Trauma Indicators in Spinal Cord Injury Rehabilitation Outcomes: A Retrospective Cohort Analysis of the National Trauma Data Bank and National Spinal Cord Injury Database

Abstract

Objective: To investigate whether initial emergency room physiologic measures and metrics of trauma severity predict functional outcomes and neurologic recovery in traumatic spinal cord injury. Design: Retrospective analysis of a clinical database. Setting: Merged multi-center data from the Spinal Cord Injury Model Systems (SCIMS) database and National Trauma Data Bank (NTDB) from six academic medical centers across the United States. Participants: 319 patients admitted to SCIMS rehabilitation centers within one-year of injury. The majority of patients were male (76.2%), with a mean age of 44 (SD 19). At rehabilitation admission, the most common neurologic level of injury was low cervical (C5-C8, 39.5%) and ASIA impairment scale (AIS) was A (34.4%). Main Outcome Measures(s): Primary outcomes were (1) Functional Independence Measure (FIM) motor score at discharge from inpatient rehabilitation and (2) change in FIM motor score between inpatient rehabilitation admission and discharge. We hypothesized that derangements in emergency room physiologic measures, such as decreased blood pressure and oxygen saturation, as well as increased severity of trauma burden, would predict poorer functional outcomes. Results: Linear regression analysis showed that neurologic level of injury and AIS predicted discharge FIM motor score. Systolic blood pressure, heart rate, oxygen saturation, need for assisted respiration, and presence of penetrating injury did not predict discharge motor FIM or FIM motor score improvement. Conclusions: Initial emergency room physiologic parameters did not prognosticate functional outcomes in this cohort.