PMID- 20407933
OWN - NLM
STAT- MEDLINE
DCOM- 20101014
LR  - 20211020
IS  - 1556-0961 (Electronic)
IS  - 1541-6933 (Linking)
VI  - 13
IP  - 1
DP  - 2010 Aug
TI  - Risk factors for organ dysfunction and failure in patients with acute traumatic 
      cervical spinal cord injury.
PG  - 29-39
LID - 10.1007/s12028-010-9359-9 [doi]
AB  - BACKGROUND: Traumatic injuries to the cervical spine cause significant 
      disability. Much of the morbidity and mortality that occurs in patients afflicted 
      with cervical spinal cord injury (SCI) occurs early after injury due to primary 
      neurologic dysfunction, systemic inflammation, concomitant injuries, treatments 
      to prevent and ameliorate secondary insults, and prolonged immobilization. This 
      study was undertaken to determine the incidence of organ dysfunction and failure 
      using validated measures: the Multiple Organ Dysfunction Score (MODS) and the 
      Sequential Organ Failure Assessment (SOFA). We also sought to determine if 
      certain patient or injury characteristics were associated with the development of 
      organ dysfunction and failure. METHODS: All patients who sustained isolated blunt 
      cervical SCIs admitted to the R Adams Cowley Shock Trauma Center over a 15-month 
      period were identified. American Spinal Injury Association (ASIA) motor scores, 
      ASIA impairment scale (AIS) scores, and level of injury were recorded. Admission, 
      first daily, worst daily, and aggregate MOD and SOFA scores were assigned for 
      each of six organ systems. A P < 0.05 was considered significant for all 
      statistical tests. RESULTS: Of 1,028 patients admitted with blunt spine injuries 
      between January, 2007 and March, 2008, 40 patients were identified with an 
      isolated cervical SCI that required an ICU length of stay (LOS) >24 h. Organ 
      failure of at least one organ system occurred in 75% of patients as calculated by 
      MOD score and 85% of patients calculated using SOFA criteria. Multiple organ 
      failure was found in 55% by MOD and 62.5% by SOFA scores. The most frequent 
      system to fail was the cardiovascular system by aggregate MODS (84%), while the 
      respiratory system was the most frequently failed system by aggregate SOFA 
      criteria (70%). There was a strong inverse correlation between ASIA motor score 
      and aggregate MODS and SOFA scores (r = -0.56, P = 0.0002 and r = -0.51, P = 
      0.0009). AIS was also found to be inversely correlated with the development of 
      organ failure (r = -0.47, P = 0.002 and r = -0.45, P = 0.004) while anatomic 
      level of injury was found to correlate poorly with the incidence of organ failure 
      (r = -0.11, P = 0.5 and r = -0.10, P = 0.5). Only ASIA motor score was 
      significantly associated with sum aggregate organ dysfunction scores when 
      controlling for age and injury severity score (parameter estimate = -0.082, P = 
      0.0005 for MODS and parameter estimate = -0.057, P = 0.006 for SOFA). 
      CONCLUSIONS: This study is the first to describe the incidence of organ 
      dysfunction and failure in patients with isolated acute traumatic cervical SCI 
      using validated organ system dysfunction scores. Respiratory, cardiovascular, 
      neurologic, renal, hepatic, and hematologic dysfunction occurred commonly both on 
      admission and over the ICU stay. Respiratory, cardiovascular, and neurologic 
      failure were frequently found, while renal, hepatic, and hematologic failures 
      were uncommon. Multiple organ failure occurred in the majority of patients. ASIA 
      motor score and AIS were found to strongly correlate with the development of 
      organ dysfunction and failure. Level of injury should be used with caution when 
      describing the risk of complications and the need for medical interventions.
FAU - Stein, Deborah M
AU  - Stein DM
AD  - R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 
      Baltimore, MD, USA. dstein@umm.edu
FAU - Menaker, Jay
AU  - Menaker J
FAU - McQuillan, Karen
AU  - McQuillan K
FAU - Handley, Christopher
AU  - Handley C
FAU - Aarabi, Bizhan
AU  - Aarabi B
FAU - Scalea, Thomas M
AU  - Scalea TM
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurocrit Care
JT  - Neurocritical care
JID - 101156086
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Aged
MH  - Cervical Vertebrae
MH  - Cohort Studies
MH  - Diagnostic Techniques and Procedures
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Multiple Organ Failure/diagnosis/epidemiology/*etiology
MH  - Risk Factors
MH  - Spinal Cord Injuries/*complications/mortality
MH  - Wounds, Nonpenetrating/*complications
EDAT- 2010/04/22 06:00
MHDA- 2010/10/15 06:00
CRDT- 2010/04/22 06:00
PHST- 2010/04/22 06:00 [entrez]
PHST- 2010/04/22 06:00 [pubmed]
PHST- 2010/10/15 06:00 [medline]
AID - 10.1007/s12028-010-9359-9 [doi]
PST - ppublish
SO  - Neurocrit Care. 2010 Aug;13(1):29-39. doi: 10.1007/s12028-010-9359-9.