006), and lesion length (P = 0.008).
Conclusion: Traumatic SCI primarily affects young males, often resulting from activities such as diving into shallow water, falls from heights, and motor vehicle accidents. Initial clinical assessments are insufficient for predicting neurological outcomes. Although MRI findings are more frequent in complete SCI, lesion length, and MCC do not reliably predict short-term neurological improvement.
期刊介绍:
The Turkish Journal of Emergency Medicine (Turk J Emerg Med) is an International, peer-reviewed, open-access journal that publishes clinical and experimental trials, case reports, invited reviews, case images, letters to the Editor, and interesting research conducted in all fields of Emergency Medicine. The Journal is the official scientific publication of the Emergency Medicine Association of Turkey (EMAT) and is printed four times a year, in January, April, July and October. The language of the journal is English. The Journal is based on independent and unbiased double-blinded peer-reviewed principles. Only unpublished papers that are not under review for publication elsewhere can be submitted. The authors are responsible for the scientific content of the material to be published. The Turkish Journal of Emergency Medicine reserves the right to request any research materials on which the paper is based. The Editorial Board of the Turkish Journal of Emergency Medicine and the Publisher adheres to the principles of the International Council of Medical Journal Editors, the World Association of Medical Editors, the Council of Science Editors, the Committee on Publication Ethics, the US National Library of Medicine, the US Office of Research Integrity, the European Association of Science Editors, and the International Society of Managing and Technical Editors.