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217: THE SIGNIFICANCE OF NEUROGENIC SHOCK AND ACUTE SPINAL CORD INJURY


DOI: 10.1097/01.ccm.0000439365.59627.b5

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Issn Print: 0090-3493

Publication Date: 2013/12/01


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217: THE SIGNIFICANCE OF NEUROGENIC SHOCK AND ACUTE SPINAL CORD INJURY

Alexander Axelrad; Punit Pandya; Muhammad Waqas; Gabriel Ryb

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Author Information: N/A, Bronx, NY,

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Abstract

Introduction: Acute spinal cord injury is associated with significant morbidity and mortality. Spinal cord injury patients often develop neurogenic shock (NS). Our objective is to determine whether the development of NS has any impact on the outcome of SCI patients. Methods: SCI patients admitted to a regional trauma center from 2005–2011 were selected from the registry. NS link to mortality, length of stay (LOS), and days on mechanical ventilation (VENTDAYS) were explored. Univariate associations were studied using contingency tables and nonparametric analysis (Wilcoxon). Multivariate associations were studied using logistic regression and Cox proportional hazards. Confounders analyzed in relation to NS and outcomes were: age,gender, level of SCI, steroid use, and injury severity. Results: 94 patients with SCI (73% male,mean age 50.6) were admitted. Most common mechanisms were falls (44%),swimming, surfing and diving (20%), and mvc (19%). SCI were located in the C1-4,C5-T1 and lower than T1 regions in 46%,32% and 22% respectively. Neurogenic shock occurred in 15% of cases. 43% of cases received high dose steroids. Mortality was 16% and median LOS was 8 days (q1-q3 4–17). Median VENTDAYS was 1 (q1-q3 0–8). Injury severity(ISS) distribution was:19% <16, 40% 16-24,28% 25–49, and 13% >50. NS was associated with mortality (No NS 10% and NS 50%,p<0.01). NS was also associated with VENTDAYS [NS median(q1-q3) 9(4–16), No NS median (q1-q3) 0 (0–5),<0.001] but not with LOS. Logistic regression revealed significant associations with mortality for Age>55[OR 5.52] and for NS[OR 7.29].Cox analysis for the prediction of LOS and VENTDAYS revealed associations with NS (Hazard ratio 0.31,p=0.03 and Hazard ratio 0.29, p= 0.02, respectively). Conclusions: Age>55 and development of neurogenic shock are both independent predictors of death in SCI. Days on the ventilator among spinal cord injury trauma patients could also be used for prognostic consideration.

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